CARE HOMES FOR OLDER PEOPLE
Rathmore 3 St Annes Road East St Annes Lancashire FY8 1TA Lead Inspector
Denise Upton Unannounced Inspection 01:30 10 February 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 Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rathmore Address 3 St Annes Road East St Annes Lancashire FY8 1TA 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) 01253 729410 01253 729410 Mrs Mary Jane Jarvis Mrs Mary Jane Jarvis Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered to accommodate a maximum of 8 service users in the category OP (Older persons 65 and over) 3rd October 2005 Date of last inspection Brief Description of the Service: The Rathmore Care Home is registered to provide personal care for up to 8 older people over the age of 65 who do not require nursing accommodation. The home is a smaller family type establishment with the experienced proprietor providing the majority of care supplemented by a small nucleus of staff, the majority of which have been employed at the Rathmore for a considerable period of time. In consequence, service users individual needs and preferences are well known and therefore more easily addressed with high quality care delivered in an informal setting. The home is conveniently situated close to the main shopping area of the Town and in close proximity to community amenities and resources. The home consists of communal accommodation on the ground floor of the building and single occupancy bedroom accommodation is located on the first and second floors. Stair lifts are provided for ease of access throughout the building. Since the last inspection, a further bedroom has been provided with an en-suite facility. This now provides two individual bedrooms with an en-suite facility. In addition, communal bathrooms and toilets are located close to the lounge and dining room and service user bedroom accommodation. Participation in community activity is encouraged either independently or with the assistance of staff and visitors are made welcome at any time of the service users choice. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over an afternoon period of a midweek day. The inspector spoke with the homeowner and her husband and a member of the care staff team. In addition, discussion also took place with three of the six residents who were ‘at home’ and two relatives who were visiting at the time of the inspection. A number of records and policies and procedures were examined and a partial tour of the building took place that included communal areas of the home, some bedroom accommodation and laundry facilities. The majority of the core standards regarding Care Homes for Older People had been assessed at the last inspection that took place in October 2005. The outstanding nine core standards were assessed at this inspection along with a reassessment of the requirement and recommendations identified at the last inspection. As not all of the core standards identified in the National Minimum Standards Care Homes For Older People were assessed at this inspection, it is strongly recommended that this report be read together with the last inspection report to get a full picture of how the service is meeting the needs of the residents living at the home. What the service does well:
This is a care home where residents felt well looked after and staff work hard to provide a high quality service. The staff team work well together, have a good relationship with all the people who live at the home and show a good understanding of the needs and wants and wishes of each individual resident. Residents spoken with stated they were very pleased with the individual care and support received. One resident said that ‘the home is comfortable and all the staff are very kind’. It is clear that there is a good relationship between residents, their family and staff that help residents feel secure and comfortable. Daily activities are determined by each resident to suit their individual requirements rather than regular group activities. Residents currently accommodated prefer this informal approach to social stimulation. However regular social events are arranged that family, friends and neighbours are invited to that is well attended and enjoyed. Visitors are made welcome at any time of the resident’s choice and there are good links with the local community. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 6 Meals are varied, well balanced and offer choice and variety that are based on the known likes and dislikes of residents accommodated. Residents were positive in their comments about the food served with one resident commenting that ‘I enjoy my meals’. The home is maintained to a good standard providing residents with comfortable surroundings in which to live. All residents spoken with were very satisfied with their individual bedroom accommodation that is furnished in a style to suit the individual resident. 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. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above six standards were assessed at this inspection. EVIDENCE: None of the above six standards were assessed at this inspection. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above five standards were assessed at this inspection. EVIDENCE: None of the above five standards were assessed at this inspection. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 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, 13, 14 & 15 Service users are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. The routines of daily living are kept flexible that enables service users to live the lifestyle of their choice. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choice. EVIDENCE: The homeowner and staff have a good understanding of each resident’s individual needs and requirements. This was apparent from the comfortable relationships that have developed between staff and residents. Residents spoken with confirmed that the home was a good place to live with a caring and supportive staff group who listened to them and enabled them to live the lifestyle of their choice. Residents are encouraged to maintain contact with family and friends and visitors are made welcome at any time. There are no restrictions on maintaining contact with family, ensuring social interaction is maintained either within the environment of the home or in the wider community. The two relatives spoken with, one of whom visits on a very regular basis, both stated that they were always made very welcome and enjoyed a good relationship
Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 11 with the homeowner and the staff group. One relative commented that the ‘staff are all extremely good’. Discussion with two of the residents during the course of the inspection indicated that they felt their particular needs and expectations were being met. It was confirmed by one resident who said, “I can do what I want when I want”. And that ‘the staff are very good and know what I like and don’t like’ In the main social activities are arranged on an individual basis to suit the requirements of each resident and includes either ‘in house’ activities or accessing local community resources and facilities. Current residents prefer this individual approach rather that arranged group activities. However at various times of the year, social events are arranged that residents, family, friends and neighbours are always invited to. Two residents and a relative spoken with all stated they had very much enjoyed the recent Christmas Party that was also attended by a number of relatives of residents who had lived at the home previously. Policies within the home state that all residents would be encouraged to handle their own financial affairs for as long as possible if this was their wish. Information regarding the local advocacy service is made available for residents and their relatives to access independently if required. From observation and discussion, it was evident that residents are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel homely and more familiar. Rathmore Care Home offers a varied, wholesome and nutritious diet with menus designed to incorporate the known likes and dislikes of residents accommodated. Specialist diets in respect of religious, cultural or medical need can be accommodated and as observed, hot and cold drinks and snacks are made available throughout the day. One resident is currently restricted to a soft diet with food supplements. Although it is usual practice that each separate food item of a blended meal is blended individually to ensure that the resident can taste each type of food, on this occasion the resident has chosen to have his meal blended together. It is recommended that his decision be kept under review to ensure that the resident’s requirements remain the same. Residents spoken with were positive in their comments regarding the quality and variety of the meals served. One resident described the meals as ‘good’ and confirmed a choice is made available and another resident also said that the meals were ‘very good’ and that she always enjoyed the food served. Although there is a rotating menu available, main meals are generally determined by what is in season and the variety of fresh fruit and vegetables available. As previously evidenced, staff discreetly and sensitively offer assistance when required. