CARE HOMES FOR OLDER PEOPLE
Promenade Hotel Marine Drive Hornsea East Yorkshire HU18 1NJ Lead Inspector
Lynne Busby Unannounced Inspection 09:45 13 September 2006
th 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 DS0000019709.V309538.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. DS0000019709.V309538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Promenade Hotel Address Marine Drive Hornsea East Yorkshire HU18 1NJ 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) 01964 533348 Continuing Care Services Limited Mrs Irene Phyllis Poole Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places DS0000019709.V309538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One (1) named service user under 65 years of age may be accommodated within the maximum number. The condition is to cease when the named Individual ceases to live at the home. 21st February 2006 Date of last inspection Brief Description of the Service: The Promenade Hotel is a residential home that caters for the needs of 24 elderly service users. The home is owned by Continuing Care Services Limited and was first registered on the 25th January 1994. Personal care is provided to all service users along with meals and a laundry service. The home is located on the sea front at Hornsea, close to all town amenities and public transport. The home comprises of three houses that were originally converted into a hotel and restaurant. Accommodation is provided on three floors - the first and second floors are accessed via a stair lift. The environment consists of 2 lounges, 14 single rooms and 5 shared rooms. The home has an extensive garden at the rear and car parking is available at the front and rear of home. The weekly charges are £328.80 to £375.30 and there are additional charges for hairdressing, chiropody, toiletries, trips, newspapers and magazines. This information was provided by the manager on the pre-inspection document. Information is available about the service through the statement of purpose and service user guide. DS0000019709.V309538.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced site visit that took place over one day from 9.45 am to 5.30 pm with a previous two days inspection preparation. As part of the inspection process, comment cards were sent out: Thirteen were returned by relatives and other visitors; six by health and social care professionals, six care managers, and one GP. In addition, four service users completed service user surveys. Responses to this consultation about the service are referred to in the report. The visit consisted of a tour of the premises and a review of documentation, including three care plans and other recording systems. Time was also spent with residents in the communal areas. The inspector spoke to a number of service users and seven of these were engaged in longer conversations. Discussions were held with staff, the manager and four visitors. What the service does well: What has improved since the last inspection?
More than 50 of the staff have achieved NVQ Level 2 or above in care. The manager has developed questionnaires to seek the views of relatives and health and social care professionals about the home. This extends the quality assurance system beyond seeking only the views of service users and staff.
DS0000019709.V309538.R01.S.doc Version 5.2 Page 6 The manager advised the changes would be incorporated in this years quality assurance audit. An unused radiator has been removed. Following risk assessments, pre-set valves are being fitted to hand wash basins to minimise the risk of scalding. This work is in progress. The practice of holding doors open by unauthorised means has ceased and, where it is necessary for doors to be held open, automatic release ‘door guards’ are now in place. All risk assessments have been reviewed. 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. DS0000019709.V309538.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 DS0000019709.V309538.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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user needs are assessed to ensure that the home can meet these. EVIDENCE: Prospective service users’ care needs are assessed prior to being accommodated in the home. The manager completes this and for those service users who are funded by a local authority there is a community care assessment undertaken by social services staff. The assessment covers health care needs, social interests and personal safety and risk. The assessment ensures that the home can meet the needs of the individual service users before they are accommodated. Three service users’ records were inspected and all contained an assessment. The home does not offer intermediate care. DS0000019709.V309538.R01.S.doc Version 5.2 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Services users’ health, personal and social care needs are fully met. EVIDENCE: The inspector examined three service users’ files. All had plans of care that were generated from a full assessment of a service user’s needs. The plans of care detail the action that needs to be taken by the care staff to ensure that all care needs are met. Risk assessments are undertaken and these record the service user’s level of risk around various aspects of care, including risk of falls, pressure sores and diet. The plan of care is reviewed on a monthly basis, and any changes to the plan of care are recorded. Reviews of the care plan are held and the review minutes indicated that the service users attend these. All surveys received from social care professionals stated that the staff work in partnership with them and any specialist advice is incorporated in the service user’s plan of care. DS0000019709.V309538.R01.S.doc Version 5.2 Page 10 The health care needs of the service user are promoted within the home. The records indicated that the service users have access to chiropody, dental and health care. All visits from GP’s and health professionals are recorded The home has policies and procedures on the