CARE HOMES FOR OLDER PEOPLE
Princess House 19 Cliffe Park Seaburn Sunderland SR6 9NS Lead Inspector
Mr Clifford Renwick Unannounced Inspection 13th December 2005 7:45 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 Princess House DS0000015714.V256337.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. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Princess House Address 19 Cliffe Park Seaburn Sunderland SR6 9NS 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) 0191 548 3723 0191 548 4198 Mr J Young Mrs J Young Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5), Old age, not falling within any of places other category (19) Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: Princess House is a detached house standing in its own grounds and overlooking the seafront at Seaburn. Some people have described it as a landmark as it stands adjacent to the area, which is used to host the yearly Sunderland Air show. Though it is a three-storey building only the ground and first floor are used for residential accommodation. The top floor is used for administrative purposes and can also be utilised for staff training. Most of the bedrooms are single occupancy and many of the rooms have a sea-view. It is only a short walk from a busy shopping parade in Fulwell as well as being close to facilities in Seaburn. In addition to this a local bus service offers easy access to Sunderland City centre. The home as its own garden which offers disabled access and also a patio area to the side of the building as well as a conservatory, which offers sweeping views of the coastline. The home provides a service to older people over the age of 65 years and is registered to provide personal care for a maximum of 19 people that includes four people who may have needs related to dementia. It is not registered for people who have a physical disability. The home does not provide nursing care but individual service users can access services provided by the Community Health team and their own GP. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours and was carried out as part of the statutory twice-yearly inspection process. Selected areas of the premises, which included communal areas and some bedrooms, were viewed. Care records were examined as well as records that related to health and safety and social activities. Discussion took place with the staff on duty throughout the visit. Discussion also took place with several residents and time was spent observing staff practices and how staff spoke to residents. It was established that the people who live in this home preferred to be known as residents therefore this term of reference is used throughout the report. The judgements made are based on the evidence available at the time of the inspection. What the service does well:
There continues to be a positive commitment by the owners to staff training and this has ensured that staff have had opportunities to develop their individual knowledge and skills. Stability is maintained within the staff team with many of the staff having worked in the home for a considerable number of years and this has ensured that they are consistent with their work. The home always a nice welcoming atmosphere and this is something that residents stated was one of the nicest things about living in the home. Staff are always pleasant and take full part in the inspection process and are quite happy to answer any questions about their work. Staff work well with residents and ensure that residents wherever possible can continue to lead a full and active lifestyle both inside and outside of the home. Observations made confirmed that staff are professional in their approach with residents whilst at the same time able to share a laugh and a joke and this contributed to the positive atmosphere. Residents stated that this is a “nice home” and “they like living here”. These and other positive comments are similar with what has been stated in previous inspections of the home. All of the residents spoken to confirmed that the home in the food is very good and that there is always a good variety. Residents also said that if there was any Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 6 thing special that you would like to eat you just had to ask and it would be provided. The building continues to be well maintained, clean, in good decorative order and residents are encouraged to arrange the furniture in their rooms to suit them. What has improved since the last 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. Princess House DS0000015714.V256337.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 Princess House DS0000015714.V256337.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): 3, 4 Positive practices are in place which ensure that no one moves into the home until an assessment of needs has taken place and the home confirms in writing that peoples need’s can be met in the home. This ensures that inappropriate admissions are avoided. EVIDENCE: Since the last inspection there have been two new people who have moved into the home. Examination of their case files confirmed that an individual assessment had been carried out by the home as well as the placing authority before it was agreed that admission would take place. Once admitted the home confirmed in writing to the resident and/or their representative confirming that on the basis of the assessment their needs would be met in the home. Staff in the home have also completed risk assessments and this leads to a risk management plan, which the home agree with the resident and the family. The families sign these documents agreeing to the strategies that are put in place by staff. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 9 The assessments lead to an individual plan of care for each resident, which sets out how staff are to meet their assessed needs. This is discussed more fully in the next section of this report. Princess House DS0000015714.V256337.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, 9 The Health and personal care needs of resident’s based on their care plans are met though some further development is required to reflect the meaningful actions that are carried out by staff. The homes procedures for storing and administering medication are not sufficiently robust to safeguard service users. EVIDENCE: Four resident’s care plans were examined as part of the case tracking process which looks at how assessed needs is to be met in the written plan of care. Developments have taken place with care plans and these now record the level of care that is offered and this offers consistency of approach by staff. Risk assessments are completed monthly in order to identify any changes in residents needs and these are signed and agreed by residents and their representatives/family. In addition to this there is a monthly review sheet, which also focuses on aspects of the care plan, and families are involved with these too. Records, which are recorded on a daily basis, are used to assist in monitoring progress with care plans. A key worker system has been introduced and this ensures that staff are allocated to work with individual residents on particular aspects of their personal care.
Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 11 Discussion was held with the manager about the care plans as a number of positive practices observed and that are carried out by staff are not always fully recorded in the care plan. The developments that have been made so far are positive and the manager is keen to develop these further. Records for the administration of medicines are satisfactory however the ordering procedure used by the home means that that the prescription is sent direct from the GP to the pharmacist. When medicines are delivered to the home staff then check them against the pre printed administration sheets as opposed to checking them against the GP’S prescription. For those medicines, which require to be stored in a fridge, these are currently stored in a separate box in the homes main fridge. In order to meet the guidelines issued by the Royal Pharmaceutical Society some changes need to be made to the ordering systems and also to the how medicines are stored in a fridge. Princess House DS0000015714.V256337.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): 13, 15 Friendships and relationships with people outside the home are encouraged. The meals provided offer a good balanced diet which contributes to the promotion of healthy eating and service users are involved menu planning. EVIDENCE: There are no restrictions on visiting the home and good contact is maintained between residents their families and friends. The families are involved in all aspects of the service and are invited to activities and events. A recent outing had been Christmas lunch at a local school, which was a special event for retired people in the community. The families are also involved with the care plan processes and are kept up to date by staff of their relatives care. Discussions previously held with families confirmed that they are very satisfied with the services that are offered in the home. For those residents who are able they can go out very day if they wish to access facilities within the community. Breakfast and lunch was taken with residents and this was a nice experience. The meal was unhurried and some residents chose to have breakfast in their rooms or have their breakfast at a time that suited them. Lunch was well presented, hot and very tasty and there was a choice for each course, Hot and cold drinks were available throughout the meal and residents were offered regular refills of coffee and tea. The meals were unhurried enabling residents to dine at their own pace and a number of residents use the mealtimes as a time for socialising.
Princess House DS0000015714.V256337.R01.S.doc Version 5.0 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): 16 Complaints in the home are handled objectively and openly with the manager and staff encouraging residents, their friends and families to offer comment on the services that are offered. Residents are confident that any complaints made would be acted upon. EVIDENCE: The home have a complaints procedure in place and this is always issued to residents and their families as part of the “Welcome” pack when moving into the home. In addition to holding regular residents and family meetings, which are used to discuss any aspects of the services, staff speak with residents each day about any concerns that they may have. Any concerns raised are always addressed immediately. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 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, 24, 26 The home is clean, warm and well maintained offering residents a homely and safe environment in which to live. Resident’s bedrooms are accessible to meet their mobility needs and furnished to suit their individual choice and taste. EVIDENCE: All communal areas and bedrooms that were viewed are in good decorative order. Residents have chosen to arrange furniture in their rooms to suit their needs and for those who have a sea view have placed their favourite chair in such a way as to take advantage of this. A good standard of housekeeping is in place and there were no noticeable hazards at the time of the visit. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 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, 30 Staffing levels are sufficient to effectively meet the needs of resident’s living in the home. A well-trained staff team meets the resident’s needs. However, further training is required in the area of dementia in order to provide staff with an understanding of this illness so that they can adequately meet the needs of all of the residents living in the home. Record keeping in respect of new staff employed in the home is robust and offers sufficient information to ensure that service users are protected. EVIDENCE: Examination of staffing rotas and observations made confirmed that there is a good level of staff on duty at all times. Staffing levels meet the standards set by the previous registration authority. Since the last inspection three new staff have commenced work in the home. All of the necessary references and employment checks have been carried out as part of the recruitment process. However there is no current photograph or a signed health declaration in respect of each member of new staff. The owners have a positive commitment towards staff training and have ensured that all staff with the exception of newly appointed staff have undergone and achieved NVQ Level 2 training. Three staff are undergoing NVQ Level 3 training and new staff will be commencing NVQ Level 2 training. Most of the staff team have completed training in the safe handling of medicines, infection control, COSHH and moving and handling. Refresher first aid courses are booked in for January 2006 for all staff. Discussion was held with the manager about the benefits of dementia training for staff due to the changing needs of the residents. This is an area that she has been considering developing and has made some enquiries about providing this training.
Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 16 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): 35, 38 Staff are appropriately supervised which assists in promoting and safeguarding the best interests of the resident’s. The care practices, which are in place and the regular staff training ensure, that at all time resident’s health and welfare is promoted. EVIDENCE: Discussion held with the manager confirmed that procedures are in place, which looks at the number of accidents that occur over a three monthly period. From this practices are reviewed in order to try and reduce the number of accidents that take place. Good records are kept of accidents and these clearly demonstrate the actions taken by staff and also the outcome. Some notifications required to be made to the commission in accordance with regulation had not been made and this was discussed with the manager. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 17 Records of finances of monies held on behalf of residents are satisfactory and give an accurate account of any expenditure incurred and also providing an easy audit trail. Fire training for staff takes place and the assistant manager is in the process of devising a fire manual to be used by staff. Fire records are maintained of staff fire instruction training and fire drills held but these are not always kept in the fire logbook but in a separate record. Observations made during the inspection confirmed that staff follows safe practices whilst lifting. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 18 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 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 19 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 17, (1) a Requirement A record of what medicines have been prescribed by the GP for residents must be kept in the home. Medicines that require storage in a fridge must be kept in their own fridge. As part of recruitment staff must complete a declaration confirming that they are mentally and physically fit for the work they are to perform. Each staff file must also contain a current photograph of the staff member. The manager must submit notifications to the commission in respect of accidents to residents. A record of every fire drill and fire instruction carried out with staff must be kept in the fire logbook. Timescale for action 31/12/05 2 OP29 7, 9, 19 31/12/05 3 OP37 37 31/12/05 4 OP38 17 (2) 31/12/05 Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 20 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 OP30 Good Practice Recommendations Consideration should be given to staff receiving training in caring for people with dementia type illnesses. Princess House DS0000015714.V256337.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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