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 12 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): None of the above three standards were assessed at this inspection. EVIDENCE: None of the above three standards were assessed at this inspection. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 13 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 Standard 24 was assessed in part. The standard of the environment within this home is good and provides service users with a comfortable and homely place to live. EVIDENCE: Residents at the Rathmore Care Home live in well-maintained accommodation that is domestic in character and has been designed to meet the individual and collective needs of residents accommodated. The home is situated in close proximity to the main shopping area of the town and local community facilities. There is a lawned garden and patio area to the front of the home with tables and seating that resident’s can enjoy in the summer months. The layout of the home gives residents opportunity to move freely round the building and access all areas with ease. The home is well maintained and decorated and offers stair lifts for ease of access to first and second floor bedroom accommodation. Residents spoken with were pleased with their individual bedroom accommodation and the communal space available. It was clearly evident that
Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 14 service users are encouraged to access all areas of the building including their personal bedroom accommodation whenever they so wish. Since the last inspection, a further bedroom has been provided with an ensuite facility. The home complies with the requirements and recommendations of the Environmental Health Department and health and safety requirements to meet the needs of residents accommodated. The Rathmore Care Home has a variety of policies and procedures in place for the control of infection and safe handling of waste products including clinical waste and dealing with spillages. Laundry facilities are sited in the basement of the home and away from kitchen and dining areas and does not intrude on residents accommodated. All laundry is washed at an appropriate temperature and it is understood that facilities comply with the Water Supply (Water Fittings) Regulations. At the last inspection it was recommended that the remaining bedroom door without an appropriate locking mechanism should be provided with one as soon as the proposed new bedroom door had been fitted. At the time of this inspection it was evident that a new bedroom door had yet to be fitted and consequently this bedroom door remains without a lock that would help protect the privacy of the occupant. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Standard 27 was assessed in part. Staffing levels are determined to ensure that there is sufficient staff on duty to adequately address the individual needs and requirements of service users accommodated. EVIDENCE: At the last inspection, a requirement was made that the actual hours worked by the homeowner and her husband must be incorporated on the staff rota. Whilst there has been some progress this has not been consistently applied. In accordance with Schedule 4 The Care Homes Regulations 2001, the hours worked by the homeowner and her husband must be recorded on the staffing rota. There have been no new staff appointments since the last inspection. However there is a clear commitment to the training and development of all staff. It has been previously evidenced that newly appointed staff undertake a basic induction to the home and then work through the detailed ‘Skills For Care’ induction-training programme. NVQ training is then encouraged. In addition, staff undertakes a variety of other training initiatives to ensure a high quality service is provided and to extend the skills and knowledge of the staff group. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 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): 31 & 35 Standard 38 was assessed in part. The homeowner/manager is qualified, competent and experienced and is well supported by the staff team. Although the home does not currently assist residents with their financial affairs, systems are in place to ensure that resident’s financial interests would be safeguarded. EVIDENCE: The registered homeowner/manager is competent and experienced to run the home and meet its stated purpose, aims and objectives. The homeowner/ manager has successfully achieved the Registered Managers Award and has undertaken periodic additional training in order to supplement her existing skills and knowledge. This has recently included the European computer driving licence qualification and further health and safety training is planned to take place in the near future. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 17 A resident and her relative were very positive with regard to the support of the homeowner describing her and the remaining staff team as ‘very good and caring’ and stated they had no concerns what so ever about living at the home. General comments from residents spoken with were that the home is a good place to live and that they liked the family like atmosphere. It was clearly evident from observation that there is a good rapport between residents, staff and visitors that helps to create sense of belonging. A relative spoken with felt that her family member was well looked after in the home and commented that ‘everybody is very well looked after and cared for here’. At this present time, all residents remain financially independent or are assisted in this task by a family member or independent advocate. In consequence the home do not hold any monies or valuables in safekeeping for residents or support residents to manage their personal allowance. However systems are in place to protect the financial interests of residents should this situation change and secure facilities are provided. As recommended in the last inspection report, arrangements have now been made for the staff group to undertake First Aid or refresher First Aid training and Food Hygiene training that are to take place in early March 2006. In addition, a further member of staff is about to commence the more advanced ‘First Aid At Work’ course. As identified in Standard 38.2,it is recommended that a qualified first aider who has undertaken this more advanced course of study should be on duty at all times. It was also recommended that staff should undertake moving and handling or refresher moving and handling training and it is understood that this is also in the process of being arranged. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 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 X 17 X 18 X 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES 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 OP27 Regulation CHR 2001 Sch 4 Requirement The actual hours worked by the proprietor and her husband must be incorporated on the staff rota. (Time scale of 31/10/05 not met in full) Timescale for action 28/02/06 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 OP24 OP38 Good Practice Recommendations The remaining bedroom door without a locking facility should be provided with an appropriate locking mechanism as soon the new door has been fitted. The specific health and safety training arranged for the staff team should be completed and a qualified first aider should be on duty at all times. All staff training that is about to be undertaken should be recorded along with the individual training already undertaken. Rathmore DS0000009743.V279624.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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