CARE HOMES FOR OLDER PEOPLE
Read House 23 The Esplanade Frinton On Sea Essex CO13 9AU Lead Inspector
Marion Angold Unannounced Inspection 9th February 2006 12:05 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 Read House DS0000017916.V282620.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. Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Read House Address 23 The Esplanade Frinton On Sea Essex CO13 9AU 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) 01255 673654 01255 673177 admin@evab.fsbusiness.co.uk Essex Blind Charity Mrs Rosemary Danby Care Home 40 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40), Sensory Impairment over 65 years of age (40) Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 65 years and over, who require care by reason of Old Age (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of a physical disability (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of a sensory impairment (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia, whose names were provided to the Commission in May 2005 The total number of service users accommodated in the home must not exceed 40 persons 3rd August 2005 Date of last inspection Brief Description of the Service: Read House is a purpose built establishment for older people with sight impediments and is owned by Essex Voluntary Association for the Blind. The home offers accommodation on three levels, with all rooms being serviced by a passenger lift. All rooms are now for single occupancy, with en-suites, and two are designated for respite care. Attached to Read House is a day centre. Service users are encouraged to participate in its activities on a weekly basis and attend special events, such as concerts. The home is situated on the promenade of Frinton-on-Sea, within easy reach of the town. Read House provides a number of facilities for older people with sight impediments. This includes a sensory garden to the rear of the premises. Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 12.05 pm and 8.10 pm, assisted by the registered persons, staff and residents. The Inspector looked at a number of the Standards with reference to the particular circumstances of three relatively new residents. The inspection also involved observation and looking at records. This inspection covered the core National Minimum Standards, not inspected on 3 August 2005, and the shortfalls, identified in the last report. For a fuller picture of the home, it would be necessary to read the last report as well. Over all, this was a positive inspection. Of the 14 Standards inspected, 13 were met. However, the requirement relating to recruitment has been repeated several times and so that Standard now presents a major shortfall. What the service does well:
Residents were positive in their comment about the home. One new resident said it was everything they could wish for, but the aspects, which stood out for them, were its cleanness, the quality of meals provided and patience of the staff. They said that staff were ‘always trying to keep residents’ spirits up’ and were ‘kindness itself.’ Induction records for new staff evidenced that they were taught how to use a care plan and to understand the concept of person-centred care. A number of examples were noted of the home promoting choice for residents. For example, supper trays were prepared according to individual preferences and residents went to bed at times that suited them. Residents were also encouraged to maintain contact with the people that mattered to them. In one case, this involved arranging for one person’s friends to join them occasionally for a meal. Residents’ views were listened to and acted on. This was happening, formally, through the use of surveys and, informally, in situations observed by the Inspector or reported by residents. The home had taken appropriate steps to protect residents from abuse and to minimise risks in their environment. Residents benefited from the employment of teams of dedicated cleaning and kitchen staff, who maintained a good standard of cleanliness in the home and provided meals that people enjoyed and catered for individual preferences.
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 6 The home continued to place appropriate emphasis on staff training as exemplified by the induction programme for new staff. What has improved since the last inspection? What they could do better:
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 7 The registered persons still need to ensure they follow all the required recruitment procedures, including the completion of POVA/CRB disclosures (Protection of Vulnerable Adult and Criminal Record Bureau), before any person comes to work at the home. They must also keep on their staff all the records that are required by regulation. 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. Read House DS0000017916.V282620.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Read House DS0000017916.V282620.R01.S.doc Version 5.1 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 the following standard(s): 3 A decision to admit a prospective resident was based on mutual understanding that their assessed needs could be met by the home. EVIDENCE: Initial assessments of need were inspected for 3 relatively new residents. These covered the individual’s strengths, interests and expectations as well as difficulties and risk factors. Care plans, generated from the assessments, showed how the home proposed to ensure that the full range of needs was met. The manager, who took responsibility for initial assessments, confirmed that, where possible, she would meet with prospective residents before they came to the home. However, in some circumstances, such as where the person came from a distance, the manager relied on information provided on the application form, together with supporting information from medical/other professionals, to determine whether the home would be able to meet the individual’s needs. One resident confirmed that their GP visited twice to discuss their admission to Read House and that this was supplemented by further assessment from the home, when they came with a view to moving in.
