CARE HOMES FOR OLDER PEOPLE
Place Court Place Court Camps Road Haverhill Suffolk CB9 8HF Lead Inspector
Cecilia McKillop Unannounced Inspection 14th September 2005 10:00 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 Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Place Court Address Place Court Camps Road Haverhill Suffolk CB9 8HF 01440 702571 01440 762022 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) Suffolk County Council Mr Tom Crichton Care Home 32 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (25) of places Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th October 2004 Brief Description of the Service: Place Court is a care home for older people, registered for 32 places, which is owned and managed by Suffolk County Council. The home dates back to 1963 although it reopened after refurbishment in 1995. The home is situated within walking distance of Haverhill town centre. The home is on two floors and has a shaft lift for full access throughout. There are private gardens for service users’ use. The accommodation is divided into four houses, Cedar, Hyacinth, Orchid and Ivy. Each house has between seven and nine bedrooms. Each house is self-maintained save for the main kitchen facilities. Orchid and Ivy provide 24-hour personal care support to elderly service users. Hyacinth provides 24-hour personal care to older people with a diagnosis of dementia. Cedar provides four beds for rehabilitation and three beds for shortterm care. Admission to the home is through Suffolk County Council, Social Care. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is a report on an unannounced inspection carried out over 4.5 hours during a morning and early afternoon. During the morning the inspector spoke with some of the staff on duty and examined a small number of records. A tour of the accommodation was undertaken and discussions about the care provided were held with one relative and 8 service users. The findings of this inspection were positive. What the service does well: What has improved since the last inspection?
Progress has been made in the updating of the statement of purpose and service user guide. Medication was found to be stored appropriately and items such as eye drops were now being dated when opened.
Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 6 Regulation 26 visits are being undertaken more regularly and a manager from another service visits the home, looks at records and speaks with service users about the care they are receiving. Reports are being forwarded to the Commission for Social Care Inspection. 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. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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 Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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, and 6 Prospective service users are provided with information about the home prior to their admission, to enable them make a choice about whether they want to move into the home. An assessment of their needs is undertaken and where service users referred for intermediate care, efforts are made to maximise their independence. EVIDENCE: The statement of purpose and service user guide were in the process of being updated and the inspector was provided with a final draft of the updated service user guide. This was informative and progress with this will be followed up at the next inspection. The last inspection report was available in the hall for service users and visitors to examine. The records relating to a newly admitted service user were examined as part of the inspection and there was evidence on file of an assessment having been undertaken by a social worker. A senior member of staff at the home had also visited the prospective service user in hospital and met with them and their
Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 9 family. It is recommended that records are maintained of the homes assessment. The home offers intermediate care in four beds in Cedar House and staff work with the County Council’s intermediate care team which includes a number of professionals including social workers and occupational therapists to promote service users independence. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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,and 10 Service users care needs are set out in a care plan and the home works alongside other professionals to ensure health needs are met. The homes procedures for the administration of medication offers protection to service users. Respect and the right to privacy are upheld. EVIDENCE: A small number of care records were examined as part of the inspection, and these contained medical histories, weight monitoring charts, risk assessments regarding falling and pressure care. Care Plans contained details of service users final wishes. The records were largely satisfactory, although there was some duplication; staff were making regular entries and undertaking reviews of the documentation. The care records relating to one service user who had been admitted about a month before the inspection were not however very detailed and it was recommended that the plans maintained for newly admitted service users are expanded, to ensure consistency of care. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 11 On the morning of the inspection, a member of staff took two service users to the surgery and there was evidence on the records of service users being assisted to access other services such as the optician and dental services. The home operates with two medication systems. A monitored dosage system operates in the three of the houses while the service users on intermediate care maintain their own medication in their bedroom. The procedures in place for the administration of medication were observed as part of the inspection and some of the shortfalls that had been identified at the last inspection were found to have been addressed. However care staff did not always sign the medication administration record (MAR) chart to indicate that they had administered medicinal creams to service users. Medication was being stored appropriately and the system in place for the storage and dispensing of controlled drugs was satisfactory. The feedback received from service users was very positive about their care. The inspector was told that this was their home and they were treated well by staff who they described as kind and helpful. The inspector was told that they were treated with respect and their privacy was upheld. The inspector noted that staff knocked on the door before entering the bedrooms and spoke with service users in a warm and respectful matter. There were a number of telephones through out the home for service users to use. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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, 14, and 15 Routines within the home are flexible however service users social and recreational needs would benefit from more organisation. Service users are able to maintain contacts with the local community and are provided with a balanced diet in pleasant surroundings. EVIDENCE: On the morning of the inspection the majority of service users were sitting listening to music. A small number spent time in their bedroom and staff accompanied two service users to appointments at the local surgery. There were no organised activities on the day of the inspection and service users said that there was sometimes bingo organised at weekends. The manager also said that during the summer the home had a holiday week and organised trips out in a minibus each day. There were books on display and in Hyacinth, the unit which cares for service users with a diagnosis of dementia, there was a reminiscence room which contained a significant number of interesting items from years gone by, which service users could touch and smell. This was very positive. The hairdresser was visiting the home on the day of the inspection and a room is set aside where she can assist service users with their hair. Care staff
Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 13 informed the inspector that there were plans to purpose games, which would be easier for service users with arthritis to handle. Some of the service users who were spoken to would like to see more activities but there was acknowledgement that staff were busy. The inspector was told by service users that the routines within the home were flexible and they could get up at a time that they wanted and while they usually had one bath a week, they thought that additional baths could be provided if requested. Service users reported that they were brought a drink in bed in the morning and had a good choice of breakfast including porridge or a cooked breakfast. On the day of the inspection, there was a good range of food on offer for lunch including sausages, fish, omelette, baked potatoes or a salad. A selection of vegetables was available in dishes from which service users could take what they wanted. The pudding consisted of rhubarb pie and ice cream. Meals are served in the dining rooms in each of the individual units and the tables were nicely set. The feedback from service users was positive although a small number of service users had some issues with how the food was cooked. This was raised with the manager at the end of the inspection and it was agreed that he would undertake a survey with service users on the meals provided. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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, and 18 Complaints are taken seriously and acted upon and there are systems in place to protect service users from abuse. EVIDENCE: The home operates within the Suffolk County Council complaints policy and this is outlined in a leaflet. Service users who were interviewed as part of the inspection were clear about what they would do should they have a concern. One complaint had been made to the manager of the home and this had been investigated and resolved at a local level. Guidance had been re-issued to staff as a consequence. Staff reported that training had been provided on the vulnerable adults procedure. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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, 20, 22, 24, 25, and 26 Place Court offers clean and comfortable accommodation. The home is well maintained and specialist equipment is available to maximise service users independence. Service user safety is taken seriously. EVIDENCE: The home was pleasant and nicely decorated and each unit had its own lounge, kitchen and dining room. Each of the units had doors out into the garden and this was well tended with comfortable seating. There is also a large multi purpose entertainments room. The bedrooms were all comfortable and had been personalised by service users. The home was clean and there were no unpleasant odours. The radiators had low surface temperatures and the water temperatures in the bathrooms, which were tested, were within the recommended levels. There was also a record maintained within the home of regular water temperature testing and there was evidence of testing of electrical items.
Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 16 Control of infection is taken seriously and staff reported that training had been provided. There were gloves and liquid soap available at key locations. The home has a range of equipment to assist service users with their mobility, including grab rails and foot rests. There is a lift between the ground and first floor. There is a range of baths including whirlpool baths. There is a call bell facility in the bedrooms and in the lounges. In one of the lounges the bell was located some distance from where the service users were sitting. One service user who required assistance when moving informed the inspector that they had to call out or ask another service user to ring the bell when they needed help. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 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 and 30 Service users needs are met by sufficient numbers of trained staff. EVIDENCE: The home generally operates with 6 carers on shift, which divided up provides 2 carers for Hyacinth house and one carer in Ivy, Cedar and Orchid House. One carer “floats ” between the houses. On the day of the inspection a carer had rung in sick just before the morning shift and there was no member of staff on duty as a float. The home was therefore operating below its normal staffing levels with 4 carers on duty; staff were busy and were observed working between the units and assisting each other. The manager and the team leader were also on duty, as well as administrative, catering and domestic staff. Staff reported that morale within the home was good although they sometimes had issues with staff sickness, which will be followed up at the next inspection. The home was almost fully staffed and there was only one part time vacancy for a senior night carer. Staff reported good access to training and that they were being supported to complete their induction, foundation and National Vocational Qualification (NVQ) training. They confirmed that they had attended a range of training including moving and handling, vulnerable adults, and dementia care. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 18 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, 34 and 35 An experienced manager manages the home, and provides clear leadership. There are monitoring systems in place to ensure that the home is run in the interests of service users however these require some changes. There is systems in place to safeguard service users financial interests. EVIDENCE: The manager who has been in post for just over a year is suitably qualified and experienced, having previously managed another home as well as working in a number of other positions within the County Council. The manager is supported by a management team, which is made up of team leaders. Staff reported that morale among the staff team was good and they worked hard to support each other. This was confirmed by the inspector’s observations on the day of the inspection, when they were operating with lower number of staff than usual.
Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 19 The feedback from service users was very positive and they were full of praise for the staff who they said “deserved top marks” “wonderful and kind and we are well looked after.” One service user said that Place Court was their home and another that they were very lucky to be at the home. The manager confirmed that he had regular supervision with a line manager. Another home’s manager undertakes the Regulation 26 visits and while there was some evidence that visits had taken place, there were some months were they had not. The visits when they had been undertaken appeared to be relatively comprehensive and time was spent with service users ascertaining their views of the care that they receive. The employer’s liability certificate and the registration certificate were both on display and were up to date and accurate. Some of the service users have accounts with the County Council and when they request money, this is provided out of petty cash, receipted and debited from their account. Some of the records were examined and all appeared satisfactory. The system was due to be independently audited within a few days of the inspection. Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 20 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 x 3 x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 x 3 3 Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13 Requirement The Registered person must ensure that staff sign to indicate that they have administered prescribed medicinal creams to service users. Timescale for action 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP22 Good Practice Recommendations It is recommended that the activities on offer in the home are developed and a regular stimulating programme is provided. It is recommended that access to call bells is reviewed in the communal areas and consideration given to mobile call bells, where it is not possible to extend the call bell to within the reach of service users. It is recommended that the care plans for newly admitted service users are expanded to ensure consistency of care. It is recommended that the home’s preadmission assessment is documented, alongside that of the social worker. 3 4 OP7 OP3 Place Court DS0000036919.V254794.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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