CARE HOMES FOR OLDER PEOPLE
Owston View Lodge Road Carcroft Doncaster South Yorkshire DN6 8QA Lead Inspector
Mike Hamstead Unannounced Inspection 07:15 31st May 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Owston View Address Lodge Road Carcroft Doncaster South Yorkshire DN6 8QA 01302 723368 01302 724019 None Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Doncaster Metropolitan Borough Council Mrs Susan McNair Turton Care Home 36 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (24) of places Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Owston View is a purpose built care home for older people situated on Lodge Road Carcroft, in a residential area close to many local facilities. It is also on the bus route to Doncaster. The home provides care for 24 older people service users in the main part of the home, and for 12 service users who have a mental infirmity in a specialist unit known as The Croft. The Home also provides a day care service in both sides of the home. The home has two floors, and has a shaft lift to enable service users to access the second floor. In addition, tea making facilities are provided for residents and visitors who wish to make their own drinks. Externally the home has extensive grounds, and there are facilities for residents and visitors to walk around them and also to sit out, where a number of benches and garden furniture are available. Fees range from £330:00 - £ 490:00 per week, as at 1st April 2006 and additional charges are made for hairdressing, specialised toiletries, and magazines etc. The registered person makes information about the service available to residents and their families via the Statement of Purpose and the Service User Guide. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection methodology consisted of bringing together the cumulative information and evidence received at CSCI, available to the inspector since last inspection in October 2005, interviews with the people who use the service where possible, and interviews with the acting care manager and staff on duty. It also included an examination of the homes records, and a tour of the accommodation. There were 32 permanent residents and 3 day care residents accommodated on this inspection. The inspection was commenced at 07:15 and finished at 15:15 and the inspector is grateful to all the residents, the care manager and staff who took part in this inspection. What the service does well: What has improved since the last inspection?
An inappropriately placed resident has been found alternative accommodation, allowing the home to now operate in accordance within its Statement of Purpose.
Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 6 Residents have arrangements. been consulted about the timing of their mealtime There were no wedged doors found on this inspection, against Fire Service advice, to affect the safety of residents and staff. The staffing deployment levels have improved as a result of reduced staff sickness levels. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is good and this judgement has been made using the evidence available. The atmosphere in the home is clearly affected by worries about whether the home is to be closed, but this is clearly a factor outside the control of the homes management. EVIDENCE: The home is now operating within its Statement of Purpose, and the inappropriately placed resident identified at the last inspection has moved to another home. The care manager has managed to obtain residents views of their life in the home as part of a quality assurance system, and an analysis of these views will be included in the Service User Guide as soon as it has been updated to show the amended staffing information. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 9 There were eleven residents who responded to the CSCI “Have Your Say About” questionnaire, completed either by the resident on their own or with staff assistance, and the comments were predominantly of a positive nature. One resident said “ I like living at Owston View, it’s my home now, and I have got company all the time. I feel safe, and get all my meals. I am quite content here” Another resident said “ I am very happy here, but I get frustrated with myself at times, when I can no longer able to perform independent tasks” One resident thought that “ sometimes the staff appear very busy, when they need help to go to the toilet, and by the time they are able to see to them it can be too late” Another resident commented in this vein mentioning that “ he/she likes to go shopping to Asda’s, but sometimes there are not enough staff on duty who can take him/ her in a wheelchair”. The inspector was also able to speak to three relatives who were all highly satisfied with the care provided at the home. It was clear however, that despite the positive comments received from residents and relatives, there was still an overwhelming atmosphere of anxiety throughout the home as residents relatives and staff awaited the decision of Doncaster Metropolitan Borough Council as to whether Owston View was to be one of the two homes planned to be closed. One resident told the inspector that “he was very anxious about what was going to happen to the home, and that the delay in letting residents know was “unreal” He also said that many families wanted to know what was happening, and that he wanted to get on with leading his life” Owston View cares for older people with a variety of needs including some with dementia who are cared for in a specialist unit known as The Croft. The care manager tries to organise relevant staff training to meet the changing needs of residents, and the majority of staff have undertaken dementia care training, and another course is planned for July 2006. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is good and this judgement has been made using the evidence available. The homes file quality audit system needs to be extended to provide more accurate information. EVIDENCE: A number of care plans were examined at random that were found to be generally of a good standard and satisfactorily recorded. A thorough assessment of needs had been carried out and care plans and risk assessments had been completed and reviewed. A named key worker is appointed for each resident who has lead responsibility for meeting each residents’ needs, but there were omissions in recording the residents life history and their social and leisure likes and dislikes, and also key elements of their physical health. The shift manager has the responsibility for auditing certain, but not all aspects of the care files to ensure that information is completed, but this clearly needs extending to include the whole file.
Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 11 The care manager has agreed to design an audit matrix document, that should ensure that all aspects of the file are audited in future to make sure that all the relevant information is recorded for the benefit of residents in the home. Healthcare arrangements are good, and the care manager said that links with the local GP practice continue to improve, and there is evidence to suggest that all the other primary care facilities are used as required. The home has a good relationship with the local surgery, and the GP visits every 2 weeks for a clinic, but residents are also able to obtain visits when required as well. The community nurse visits as directed by the GP. There is some NHS chiropody service provided, but the care manager has organised for a private chiropodist to visit because of the demand from residents, and has negotiated a reduced fee on their behalf. In addition, a number of care staff have attended an accredited training course that enables them to undertake routine nail cutting that is a useful additional and free service offered to residents. One resident has a pressure sore and is accommodated on an air mattress, and 4 other residents have air mattresses for preventative measures. There is an ongoing liaison with the tissue viability nurse, and the continence advisor visits on a regular basis to do assessments. The home also has a designated member of staff that liaises with the continence adviser. There is also input from a visiting physiotherapist, who attends weekly to do music and movement, and a physiotherapist is available from the GP surgery if required. Medication procedures were observed and the home has recently changed its administration system, and is currently working through some initial problems. The MAR sheets were checked and were recorded satisfactorily. The inspector checked the controlled drugs register and the stock levels of one type of medication stored, that was also satisfactory and a second member of staff had verified the dosage given. Since the last inspection staff have held a residents meeting to ask whether any residents who are early risers would like their breakfast when they get up. The overall decision was that they would like to wait until the normal time of 9:30, and were happy as long as cups of tea were provided, that are available at all times, verified on this inspection. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. Quality in this outcome area is and this judgement has been made using the evidence available. Residents have plenty of opportunities for social and recreational activities. EVIDENCE: Residents and relatives are advised of all planned or proposed activities on a comprehensive notice board inside the main entrance to the home. There is also a suggestions envelope asking residents to suggest ways in which the home could be improved, and information on how to make a complaint including the address and telephone number of CSCI. A good variety of activities are provided, and following on from last years Victory in Europe celebrations, staff have compiled a VE memorial folder that has lots of information and photographs of residents including where they were and what they did in the war and at other stages in their lives. There is a monthly programme of activities displayed in both the main home and The Croft dining rooms, that for June 2006, includes internal activities such as dominoes and board games, a physiotherapy class, baking (buns and biscuits) and painting and drawing. A resident informed the inspector that they had a quiz yesterday, followed by a buffet tea.
Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 13 Other activities include bingo, movie nights, fish and chip suppers, and visiting entertainers, and contact is maintained with the local community via trips out to garden centres, shopping trips to Doncaster, and the occasional barge trip. The care manager informed the inspector that the organisation of a summer Fair had been affected by the knowledge that DMBC have a home closure programme, and by staff wondering whether had they arranged the event, the home would still be open to go through with it. There are regular visits from families and friends verified on this inspection, that is encouraged, and a number of residents spoke about how they look forward to these visits. There are a number of residents who maintain some aspect of their financial affairs, and all residents are entitled to bring their personal possessions into the home. Staff would arrange an advocacy service for any residents in need if necessary to ensure their interests are protected. Residents show little interest in having access to their personal records, and they appear happy to place their overall care in the hands of staff. Most of the resident enjoyed a cooked breakfast, that is available every day, and the cook showed the inspector the 4 weekly summer menus, that are to be introduced shortly. Some residents are keen to try different foods, and pizza’s and curried dishes are on the menu. One resident has a vegetarian diet, another a soft diet, and there are 5 diabetics controlled by diet and medication. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, & 18. Quality in this outcome area is excellent and this judgement has been made using the evidence available. The willingness and determination of certain staff to follow procedures and report any instance affecting the general welfare of residents in the home is to be commended. EVIDENCE: There has been one complaint recorded since the last inspection, reported via the homes whistle – blowing procedure that is to be commended, and involves an allegation of verbal abuse by a member of staff to a resident. The member of staff involved is currently suspended, and the matter has been referred to Adult Protection. The care manager continues to address the issue of complaints at staff meetings, to ensure that staff act proactively to obtain residents complaints/comments as a means of improving the overall services provided. All residents are made aware of their right to vote, and five did so at the recent local elections using postal votes. There is a policy and procedure regarding residents monies and financial affairs, and the monies of three residents monies were checked at random and were all found to be correct. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good, and this judgement has been made using the evidence available. Resources need to be directed to The Croft, to provide a comfortable environment for residents. EVIDENCE: Since the last inspection, continuing investment has meant that the office has been redecorated, and the lounge and dining room in The Croft and three bedrooms in the main home have been redecorated. In addition, the ground floor corridor and stair carpet has been replaced in the main home. A tour of the premises revealed that the home generally is in a good decorative state. There are the usual scuffed doors and jambs affected by wheelchairs, and there is evidence of the need for further redecoration, but nothing that cannot form part of the homes planned maintenance programme.
Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 16 The care manager said that it was their intention to allocate an upstairs lounge in the main home as the “World Cup” lounge, for the tournament starting next week, for those residents interested, and to decorate it with bunting including flags, photographs, and the usual football memorabilia. Staff in The Croft said that it was still proving difficult to obtain hot water from some of the bedrooms in that unit, and the inspector is aware that this has been a problem on other occasions in the past. In addition, staff are finding it difficult to eradicate all the odours in this unit even with the equipment available, and the care manager may want to consider replacing some of the carpets with non-slip surfaces as soon as possible. There was also evidence of a broken seal in a double glazed sealed unit in a Croft lounge window that needs attention. The outside grounds are pleasant with seating available and a number of residents were sat outside enjoying the fresh air in safe and comfortable surroundings, on both sides of the home. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30. Quality in this outcome area is good, and this judgement has been made using the evidence available. The home is making every effort to ensure that staff achieve the required 50 NVQ Level 2 qualification as soon as possible. EVIDENCE: In addition to the traditional hierarchical management organisation, the home also employs a shift manager that enables the care manager to focus on other specific aspects like risk assessments and staff training to continually improve the care given to residents. The rotas were examined that identified that a Senior and 2 care staff per shift are deployed in both the main home and The Croft during the waking day, and a Senior, and 2 care staff per shift at nights for the whole home. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 18 Because of criticisms in previous reports about insufficient staffing levels, the care manager has tried and is currently managing, to employ a fifth carer more often during the waking day where possible to “float” between the main home and The Croft. The care manager said that very occasionally for special occasions it is possible to deploy a sixth member of staff, but this is dependent upon staff sickness and holidays. Staff in The Croft are instructed not to leave “at risk” residents unattended, whilst they are both involved in getting others residents up who require double handling. Observations in The Croft before breakfast revealed that although residents were unsupervised on some occasions because the two staff working on that unit were busy, they did not appear to be at risk of falling and in any event, the shift manager made regular visits, and there were domestic staff in the unit as well. This pressure can be compounded by the fact that the Croft takes additional people on a day basis as well as the 12 permanent residents when the Croft is full. The staff complement in total have still not achieved the 50 NVQ Level 2 qualification that currently stands at 33 , but other staff are currently undertaking the course in order to obtain this qualification in the interests of residents. The recruitment procedures ensure that CRB checks are undertaken for all new staff before they start thus ensuring the safety of residents and the files of two new members of staff employed since the last inspection were examined and found to be satisfactory. There is a personal staff profile for all staff containing all the training undertaken by them, and future training needs designed to ensure that the changing needs of residents are met as identified at supervision sessions. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, & 38. Quality in this outcome area is good, and this judgement has been made using the evidence available. Safe working practices are observed for all residents. EVIDENCE: The care manager has many years of experience in the management of this client group and is suitably qualified for this task. The introduction and duties of the shift manager enables the care manager to have freedom to focus on key responsibilities to improve the overall care of residents. All staff undertake statutory training in the protection of residents, and the manager continues to be of the opinion that agreement was reached between DMBC Social Services management and CSCI that care managers of a certain age would not be required to undertake the NVQ Level 4 qualification in management and care.
Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 20 The home still has a part-time administrative/clerical support post which enables the homes management to spend more time in resident care, to the clear benefit of residents. Staff confirmed that they were happy with the care managers approach to management, and felt able to speak their minds on all aspects of resident care and said that they felt that their views were received well and considered objectively. The home now has its own quality assurance system, and the line manager is undertaking Reg 26(4c) monthly visits to the home and supplying the CSCI with copies as required by the regulation. The care manager has devised her own annual development plan, which is displayed on the notice board inside the main entrance, and has managed to obtain the views of residents via a formal questionnaire. The home maintains the monies of those residents who cannot manage their own affairs, which is the majority, and written records of all transactions are maintained and monies are kept individually and not pooled. The health, safety and welfare records demonstrated that the management and staff ensure the protection and safety of residents. The fire records, servicing of the gas boiler, PAT testing, Legionella testing, and a “Thorough Examination” of the shaft lift and handling equipment were checked and found to be satisfactory. The electrical hard wiring was tested on the 14/07/03, and is still within the 5 year re -testing period. Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 4 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that all the residents files are complete and up to date. The registered person must ensure that residents live in a safe well maintained environment. The registered person must ensure that a minimum ratio of 50 trained members of staff NVQ Level 2 or equivalent is achieved as soon as possible. Timescale for action 30/06/06 2. OP19 23 30/08/06 3. OP28 18 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Owston View DS0000031963.V296591.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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