safe storage and administration of medication. The medication for three service users was checked and found to be appropriately recorded. The home uses a monitored dosage system. Controlled drugs were appropriately stored. The manager said she was thinking of changing how controlled drugs were recorded was advised that all appropriate drugs should be recorded in the controlled drugs register. There are no service users who self medicate. Medications requiring refrigeration are kept in the home’s main fridge. These need to be kept in a separate container that is clearly labelled to minimise any risk of cross-contamination. The staff treat service users with respect and this was observed during the visit. Service users’ preferred form of address is used. Service users’ privacy and dignity is respected and this was confirmed by service users and staff. Any treatment or medical examination is conducted in the service user’s own room. Some of the service users have their own telephone enabling them to make and receive calls in privacy. DS0000019709.V309538.R01.S.doc Version 5.2 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take full advantage of activities and interests and participate in community and family life. EVIDENCE: Information is posted on the notice board and in the lounge regarding forthcoming activities. There is an activity every morning, such as bingo, quizzes and dominos. Entertainers also come into the home every month. Trips are organised and on the day before the site visit a large number of the service user had been out to Burnby Hall and gardens and had lunch out. The service users who had been on this trip said it was very enjoyable. One said, “I had a lovely time, it was very tiring but I slept really well”. Service users’ individual interests are recorded on file. One service user who enjoyed reading said there were always books available in the home’s library. Service users can maintain contact with family and friends and can see their relatives in private. Relatives spoken to during the visit said they were always made to feel welcome. All service users’ comment cards stated their visitors were made welcome at the home.
DS0000019709.V309538.R01.S.doc Version 5.2 Page 12 Staff promote the independence of service users and they are given choice over their daily living. Service users are aware they can access their own records. During the tour of the premises it was noted that service users could bring in their own possessions and decorate their room with pictures and ornaments. The home usually has two cooks but one has recently left and a care worker who has experience in catering is presently assisting. All meals are freshly prepared and offer fresh vegetables and are well presented. Lunch on the day of the visit was chicken, potatoes, broccoli and turnip followed by treacle sponge and custard. Service users have a choice of meals at teatime; at lunchtime there is one main mea. However, service users said they could have something different if they wished. One service user was observed not to want their lunch and staff tried to assist in a sensitive manner. Service users’ nutritional intake is monitored but where concerns are identified food and fluid intake should be recorded to ensure that adequate nutritional assessment can be carried out. DS0000019709.V309538.R01.S.doc Version 5.2 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are listened to and protected from abuse by sound procedures and staff who are aware of their responsibilities. EVIDENCE: The home has a complaints procedure that is available to all service users and visitors. There have been no complaints made since the last inspection. Service users are aware of how to make a complaint. Eleven relatives comment cards indicated they were aware of the home’s complaints procedure. The home has a copy of the Hull and East Riding Protection of Vulnerable Adults procedures. The manager has developed the home’s policy and procedures and these are available to the staff. The staff demonstrated that they are aware of their roles and responsibilities regarding protection of service users. DS0000019709.V309538.R01.S.doc Version 5.2 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): 19,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users live in a safe and comfortable ‘homely’ environment. EVIDENCE: The home is located on the seafront at Hornsea and service users commented that they liked the location. The front of the home has benches for service users to sit out. The rear garden is large and has walkways so service users can fully access the garden, which is well tended and has a summerhouse and seating areas. The access from the rear of the home to the garden is through a corridor and there are plans to change the rear of the building so access to the garden for service users will be easier. To minimise the risk of scalding water temperatures in the washbasins have been controlled by pre set valves in half the building. The manager advised
DS0000019709.V309538.R01.S.doc Version 5.2 Page 15 that this work is continuing for the whole building and will be completed in the near future. The laundry has floor finishes that are impermeable and wall finishes are easily cleanable. There is a washing machine that has the specified programming ability to meet disinfection standards and a sluice facility. There is a separate hand washing facility available for staff. There was no evidence that the services and facilities comply with the Water Supply (Water Fittings) Regulations 1999 but the manager advised this had been completed. The premises are clean and hygienic and there are no offensive odours and there are systems in place for control of spread of infection. During the tour of the premises it was noted that cleaning materials were stored in an unlocked cupboard. A lock must be fitted to ensure safe storage of these materials. DS0000019709.V309538.