CARE HOMES FOR OLDER PEOPLE
Rathmore Care Home 3 St Annes Road East St Annes Lancashire FY8 1TA Lead Inspector
Denise Upton Announced 3 October 2005 10:00am
rd 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. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 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 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 Jarvis Mrs Mary Jarvis Care home only 8 Category(ies) of OP Old Age (8) registration, with number of places F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The service is registered to accommodate a maximum of 8 service users in the category OP (Older persons 65 and over). Date of last inspection 6th January 2005 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. Although only one bedroom provides an en-suite facility, 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. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over a morning and lunchtime period of a midweek day and in total spanned a period of almost three and three quarter hours. The inspector spoke with the homeowner and her husband and two members of the care staff team. Individual discussion also took place with three of the five residents currently accommodated. A number of records and policies and procedures were also examined and the communal accommodation in the home was observed. At this inspection, the Commission For Social Care Inspection pharmacist inspector also visited the home and assessed the medication standard. As is normal practice, a separate letter has been sent to the homeowner with the outcome of the pharmacist inspection however a brief summery of the findings are included in this report. Prior to this inspection, two relative/friends comment cards provided by the Commission For Social Care Inspection were completed. This provided further information on how relatives/friends of residents accommodated felt that the Rathmore Care Home was meeting the needs and requirements of people who live at the home. What the service does well:
The Rathmore Care Home has a small group of staff that enjoy working at the home and are keen to provide a good service to residents who live there. Staff and residents get on very well together and residents spoken with said they were happy living at the home and felt they were well looked after. Staff were seen responding to the residents needs appropriately and all tasks were carried out in a sensitive and caring way. Routines within the home are flexible so that the people who live there can enjoy the lifestyle of their choice. Residents are encouraged to have their say and help make decisions about the running of the home. The atmosphere in the home is welcoming, relaxed and friendly that helps residents feel comfortable and secure. One relative commented on a Commission For Social Care Inspection comment card that the home was always ‘welcoming and caring’. The home has good systems in place to make sure that the staff group understand the needs, wants and wishes of each resident. Health care needs are well met and there are also good systems in place of the administration of
F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 6 medication to make sure that residents are well protected. However the pharmacist inspector has made a small number of recommendations that will help improve the systems already in place. What has improved since the last inspection? What they could do better:
The homeowner and staff at the Rathmore Care Home work hard to ensure that the needs of residents are well met and that residents feel comfortable living at the home. However there are a small number of things identified at this inspection that could be improved. The staff rota that must be maintained in the home should include all the hours worked by each member of staff including the homeowner and her husband. This will then provide an accurate record of the staff on duty during each period of the day and night. Although it is understood that care staff receive ‘in-house’ moving and handling training and first aid training, it has been recommended that staff be enabled to undertake formal certificated moving and handling training and first aid training. This will make sure that staff have the skills and abilities to protect residents and ensure as far as possible safe working practices in respect of these matters. It has also be recommended that consideration should be given to providing staff with responsibility for food preparation and food handling with updated food hygiene training. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 7 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. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 8 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 F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 9 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 The pre admission assessment information to identify what the prospective service user can do well and what help may be required is detailed in order to establish if current needs, wants and wishes could be met at the home. EVIDENCE: Although no new service users have taken up residence at the Rathmore since the last inspection, it was evident that service users are only admitted to the home following a pre admission assessment of current strengths and needs by the homeowner. In some instances, the information obtained is further supplemented by a health and/or social services multi disciplinary assessment that provides further information regarding the prospective service user. This collated information, evidenced at inspection, enables an informed decision to be made as to whether the home could satisfactorily address the prospective service user’s current strengths, needs, wants and wishes. This collated information forms the basis of the initial plan of care. