CARE HOMES FOR OLDER PEOPLE
Place Court Place Court Camps Road Haverhill Suffolk CB9 8HF Lead Inspector
Cecilia McKillop Unannounced Inspection 28th February 2006 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.V285350.R01.S.doc Version 5.1 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.V285350.R01.S.doc Version 5.1 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.V285350.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th September 2005 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.V285350.R01.S.doc Version 5.1 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 during a morning and early afternoon. 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 seven service users. The findings of this inspection were positive. What the service does well: What has improved since the last inspection?
The Statement of Purpose and Service User Guide have been drafted and are presented in easier to read formats. The pre-admission assessment is documented and the care plans, showed signs of significant improvement and were detailed and informative. An extension has been provided to the call bells in one of the lounges, which should make it easier for service users to call for assistance when needed. A display board in the reception area now outlines the activities, which are planned and there were posters throughout the home with regard to specific
Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 6 events. The entertainment and activities on offer looked interesting and service users were positive about what was on offer. 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.V285350.R01.S.doc Version 5.1 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.V285350.R01.S.doc Version 5.1 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 Service users needs are assessed prior to their admission and written information is available on the service. EVIDENCE: The statement of purpose and the service user guide have been re-drafted and are written in an easy to read format. A copy of the last inspection report was in the reception area for service users and visitors to read. The records of a newly admitted service user were examined and there was evidence in place of a completed pre-admission assessment. Staff had also begun to develop a care plan and this was detailed and informative. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 9 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): 7,9 Service users care needs are set out in a plan, which documents their care, and health needs. The home’s procedures for the administration of medication offers protection to service users but some additional clarity is needed regarding changes to medication. EVIDENCE: A sample of care plans examined during the inspection were detailed and informative. The plans were up to date and were being regularly reviewed. There was evidence of ongoing monitoring with nutritional screening, and pressure care observations in place. Incident reports were logged and risk assessments and manual handing assessments were all clear and assessable. There was evidence in the records of staff liaising with other professionals such as chiropodists and opticians. The records also reflected an awareness among staff of the importance of promoting service user independence and assisting them to access additional support. Medication was found to be stored appropriately. The home operates a monitored dosage system and staff were clear as to the procedures in place for the administration of medication.
Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 10 The medication records examined were satisfactory although the inspector noted that there was one gap in the records where a member of staff had not signed to indicate whether the medication had been given. The member of staff said that she intended to follow this up with the responsible member of staff. The inspector noted that a change had been made to the printed medication records of one service user. However this change was not clearly signed and there was no corresponding record on the service users notes to reflect the discussion with the GP and the directions given. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 11 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): 12,13,15 The staff at Place Court provides opportunities for service users to meet socially and participate in recreational interests. Visitors are welcomed and service users provided with a good choice of meals. EVIDENCE: On the morning of the inspection service users were spending their time in a variety of ways. A number were in their bedrooms while others were sitting in the lounges talking with other service users and visitors. In one lounge a video was playing and a number of service users were singing along to this. The atmosphere was relaxed and friendly. Staff were observed talking to service users as they laid the table and undertook other small tasks in the units. There was a selection of cold drinks available and service users were observed being offered a hot drink. There were fruit bowls in each of the lounges. Service users have a good choice of meals and are offered the meal selection at the beginning of each day. On the day of the inspection options to the main course included baked potatoes omelettes as well as fish and a number of other items. Most service users choose the pork casserole and they were provided with a selection of vegetables from which they could help themselves. Bakewell tart and custard or ice cream was available for dessert.
Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 12 The meal served was well presented and nutritious and the inspector was informed by service users that the food was generally tasty and of good quality. A large display board in the hall outlined the planned activities for the next month. There were trips out as well of in-house activities. The inspector was informed that during the previous weekend, there was a Chinese takeaway organised for the Friday night, Bingo on Saturday and a musical session on Sunday. Staff have started a new cookery club and this will take place on a weekly basis. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 13 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): 18 The home has systems in place to protect service users from abuse. EVIDENCE: There are clear procedures in place within the home for responding to any allegation of abuse. All staff receive a copy of the vulnerable adults procedures and they confirmed that they had been provided with training on the procedures and what constitutes abuse. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 14 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): 19,22 Place Court offers clean and comfortable accommodation. 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 leading 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. At the last inspection a number of service users had not been able to easily reach the call bell in one of the lounges and the inspector was informed that an extension lead had been fitted to the call bell. The home had recently had a problem with the call bell system and the bell was not working in one of the bedrooms. This was not an immediate issue as this room was vacant, however it should be repaired before the room is occupied.
Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 15 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): 27,29,30 The home’s recruitment practices and the training of staff offers protection to service users. The staffing levels are satisfactory. EVIDENCE: On the day of the inspection there were 27 service users in residence and one service user was in hospital. The Deputy Manager was on duty and was being assisted by seven carers and one team leader. The staff were generally working individually in the units, with the exception of the dementia care unit where there were two staff on duty. A number of staff operated as floating staff to assist their colleagues. Staff were observed spending time with service users and responding to their requests for assistance in a calm and unrushed manner. A sample of recruitment records were examined as part of the inspection and the inspector found that the records were neatly subdivided and well maintained. There was evidence on the file of two references, including one from the last employer, a record of interviews, identification checks and confirmation that a Criminal Record Bureau (CRB) check had been undertaken. Each file evidenced that staff were provided with essential information on their role on the first day of their employment. This information includes health and safety and fire procedures. In addition all newly appointed staff attends induction, foundation and manual handling training. The inspector was informed that over half the staff have undertaken either NVQ level 2 or 3.
Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 16 A sample of staff training records were examined and there was evidence that staff were being provided with a wide range of relevant training. Staff said that they received regular supervision with a senior member of staff. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 17 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): 33,38 ` There are systems in place to protect the safety and welfare of service users and while there was evidence of some consultation with service users this was an area that could be expanded further. EVIDENCE: Discussion with staff and an examination of the records confirmed that staff receive training on manual handling, infection control, food hygiene and first aid. Accidents are logged on service users records and risk assessments are undertaken. The records on fire prevention systems were examined as part of the inspection and there was evidence of regular testing, training and maintenance. The lift was subject to regular servicing. The inspector was informed that a quality assurance system was being developed and progress with this will be followed up at a future inspection.
Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 18 Regular residents meetings are held to ascertain service users views. Questionnaires have been sent to service users in the past, about matters such as the meals provided. The Local Authority is currently consulting with the service users and their relatives as part of a countywide review of services for older people and questionnaires where on display in the reception area for people to complete. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 19 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 3 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X 3 X X X X STAFFING Standard No Score 27 3 28 X 29 4 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 20 NO Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP9 Good Practice Recommendations It is recommended that the policy for staff to follow when there is a change of medication is clarified, and the home ensures that the records evidence any changes, the name of the doctor and the date that they were introduced. Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 21 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
© 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 Place Court DS0000036919.V285350.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
