CARE HOMES FOR OLDER PEOPLE
Richard House 69-73 Beech Road Cale Green Stockport Cheshire SK3 8HD Lead Inspector
Sylvia Brown Unannounced Inspection 21st February 2006 18:30 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 Richard House DS0000008583.V281441.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. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Richard House Address 69-73 Beech Road Cale Green Stockport Cheshire SK3 8HD 0161-429 6877 0161 474 0457 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) Denmax Limited` Joyce McDonald Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 33 OP. Date of last inspection 15th August 2005 Brief Description of the Service: Richard House is situated in a quiet street across from a local school, close to local shops and public transport. The home can accommodate up to 29 older people. Residents have the use of three main lounges with an additional sun lounge, conservatory and seating area at the entrance to the home. The home has been upgraded, redecorated and new fittings and fixtures are in place. Bedroom accommodation has been improved and the home offers 21 single and four double rooms for those who wish to share. A stair lift enables access to the upper floors. To the rear of the home is a garden where a decked patio area has been created to offer further outside seating. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Richard house was unannounced. Time was spent talking with residents and following the care support of one recently admitted resident. The inspector observed the routines at one mealtime, evaluated a selection of records and ensured all the core standards had been assessed for this inspection year. Comment cards had been left at the home for residents and relatives to complete at their leisure. At the time of writing this report, none had been returned. To obtain a full view on how the home is operating, the reader is advised to read this report in conjunction with the report of the inspection carried out in August 2005. What the service does well: What has improved since the last inspection?
The home has not made any significant developments following the home’s full refurbishment programme last year. The registered manager was in the process of reviewing recently introduced care plans and confirmed that they needed further development. Richard House DS0000008583.V281441.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. Richard House DS0000008583.V281441.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 Richard House DS0000008583.V281441.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): 1, 2 & 5 Residents receive information about the home and visit prior to making decisions about being accommodated. Pre-admission assessments are completed, however terms and conditions of residency are not provided in a timely manner. EVIDENCE: The registered manager stated that within the past 12 months she has reviewed and updated the home’s statement of purpose and service user guide. Evaluation of two residents’ files confirmed that their needs were assessed prior to being admitted to the home. They had not, however, been supplied with the home’s terms and conditions of residency. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 9 During the course of the inspection, the inspector observed a family viewing the home and seeking information from the registered manager regarding the services provided at the home. The registered manager confirmed that residents are invited to visit the home and stay for a meal, to talk with other residents and see the daily routines in place. Richard House DS0000008583.V281441.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, 8, 9 & 10 Residents’ health care needs are met through effective monitoring systems and delivery of care. EVIDENCE: Each resident has a care plan in place. The registered manager is aware that they need developing to ensure all the care needs, risks and residents’ personal preferences are identified. Both care files evaluated failed to record all the residents’ care needs. Risk assessments were not evident, neither was nutritional information. Records confirmed that doctors visit the premises when required and that district nurse services also provide health care support. Dental, optical and chiropody treatments are recorded. Medication administration records were evaluated and found to meet the required standard. Two residents stated that they felt well cared for and that staff were attentive to their care. One resident stated her health and improved and that she was “feeling better than when she first arrived”.
Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 11 Residents also confirmed that staff attended to them at night time in a timely manner. They stated staff were kind and considerate and treated them with respect. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 12 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): 13, 14 & 15 Residents were satisfied with their lifestyles and are able to make their own decisions and choices. Residents receive a varied diet. EVIDENCE: A number of residents continue to visit the local community independently with family and friends. Residents are able to receive visitors as they wish and in private. One resident spoken with, stated that she likes to rise early and, as far as possible, support herself when getting ready. She explained, she then rings for staff who assist in her final preparations. Residents stated they are supported to retire to their rooms when they wish, some of whom prefer to continue to watch television until they want to sleep. Residents have choice at mealtimes. They confirmed they liked all the food offered and that should they want something different, they would “just ask staff”. The mealtime observed appeared to be a pleasant experience, residents were unrushed and stated the meal was hot, tasty and enjoyable. Richard House DS0000008583.V281441.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): Standards 16 and 18 were assessed at the previous inspection. EVIDENCE: Richard House DS0000008583.V281441.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): 19, 23 & 26 Richard House is clean and well maintained. Rooms are furnished in a homely manner and offer residents comfort and security. EVIDENCE: The registered manager was able to demonstrate that she has recently assessed the building and produced a written plan of action to ensure minor repairs and odd jobs were completed appropriately. There was evidence that residents are able to choose which bedroom they prefer and of the arrangements in place to transfer to their preferred bedroom when a vacancy arises. One resident explained the process and of her pleasure at the bedroom standard. She stated she was comfortable and had all her own things around her. The home had made arrangements to remove all unwanted bedroom furniture into storage, enabling the resident to have as much of her own furniture from home as possible.
Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 15 The home maintains a good standard of cleanliness and was, on the day of the inspection, free from odours. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 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 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 & 30 Residents receive experienced. care from staff who are appropriately trained and EVIDENCE: At the time of the inspection the home had a significant number of staffing vacancies. As a consequence, the registered manager has been completing direct care duties. Furthermore, care staff have been working additional hours. The registered manager explained that, for consistency purposes, she prefers residents to be supported by staff they know rather than agency staff. As a consequence, some staff have been completing 14 hour duties. Evaluation of the duty rota identified that, at times, it appeared that staffing levels fall below the minimum level for part of the day. Furthermore, the duty rota failed to clearly identify who covered additional duties and their complete times of working. Notwithstanding the above comments, residents stated they had not felt any changes to the standards and that they received care and support in a timely manner. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 17 There have been no new staff employed at the home since the previous inspection. The registered manager stated she was attempting to recruit staff, however those applying had not been of the standard required at the home. The home has a ‘care cadet’ programme in place, which offers young people the opportunity to work in a care home. Currently, one care cadet works at the home. Although they are over 18 years of age, they are not yet permitted to complete personal care tasks or work alone with a resident. Records in place confirmed that statutory checks and references had been received and that a full training programme was in place. Staff continue with their training and NVQ training is seen as a priority by the home and positively by care staff. The registered manager was able to demonstrate her continued training and is about to commence an extensive training course relating to the care of people with dementia. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 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 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): 32, 33, 36 & 38 Richard House is well managed for the most part and residents’ safety is maintained by policies and procedures which are followed in practice. EVIDENCE: The registered manager has a strong leadership style and clear expectations of staff. She stated she recognised the areas of development in the home and will be in a position to implement changes in a timely manner once she is relieved from supporting the care rota. Currently, staff have not received formal supervision at the required frequency. Quality assurance procedures commenced in March 2005 have not been completed.
Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 19 Evaluation of fire safety and environmental health reports identified that correct standards are maintained. Accidents are recorded and routine systems for analysing such occurrences are to be introduced. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X 3 X 3 Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 21 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 OP33 Regulation 24 Requirement Timescale for action 31/03/06 2 OP2 4 3 OP7 15 The registered person must ensure that effective quality assurance and quality monitoring systems, based on seeking service users views, are in place, as detailed within standard 33. (Previous timescale of 01/12/04 not met). The registered person must 31/03/06 ensure that residents receive terms and conditions of residency prior to or at the point of admission. The registered person must 30/04/06 ensure that care plans detail all the care needs of residents and their personal preferences for support and how they are to be met. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 22 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 3 4 Refer to Standard OP3 OP27 OP27 OP36 Good Practice Recommendations The registered person should ensure that risk and nutritional assessments are recorded for all residents. The registered person should cease the practice of staff routinely working 14 hour duties. The registered person should ensure the duty rota records the accurate hours worked by staff, including additional hours. The registered person should ensure staff receive formal supervision no less than six times per year and more frequently if required. Richard House DS0000008583.V281441.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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