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 10 Service users spoken with stated they were very satisfied with the level of care and support provided at the home with one service user reporting that ‘he felt well looked after and cared for by the staff group’. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 11 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) 7,8,9 & 10. Standard 11 was assessed in part. There is a clear and consistent care planning system in place to provide staff with the information they need to satisfactorily meet service users needs and requirements. The health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure service users medication needs are met. The values of privacy and dignity are given high priority at the Rathmore to ensure that basic human rights of service users are not diminished. EVIDENCE: All service users at the Rathmore Care Home have an individual plan of care that identifies the individual service user’s current strengths, needs, wants and wishes. As observed, this process also incorporates relevant individual risk assessments. All care plans are drawn up in consultation with the individual service user and signed by the service user where ever possible or their representative. However when a service user does not want to become involved in the care planning process this is also recorded. It was observed
F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 12 that care plans are routinely reviewed on a monthly basis and updated as required. Service users spoken with were, in the main, not very interested in their actual care plan or the content of their care plan, but were able to confirm that the staff team provided all the help and support they required. The staff have a good understanding of service users support needs. This is evident from the positive relationships that have been formed between staff and service users. It was evidenced through discussion, observation and documentation that service users health needs are fully met. There is a good relationship with health and social care professionals in order to maintain health and social wellbeing. A service user spoken with stated that he had been ‘well looked after’ during a recent illness and that the staff were ‘very good’. During the course of this inspection, the Commission For Social Care pharmacist inspector also visited the home to assess the medication standard. As is normal practice following a pharmacist inspection, a separate letter in respect of the findings has been provided to the homeowner independent of this report. In the main, the home has good systems in place in respect of medication however a number of recommendations have been made to strengthen the systems already in place. In addition, an independent pharmacist visits the home on a regular basis to undertake a pharmacy inspection and also provides advise to the home on medication matters. All staff with responsibility for the administration of medication has received appropriate medication training. Discussion with a service user and two members of staff confirmed that the maintenance of service users privacy and dignity is given high priority at the Rathmore Care Home and upheld at all times. Staff receive induction training on how to respect service users rights that is reinforced in policy documents. Personal care is provided in the privacy of individual bedroom accommodation that can also be used for private consultation. The preferred term of address is identified at the point of admission and always respected. It was noted that as recommended in the last inspection report, the home’s policy and procedures in respect of terminal care and death have been personalised to reflect the requirements of the home. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 13 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) None of the four standards were assessed at this inspection. EVIDENCE: None of the four standards were assessed at this inspection. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 14 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 & 18 The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Staff have a good understanding adult protection issues that protects service users from abuse. EVIDENCE: The complaint procedure at The Rathmore Care Home is fully compliant with requirements and identified in the Statement of Purpose and Service User Guide. It was identified that all complaints would be responded to within seven days and the document incorporates details of the Commission for Social Care Inspection should the complainant consider the issue had not been resolved to their satisfaction and wish to take the matter further. A service user individually spoken with was very clear about who he would speak with if he needed to make a complaint and stated he felt confident that any concern would be ‘looked into’. The Rathmore has available a variety of policies and procedures evidenced at the time of inspection for the protection of service users. These include an Adult Protection Policy based on the ‘No Secrets’ document that helps to protect service users from abuse or discrimination and a whistle blowing policy to inform staff of their responsibility in respect of any suspicion of abuse. Policies have also been developed in respect of service users monies, gifts, wills and physical restraint. Advice regarding personal insurance is incorporated in the contract of residency. Policies in respect of adult protection have now been personalized to reflect the requirements of the home.
