CARE HOMES FOR OLDER PEOPLE
Qu`Appelle 32 West Street Bourne Lincs PE10 9NE Lead Inspector
Julie Western Key Unannounced Inspection 4th July 2006 09:00 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 Qu`Appelle DS0000052676.V302382.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. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Qu`Appelle Address 32 West Street Bourne Lincs PE10 9NE 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) 01778 422932 Qu`Appelle Residential Care Home Ltd. Care Home 19 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (15) of places Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: QuAppelle is a two storey period house with an adjoining cottage. It is situated within a block of other period houses and is within 500 metres of the centre of the town of Bourne, with its shops and local amenities. The home is registered to provide personal care for up to nineteen people of both sexes over the age of 65 years, four of whom have a diagnosis of dementia. There are eleven single and four double bedrooms, none of which is en-suite. Communally, there are two lounges, a sun lounge and a dining room on the ground floor. Access to the first floor is via a stair lift. There are three communal bathrooms and seven toilets on the two floors. A garden is available to residents at the rear of the property. Limited car parking is available on the road outside the home and on roads near to the home. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took into account any previous information held by CSCI including the homes previous inspection reports, their service history, the homes pre-inspection questionnaire and residents questionnaires sent to the home by the Commission prior to this inspection. The site inspection consisted of case tracking a sample of two residents’ records and assessing their care. Some policies and procedures were examined and some records concerning the safety of the home were also seen. Three residents, two care and ancillary staff and two visitors were spoken with. The proprietor was present throughout the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection the office has been relocated to a much larger room and this has been very beneficial, as the Manager can now hold meetings. There is now space to organise records and the Manager has started to revise care plans. A new kitchen is being fitted and the home has had new gas plumbing, to included a safety cut-out switch in the kitchen. Room 5 has been completely refurbished and there is new flooring to the ground floor hallway.
Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 6 Six new beds have been purchased and there is a new gazebo in the garden for residents to sit out in good weather. 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. Qu`Appelle DS0000052676.V302382.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 Qu`Appelle DS0000052676.V302382.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 the service. The home clearly sets out what it intends to provide for residents and this information is freely available to residents and their visitors. Prospective residents are encouraged to visit the home before making the decision to move in on a permanent basis. The home does not provide intermediate care. EVIDENCE: The statement of purpose and the service user guide have been revised and ensure that information is freely available to residents. A comprehensive initial assessment ensures that the needs of residents can be met. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis Qu`Appelle DS0000052676.V302382.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): 7-10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home’s records give a clear indication of the needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity. EVIDENCE: The two care plans looked at in depth contained clear and comprehensive assessments, were reviewed regularly and were signed where possible by the service user or relatives/advocates. There was a clear medication policy and the pharmacist visited regularly. All staff have undergone a distance learning course on medication. A drugs trolley has been purchased and the fridge moved so that all medication is dispensed from the same area. Residents said they felt safe and well looked after; one said ‘They’re marvellous – you couldn’t be better looked after’ and a visitor said ‘They really do look after them’. The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs.
Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 10 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Social activities are extensive and well promoted, creating a variety of events and activities which residents are informed about. The residents exercise choice about which activities, if any, they wish to participate in and what meals they want to eat; the menu needs reviewing to include alternatives at lunch times. EVIDENCE: The home has an activities co-ordinator who works 6 hours weekly and a carer who works 2 hours weekly. The Manager said that recent activities had included monthly entertainers, church visits, weekly exercises and Bingo and residents confirmed this. FOne resident described her recent 100th birthday and the garden party held in honour of it. Residents were also escorted into town, or to the local garden centres. All residents said they enjoyed the food; one said ‘It’s good wholesome food but not too heavy and there’s always a choice’. Menus showed that there was a balanced and varied diet, with an alternative to the main meal. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 11 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 the service. The home’s complaints procedure is clear and gives residents and their relatives the confidence that comments and concerns will be listened to. EVIDENCE: Residents and visitors to the home all said they did not wish to complain but knew how to make a complaint. The home had received no complaints in the last twelve months. A suggestions box was located in the front entrance hall. All staff members spoken with had received training on adult abuse and were knowledgeable about complaints. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The residents live in a comfortable, pleasant and safe environment with both private and communal space being on the whole suitable for their needs. EVIDENCE: Overall, the standard of decoration internally was high and afforded residents a great degree of comfort. Rooms were clean, comfortable and well personalised. The gardens were well-tended, with places for residents to sit out in good weather and on the day of the inspection the residents were enjoying sitting out in the good weather under the recently purchased gazebo. The garden pathway was uneven in one place, which could cause residents to trip up. Residents and visitors said that the home was clean and tidy and always smelled fresh. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 13 Six beds had recently been purchased and one resident said they were extremely comfortable. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to the service. Staff numbers are in sufficient quantity for them to be able to care for the residents. Staff members are suitably trained, qualified and competent. EVIDENCE: The residents were positive about the care they received; one said ‘ the staff would do anything for you’. The most recent staff member to be interviewed said she had given two references, which were followed up, had a CRB check and had undertaken a three-day induction programme before commencing work. Staff records seen verified this. The Manager is a qualified nurse. The core staff group has been stable for many years and there is a waiting list for staff vacancies. Training records showed that five care staff had achieved the National Vocational Qualification at Level 2 and one had achieved NVQ at Level 3, with one working towards it. Recent training included the purchase of a Fire Training video and distance learning in medication and future training included dementia and moving and handling courses. On the day of the inspection there was a total of 7 staff members including four carers for 19 residents; this was in excess of the recommended staffing forum. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 15 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home is managed competently and the staff members are supported in carrying out their respective roles. Residents are included in decisions affecting them. EVIDENCE: The manager, who is currently unregistered, is an enrolled nurse who has worked in various roles in the care sector and has a Teacher’s Award. She is working towards her NVQ 4 in care, to be followed by her Registered Manager’s Award and will apply within the next few months to become the registered manager. Residents and visitors commented that the manager was approachable and accessible. The office has been moved to a larger room and
Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 16 policies and procedures have been re-organised, although the Manager acknowledges that there is still some work to do. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 17 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 18 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 OP19 Good Practice Recommendations It is a recommendation that the uneven pathway in the garden is made safe to prevent residents from falls or trips. Qu`Appelle DS0000052676.V302382.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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