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 10 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 and 10 Residents were benefiting from a more holistic approach to care planning and respect for their privacy and dignity. EVIDENCE: The manager had revised the home’s care planning methodology since the last inspection. This included an index, which served both as a checklist and guide to the contents and monthly reviews. The three care plans sampled showed that the previous emphasis on physical, medical and sensory needs, had been expanded to include information and instructions to staff about the social, emotional, spiritual and recreational aspects of people’s lives. The content of these care plans fitted with what the residents told the inspector about themselves. Induction records for new staff evidenced that they were taught how to use a care plan and to understand the concept of person-centred care. All observed interactions between staff and residents showed respect for residents’ privacy and dignity and residents, who were asked to comment, had no reservations about how they were cared for. One person confirmed that staff always knocked before entering their room. Screens were in use in the evening, when residents were being assisted to bed.
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 Residents were experiencing flexible routines, attention to their social, recreational and spiritual needs, and support to maintain contact with the people, who mattered to them. EVIDENCE: As noted above, care plans had been developed to include residents’ social, recreational and spiritual needs and preferred activities. Since the last inspection, the home had taken on an activities coordinator for 18 hours a week, but activities were scheduled for mornings and afternoons throughout the week. The activities coordinator was enthusiastic about developing their role both with individuals and groups. They had talked with residents about their lifelong interests and occupations and current preferences. Residents had been invited to come along to observe and socialise, even if they chose not to join in. A number of residents were gathered in the ‘day centre’ for an afternoon quiz, some participants and others observing. Comments from 3 residents were positive about the activities arranged, although one person said they found it difficult to hear what was going on. The activities programme was displayed in several locations and residents were overheard asking about the afternoon activity as they came out of the dining room. One person with visual impairment said that staff kept them informed about the programme of
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 12 activities and they had enjoyed a couple of outings in support of their particular interest. Residents confirmed that they were able to get up and go to bed at times that suited them. A number of residents were still up and clothed when the inspection ended, after 8 pm and staff were observed supporting residents’ choice about when and how they were assisted. One member of staff said that they would be guided by non-verbal queues, such as body posture, to determine whether a person, who was unable to express a choice, was ready for bed. The care planning methodology on the sample of residents’ files included a record of their visitors. Relatives and representatives’ involvement was encouraged through surveys sent to them annually. Residents confirmed that they were free to have visitors and one person’s situation showed that it was possible, with prior arrangement, for family and friends to join the resident for a meal. Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents’ views were listened to and acted on and arrangements were in place to protect them from abuse. EVIDENCE: Management reported that the one complaint, made to the home since the last inspection, had been withdrawn with an apology from the complainant. The home were found to be proactive in getting feedback from residents both, formally, through surveys and meetings and, informally, as staff consulted residents about the care they received or asked them for feedback about their meal or an activity. In one observed situation, appropriate action was taken in response to the person’s comments. Induction training covered adult protection, and understanding and applying related policies and procedures. Twenty-seven staff had also attended a training session on the protection of vulnerable adults. The home’s information and policy folder on adult protection contained several related policies. Management were advised to remove from this folder an old Protection of Vulnerable Adults policy, containing some misleading advice. The most up to date procedures were in line with locally agreed protocols. Residents’ comments about the way staff treated them were very positive. One person said of the staff, ‘They are kindness itself’. Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Residents were benefiting from a clean, fresh and hygienic environment. EVIDENCE: Up to 6 domestic staff were on duty each morning (2 at weekends) and the home was clean and fresh in all areas inspected. The laundry room was fit for purpose with tiled walls and suitable flooring, a separate hand-washing facility, heavy-duty machines with sluice and high temperature/disinfecting facilities. Appropriate instructions to staff for maintaining health and safety were displayed in various areas of the home. Read House DS0000017916.V282620.