F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 15 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) 24 assessed in part. The standard of the environment in this home is comfortable providing service users with a homely place to live. EVIDENCE: As recommended in the last inspection report, all bedroom accommodation with the exception of one bedroom has now been provided with an appropriate locking mechanism to ensure privacy for the occupant. It is understood that in the near future, the remaining bedroom with be provided with this facility following the replacement of the existing bedroom door. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 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 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) 27,28, &29 Since the last inspection the standard of vetting and recruitment practices have been strengthened and will meet requirements in respect of future staff appointments. There is a good match of well-qualified staff offering consistency of care within the home. Staff morale is high resulting in a workforce that work well together to help improve service users quality of life. EVIDENCE: Staffing levels at the Rathmore reflect the needs and requirements of current service users accommodated. A staffing rota was observed that reflects the actual hours worked by staff however in accordance with Schedule 4 The Care Homes Regulations 2001, the hours worked by the homeowner and her husband must also be recorded on the rota. The homeowner is aware that employees under the age of 18 cannot provide personal care to service users and those left in charge of the home must be at least aged 21 years old. Since the last inspection further members of staff have successfully completed a nationally recognised qualification in care and the number of care staff with a relevant qualification now exceeds minimum recommendations. Currently the remaining member of the care staff team without a formal qualification is undertaking a National Vocational Qualification Level 2 in care and a further member of staff is undertaking Level 3 of this award. Staff spoken with stated they were pleased with the training undertaken and also confirmed that further short course ‘in house’ training had also been provided that included falls prevention and heatstroke training. As previously recommended, the hours
F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 17 spent in training activity in respect of each member of staff should be recorded. There have been no new staff appointments since the last inspection. However the Rathmore Care Home operate a structured recruitment and selection process. Recruitment practices have been tightened up and all the required references and clearances have now been obtained in respect of the most recently appointed member of staff. Through discussion with the homeowner, it is understood that in future newly appointed staff will not actually take up employment at the home until all the references and clearances required by Regulation have been obtained and deemed to be satisfactory. Through discussion with the homeowner and members of staff, it was confirmed that all staff receive a statement of terms and conditions and are now provided with the General Social Care Council’s Code of Conduct. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 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 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 & 38 The systems for service user consultation are good and reflect the current requirements of service users accommodated. EVIDENCE: The Rathmore Care Home has available service user satisfaction questionnaires the outcomes of which are incorporated in the Service User Guide. In addition, anonymous service users/relative questionnaires are also available and it is understood that the views of other stakeholders were obtained as part of the Registered Managers Award that was successfully completed by the homeowner. Rathmore Care Home has also achieved the ‘Investor In People’ award. The outcome of these initiatives will assist the internal audit on how the home is achieving aims and outcomes for service users accommodated. It was evident that service users were aware of the planned inspection. A number of existing policies and procedures have now been personalised to
F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 19 reflect the requirements of the home however this will remain an ongoing process until the task is completed. The Rathmore Care Home has policies and procedures available in order to ensure the health, welfare and safety of service users, relatives and staff. Although it is understood that a book and video training in respect of moving and handling is made available to the staff team concluding with a questionnaire answer form, formal certificated moving and handling training has not been undertaken by the care staff team. It is recommended that consideration be given ensuring that all staff be provide with formal, certificated moving and handling training to ensure as far as possible the safety of all service users and staff. It is understood that the staff team have undertaken first aid training ‘inhouse’ however this could not be evidenced through documentation. As discussed, at minimum staff should be expected to complete a questionnaire to evidence their understanding and competence of the training undertaken and the training undertaken should be recorded in respect of each member of staff who participated. In addition, as identified in the previous inspection report, is recommended that all care staff be enabled to undertake up-to-date food hygiene training as all staff are involved in food preparation and handling. An infection control policy was evidenced that all staff are expected to read and implement. A written statement in respect of the policy, organisation and arrangements for maintaining safe working practices was also available. Risk assessments are routinely conducted in respect of electrical appliances taken into the home with the proprietors reserving the right to refuse equipment the service user takes in if it does not meet current safety requirements. This is clearly identified in the Service User Guide. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 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 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x 3 x x STAFFING Standard No Score 27 2 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x 3 x x x x 3 F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 21 NO 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 27 Regulation Requirement Timescale for action 31/10/05 Schedule The actual hours worked by the 4 The proprietor and her husband must Care be incorporated on the staff rota. Homes Regulation s 2001. 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 24 38 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. Consideration should be given to all staff undertaking formal certificated moving and handling training and first aid training. All staff with responsibility for food preperation and food handling should be enabled to undertake updated food hygiene training. All staff training undertaken should be recorded. F57 F09 S9743 Rathmore V245473 031005 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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