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff are employed and trained in sufficient numbers to meet the service users’ needs. The welfare of service users could be compromised if recruitment checks are not carried out fully. EVIDENCE: Three staff files were checked and all had an application form, two written references and a Criminal Records Bureau (CRB) check. However, one was from a previous employer. The manager advised that she accepted CRB’s from previous employers when staff had not had a break in employment. The manager was advised that CRB’s are not portable . The manager is committed to promoting training for staff. All new staff have an induction to Skills for Care specifications and evidence of this was seen on staff files. Sixty-five per cent of staff that have completed NVQ Level 2 or above in care. All but two staff are working towards this qualification. Staff have undertaken various training including fire safety, moving and handling, basic food hygiene and dementia awareness. They are presently attending an indepth course on Safe Medications. DS0000019709.V309538.R01.S.doc Version 5.2 Page 17 The staff rota indicates there are four staff on duty in the morning and three staff in the afternoon and evening. Two waking night staff are on duty each night. Three domestic staff, two cooks and a kitchen assistant provide the ancillary services. Staff said there were enough staff on duty to meet the needs of the service users. Twelve of the relative comment cards received stated there were enough staff on duty. DS0000019709.V309538.R01.S.doc Version 5.2 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): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well-managed and service users’ financial interests are safeguarded. The health, safety and welfare of service users are not fully met. EVIDENCE: The manager is experienced in caring for older people and has managed the home for a number of years. There is deputy manager and senior staff to support the registered manager. The manager has attended training to update her skills and has completed NVQ Level 4 in care and management. Staff commented that they are well supported by the manager and can go to her with any concerns. DS0000019709.V309538.R01.S.doc Version 5.2 Page 19 The home has a quality assurance system in place that seeks the view of service users through questionnaires. The manager advised that since the last inspection they are developing a more formalised system to obtain feedback from family, friends and other stakeholders. The home have been awarded Parts 1 and 2 of the East Riding Social Services Departments Quality Development Scheme. The home also holds the Investors in People Award. There are written records of all transactions with regard to individual service users’ money. The inspector checked three service users’ money and found this to be correctly recorded. There are secure facilities provided for the safekeeping of money and valuables. However, it was noted that some valuables were held and a record had not been kept. This was rectified at the inspection. Staff advised that they have had supervision but records indicated and discussion with manager showed that this had lapsed. Formal supervisions should be provided for all care staff at least six times a year, so that they understand the policies and ethos of the home and are supported in their role. There were up to date maintenance records available for inspection. However, the staff call system was newly fitted over a year ago but has not had a maintenance check. The fire alarm system is regularly checked and a there is an up to date fire risk assessment in place. There are risk assessments in place for the building. However, it is recommended that a risk assessment is completed on the conservatory that is used by staff but is accessible to service users. It was noted that in a number of bedrooms, including shared rooms, service users’ toiletries were on open display. Some of these, including items such as Steradent, may be hazardous if ingested and this can happen where a confused person is unable to safeguard their own safety. Such items must be stored safely wherever a risk assessment indicates the need. DS0000019709.V309538.R01.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 DS0000019709.V309538.R01.S.doc Version 5.2 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 OP29 Regulation 19 Schedule 2 13(3)(4) (a)(c) Requirement A new Criminal Record Bureau check must be completed on all new staff before they are deployed in the home. The registered provider must ensure that risk assessments are in place to test water temperatures in washbasins. Where required pre-set valves which have fail safe devices are fitted locally and are regularly maintained to provide water close to 43°C. (Previous requirement –timescale 30/04/06 – not fully met). Cleaning materials must be stored in a securely locked facility. Risk assessments must be undertaken on toiletries, including Steradent, that are stored accessibly to service users and, if necessary, these must be locked away in a suitable facility. Timescale for action 30/11/06 2 OP25 30/11/06 3 OP38 13 21/10/06 DS0000019709.V309538.R01.S.doc Version 5.2 Page 22 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 3 4 5 Refer to Standard OP8 OP9 OP26 OP36 OP38 Good Practice Recommendations Records should be kept of nutritional intake including fluids for those service users where concerns are identified. Medication requiring refrigeration should be held in a separate clearly labelled container. There should be evidence that the home meets the Water supply Water Fittings) Regulations 1999. Formal supervisions should be provided for all care staff at least six times a year, so that they understand the policies and ethos of the home and are supported in their role. There should be evidence that the staff call system has been maintained. A risk assessment should be carried out on access to the conservatory by service users. DS0000019709.V309538.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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