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): 27 and 29 Residents were supported by adequate numbers of staff but were not fully protected by the home’s recruitment procedures. EVIDENCE: Using the Residential Forum tool for their calculations, management demonstrated that the home was exceeding minimum recommended staffing ratios. A sample of rotas showed that six staff covered each of the daytime shifts (an increase of a senior carer on the afternoon shift) and, 4, the night shift. An activity coordinator had also been taken on since the last inspection and their hours, like those of new staff (at the start of their induction training), were supernumerary to the care rota. Domestic, kitchen and maintenance tasks were also undertaken by dedicated personnel. One member of staff said that, with additional staff, they were able to spend more time with residents, who were less active. Residents also spoke positively about the attention they received. In the main, files of 3 new members of staff evidenced satisfactory recruitment procedures. However, one lacked a second reference and, although Criminal Record Bureau disclosures were in place, neither these, nor the POVA First disclosures had been obtained before the people started work. In one case other recruitment documentation required by regulation was missing from the file.
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 16 The home continued to place appropriate emphasis on staff training. Discussion with the person responsible for training, and individual records for new staff, evidenced a thorough approach to their induction. This covered a broad range of practice topics and used a variety of media, including videos, one-to-one discussions and shadowing. Since the last inspection, the trainer had attended a course on the Common Induction Standards. One member of staff said that they had valued the particular support they had been given to meet their training targets. Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 17 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): 33, 35 and 38 The views of service users formed a significant part of the home’s quality assurance system. Residents were protected by the home’s arrangements for handling and securing their personal money and by their approach to health and safety issues. EVIDENCE: Satisfactory arrangements were in place for ensuring that residents’ personal money was safe and accessible to them. Where their money/pension was paid directly into the home’s business account, a proportion was retained by the home, to meet their agreed contribution to the fees and their statutory personal allowance was transferred to them in cash. In most cases, this cash was held safely by the home on their behalf. All these transactions were recorded and backed with receipts and signatures. The process, tracked for
Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 18 three residents, was clearly and accurately documented and, in each case, the balance of personal money held by the home tallied with bank statements, ledgers and receipts. One resident said they were content not having responsibility for their money as they got what they needed. At their meetings, residents had opportunity to comment on the way their home was run. For example, the chef attended these meetings to hear their suggestions about menus. With the support of volunteers, as needed, residents had also completed user satisfaction surveys; their relatives and representatives had been invited to do the same. Analysis and discussion of the responses, at both staff and management levels, had led to an action plan. Records showed that staff were able to contribute ideas and bring about change through their meetings. Other examples of quality monitoring were noted, such as the 6-monthly analysis of accident records. Discussion took place with management about continuing and developing this cycle of planning, action and review. All evidence pointed to the home taking seriously the health and safety of residents and staff. Staff were encouraged to highlight health and safety issues and a health and safety committee met to review policies and procedures. Environmental risks had been identified and action plans put in place and reviewed. Appropriate safety information was available to staff in the different areas of the home where they worked. Certificates showed that installations and appliances were regularly serviced Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 19 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 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 20 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 OP29 Regulation 17, Sch4 19, Sch2 Timescale for action The registered persons must 10/02/06 ensure that they adhere to thorough recruitment procedures, including the completion of Criminal Record Bureau disclosures on all paid and voluntary staff. THIS IS A REPEAT REQUIREMENT AND HAS EXCEEDED AGREED TIMESCALES OVER SUCCESSIVE INSPECTIONS. Requirement 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 OP7 Good Practice Recommendations The registered persons should ensure that all records are signed and dated. Read House DS0000017916.V282620.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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