CARE HOMES FOR OLDER PEOPLE
Rest Haven 15 Gussiford Lane Exmouth Devon EX8 2SD Lead Inspector
Anita Sutcliffe Unannounced Inspection 21st February 2006 10:15 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 Rest Haven DS0000022014.V283170.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. Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rest Haven Address 15 Gussiford Lane Exmouth Devon EX8 2SD 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) 01395 272374 01395 278748 resthavenhome@tiscali.co.uk Rest Haven Charitable Home Trustees Mrs Cheryl Suzanne Hocking Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th August 2005 Brief Description of the Service: Rest Haven is registered to provide personal care for up to 34 older people. It is a Christian home of charitable status run by Rest Haven trustees and managed on a day to day basis by a registered manager. The property is a large Victorian detached house situated at the top of a sloping driveway close to the centre of Exmouth. There are gardens to the front and rear of the property. All bedrooms are single, and most are very spacious. One is slightly below 10 square metres. 12 bedrooms have en suite facilities. There is a passenger lift to the first floor and most rooms have level access. There are three large lounges (one of which is a music room), a dining room, 2 conservatories, a Chapel, a salon/therapy room, and a large entrance hallway with sitting areas. Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection began at 10:15 am and lasted 5 hours. Several key standards were inspected, and progress on a recommendation made at the last inspection to the home was assessed. During the inspection the care of three service users (residents) was examined. This involved meeting them, visiting their room, reading records relating to their care, and discussion with care staff. Conversation was held with two other residents and many others met. Most of the home was visited during which a residents’ exercise session was seen in progress. Medication was examined, plus records of recruitment, training, medication, fire safety, care assessment, care planning and the assessment of certain risks. Staff provided information and the registered manager was available throughout. CSCI information on inspection, including contact details, were left at the home so that residents, visitors or staff can make contact with the inspector should they wish. What the service does well: What has improved since the last inspection?
Care staff continue to undertake the NVQ qualifications in care and the home now achieves the 50 which is considered the minimum standard. This is one way of confirming that staff are competent in their work. The registered manager is undertaking the Registered Managers Award and the deputy manager has recently completed the NVQ level 4 in management. The programme of redecoration continues. The entrance hallway is now much brighter and considered more inviting. Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 6 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. Rest Haven DS0000022014.V283170.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 Rest Haven DS0000022014.V283170.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): 3 Assessment arrangements ensure that residents’ needs are properly understood and recorded. EVIDENCE: The home has introduced an effective new system for recording information towards planning care so that assessed needs can be met consistently. However, records did not include all relevant information (see Standard 7), but this was available within hospital and social service assessments. There was also limited confirmation that residents were involved in producing their assessment. (See Standard 7). Two residents said they were very pleased with how their admission had been handled. Rest Haven DS0000022014.V283170.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): 7, 8 & 9 Residents are not sufficiently consulted about their care and care plans were unsatisfactory as they failed to inform staff how to meet the needs of residents in a consistent way. The health care needs of current residents were well met. Medication at the home is well managed. EVIDENCE: Residents were very complimentary about the care provided at the home and confirmed that their needs were fully met. Records confirmed that health is monitored, routine appointments, such as hearing and foot care, are arranged, and district nurses visit regularly. Residents looked very well cared for and staff were knowledgeable about health and care issues. Residents were unable to confirm that they had been involved in planning their care, nor did records indicate they had been. Care plans contained some good information, but also lacked some of importance. Staff are not using care planning to provide the care residents want in a consistent way.
Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 10 The home uses a monitored dosage system for administering medicines safely, and if a resident wishes to administer their own they are supported to do so. Medicines are stored safely. Records contained one or two signature gaps but were otherwise well kept. Staff receives training in how to handle medicines safely. Rest Haven DS0000022014.V283170.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): Not inspected on this occasion. EVIDENCE: Rest Haven DS0000022014.V283170.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): Not inspected on this occasion. EVIDENCE: Rest Haven DS0000022014.V283170.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 & 23 The home is clean, pleasant, safe, well maintained and meets residents needs. EVIDENCE: The home has some unique features, such as the chapel, and is quite large and rambling. It has been well adapted, and few residents need to negotiate steps. There is a continuing programme of redecoration and upkeep, which keeps the home looking pleasant. It is well maintained, clean, warm and comfortable. Some bedrooms are like apartments and most residents were extremely pleased with their accommodation, which contains their own furniture and items of importance and interest. Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Residents benefit from staff who are qualified and competent in providing personal care. Residents are protected by robust recruitment practice. EVIDENCE: Most care staff have many years experience. They receive structured induction when new and then on-going regular training. Staff are encouraged to undertake the NVQ qualifications in care and the home has now achieved 50 of care staff with the qualification to level 2 or above, thus further ensuring service user safety and well being. All service users spoken with said that staff knew exactly what they were doing. The recruitment records of two recently employed staff, and discussion with one of them, confirmed that staff are only employed following thorough safety checks to ensure they are suitable to work in a home with vulnerable adults. Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The home is well managed, run in the bet interest of residents, and their health and safety are properly attended to. The Responsible Individual for the home is not fully complying with their duties. EVIDENCE: The home benefits from the experience and competence of the registered manager who maintains her knowledge through regular training and is currently undertaking the Registered Managers’ Award to further ensure competence. The quality of the service provided by the home is checked using quality survey questionnaires and resident and staff meetings. The manager hopes to improve the system for monitoring standards by introducing a more consistent approach. The person undertaking the responsibility for the home on behalf of
Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 16 the organisation has recently changed, and whilst it was confirmed that the unannounced monitoring visits are continuing, the report from this has not been supplied to the Commission as it must. Residents are encouraged and supported to look after their own financial affairs. Secure storage is provided for their money, which is safely handled by the home. The home is well maintained and staff well trained in health and safety. Equipment is serviced and properly maintained. Risks are identified, assessed and well managed. Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 31/03/06 out such consultation the registered person shall, with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. [This refers to omissions identified regarding health and welfare needs and lack of consultation with service users] The registered provider shall 21/02/06 supply a copy of the report to be made under paragraph (4)(c) (on the conduct of the home) to the Commission. [This refers to the lack of report following the monthly unannounced visits by a representative of the organisation] Requirement 2. OP33 26(5) Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rest Haven DS0000022014.V283170.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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