CARE HOMES FOR OLDER PEOPLE
Queensmead 1 Bronte Avenue Christchurch Dorset BH23 2LX Lead Inspector
Trevor Julian Unannounced 17 August 2005
th 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 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. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Queensmead Address 1 Bronte Avenue Christchurch Dorset BH23 2LX 01202 485176 01202 487805 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Fulcher, Care South Mrs L Thornhill CRH PC- Care Home only 40 Category(ies) of OP Old age (36) registration, with number of places DE(E) Dementia - over 65 (4) MD(E) Mental Disorder -over 65 (4) Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 36 in the category OP (Old Age) and 4 in the categories DE(E) and/or MD(E). Date of last inspection 31st January 2005 Brief Description of the Service: Queensmead is registered with the Commission for Social Care Inspection to accommodate 40 older people; this includes 4 places for people with a diagnosis of dementia or mental illness. Queensmead is operated by Care South, a non-profit making organisation with several residential homes and community services across the South West. Mrs L Thornhill is the registered manager. The home is situated in a residential estate close to Christchurch Hospital and one mile from the town centre. Queensmead is a purpose built home set in large, well-maintained grounds. Local shops and amenities are available within a short distance. The premises extend over 3 floors with service users accommodated on every floor. The ground floor comprises of 11 bedrooms, an assisted bathroom, 8 separate toilets, a dining room, two lounges, a conservatory and a smokers lounge. The first floor houses 15 single rooms, 2 bathrooms, one shower room and two separate toilets. The second floor has the remaining 14 bedrooms, two further bathrooms and two separate toilets. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 17th August 2005 between 10:15 and 14:15. The deputy manager was on the premises throughout the inspection. The inspection was the first of two statutory visits to be completed during the inspection year. Information was gathered through discussion with residents, visitors, staff, and the deputy manager. Further evidence was obtained by a review of records, procedures and a tour of the communal areas. For the purposes of this report the terms resident and service user are interchangeable. What the service does well:
Placements at the home are only offered after senior staff have completed an assessment of needs to ensure that those needs can be met within the home. One visitor to the home said the staff had been supportive during and since the admission process and added that the home and other agencies had provided information about the services offered which had helped with the decision to accept the placement. The pre-admission assessment formed the basis for the initial care plan informing staff of needs and how they were to be met. Reviews of care needs were carried out regularly and when changes occurred. Residents said that the staff called for GP appointments when requested. The records showed good access to community health services including community nursing, specialist nurses etc. Residents and visitors said they were treated with respect. There was a relaxed atmosphere in the home with a good rapport noted between staff, residents and visitors. One person added that there dignity was respected and gave bath times as an example with staff running the water assisting the resident in and then leaving the room. Residents said that there were activities organised in the home they had access to a minibus and there were excursions held during the spring and summer. People found the home offered them a range of choices regarding their daily lives these included examples of food, bedtime, etc. All those spoken with described the food as very good with a range of options available for every meal.
Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 6 The organisation’s complaint procedure was displayed in the entrance lobby accessible to residents and visitors. People seen during the visit felt they could raise concerns with the senior staff. The staff were aware of their responsibilities regarding Adult Protection procedures. Care staff felt that the workloads were busy but manageable based on the current needs of the residents and level of occupancy. The organisation had commissioned an independent Quality Audit with the results used to identify areas for improvement. The staff said they were able to give their views and ideas during supervision and staff meetings. Personal finances were not managed by staff at the home although most of the residents deposited cash in the home to cover personal expenditure for hairdressing and toiletries etc. The accounts seen were up to date and matched the balances held. Staff received regular fire safety and evacuation training. Any agency or bank staff receive orientation training and basic fire procedures before their first shift in the home. 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.
Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 standard(s) 3. Standard 6 Intermediate care was not offered at the home and was therefore not assessed. New residents were only admitted once the senior staff had completed an assessment to ensure the identified needs could be met. EVIDENCE: The admission records for a new resident were examined, there was a preadmission assessment which considered the recommended topics. The assessment had been completed before a formal offer of accommodation was made. During the visit another recently admitted resident and her daughter told the inspector that the admission process was very good with support from the social services department they had also referred to inspection reports before deciding the placement was suitable. The deputy manager added that two recent referrals were not offered a place as the home was not able to meet the care needs of the individuals. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, and 10. Care plans were used to inform care staff about how identified needs were to be met. Healthcare needs were addressed with support from community healthcare services. People were treated with dignity to ensure their basic rights were respected. EVIDENCE: A sample of files showed the care plans were developed from the preadmission assessments and the initial care reports. Those seen included information about specialist equipment provided for individuals. The resident or their representative had signed the care plans on the files seen. There was also evidence of reviews when changes of need were identified. The sample showed the home working with specialist healthcare agencies including community nurses, dieticians and Parkinson’s nurses. Residents said that the home contacts their GP with any health concerns. The home was also working with the falls clinic when they identified people at risk. Medication was not checked during this inspection the previous requirement was repeated for consideration at the next visit.
Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 10 During the visit several people said they were well treated. One person explained that they preferred to bath alone this was respected by the staff who ran the bath and then left the bathroom. Others said the staff were kind, helpful and supportive. During the visit the home had a relaxed atmosphere and the staff were seen treating people in a dignified manner, there was also good-hearted banter between the staff and some of the staff and visitors. One person added that there was a slow way of life at the home and that suited their own preference. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 and 15. The home’s activity programme allows residents to follow their preferred pastimes. The home encouraged contact with the community, family and friends to help the individuals not to feel isolated. Meals were provided in suitable surroundings, the menu offered good levels of choice and the food was appetising to encourage a healthy nutritional intake. EVIDENCE: Residents and visitors said the homes activity organiser was in the home most weekdays and organised a variety of pastimes. The home had access to an adapted minibus that was used for excursion. One resident commented that there were things to keep residents occupied and that they were optional. One person was enjoying a crossword puzzle book and there was a variety of library book available to residents in the lounge. A record of activities was kept and was up to date. Residents and visitors said they were able to call at the home at any time and were always welcome. One person had recently had a telephone installed that allowed her to maintain links with distant family and friends.
Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 12 People commented that there were good levels of choice in the home including meals offered and when they get up and go to bed. Most residents were very positive about the standard, variety and quality of food offered; on the day of the visit the options included roast lamb and trimmings. There had been comments recorded by a small group of the residents that the food was sometimes not up to standard and the meals served were not warm. The deputy manager was aware of the issues raised and was actively looking for a solution for those people. During the visit chef was seen asking residents if they had enjoyed their meal and if they had any concerns. The menu board in the dining room gave residents a list of the food options for the day. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 standard(s) 16 and 18. The home’s complaint procedure allows people to raise concerns and that those concerns would be acted upon. The organisations Adult Protection policy provides residents with protection from abuse while in the home. EVIDENCE: The complaint procedure was posted on the main notice board by the entrance. Residents and visitors were able to raise concerns through several channels including the residents meeting and also by talking directly to the staff. Records showed that complaints were appropriately investigated and the outcome given to the complainant. The home also retained letters and cards from grateful residents and their families. Staff were aware of their responsibilities in respect of adult protection matters. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 standard(s) Not assessed during this inspection. EVIDENCE: The areas visited were clean and well aired. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staffing levels were appropriate for the needs of the residents. EVIDENCE: Since the last inspection the home had success in recruiting permanent carers reducing reliance on agency from 22 to currently less than 8 . Staff said that with a reduction in dependency levels the workloads remained busy although they were manageable. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38. The views of residents and others are obtained to help ensure the home is run in their best interests. The organisation’s procedures protect residents from the risk of financial abuse while in the home. The organisation provides a safe environment for the protection of residents and staff. EVIDENCE: The organisation had completed an independent quality assurance audit involving residents, family, staff, visitors, healthcare professionals etc. The results were used to identify where ongoing improvements could be introduced. Residents were also able to raise issues during resident meetings; minutes were produced and circulated. Staff were also able to give their views in their supervision and staff meetings. The home also held complimentary letters and cards from grateful residents and their families.
Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 17 The home did not manage the finances for any of the residents. However, most residents had personal allowances deposited with the home for payment of hairdressing, toiletries etc. The monies were securely held. A small sample showed the balances held matched the transaction records and receipts. Fire records showed the monthly checks of the emergency lighting and fire fighting equipment had not been recorded since April and May 2005 respectively. Weekly tests of the warning system and contractor testing and servicing was up to date. Staff fire safety training records showed staff received regular training and refreshers. Agency staff were given instruction before starting their first shift in the home. Staff said the core and specialist training provided was of a good standard they discussed training needs within their supervision sessions. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 2 Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 19 YES 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. 1. Standard OP 9 Regulation 13(2) Requirement The quantity of each medication received into the home must be recorded. This requirement was not assessed during this visit and is therefore repeated for the next inspection. Timescale for action 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP 38 OP38 Good Practice Recommendations Fire fighting equipment checks should be recorded monthly. Emergency lighting checks should be recorded monthly. Queensmead D55 S26862 Queensmead V244213 170805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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