CARE HOMES FOR OLDER PEOPLE
Rockley Dene Residential Park Road Worsbrough Barnsley South Yorkshire S70 5AD Lead Inspector
Jayne Barnett-Middleton Unannounced Inspection 14th February 2006 09:30 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 DS0000018277.V278707.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. DS0000018277.V278707.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rockley Dene Residential Address Park Road Worsbrough Barnsley South Yorkshire S70 5AD 01226 245536 01226 280 187 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) Angel Care Plc Mrs Beryl Skidmore Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places DS0000018277.V278707.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: Rockley Dene is a purpose built home specialising in providing residential care for up to 40 residents over the age of 65 years. It is situated in a residential area of Barnsley close to amenities and on the local bus route. The home comprises of 22 single rooms, 3 of which are en-suite, and 9 double rooms, 2 of which are en-suite. A range of communal rooms is provided, including 3 lounge areas and a large dining room. The home has sufficient bathing facilities, aids and adaptations such as ramps, a lift and handrails are available. A central kitchen and laundry room serves the home. The grounds are provided with a range of seating. A car park is available. DS0000018277.V278707.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out from 9.30 am to 2.30 pm. Most of the residents were seen during the inspection. Seven residents, four staff, two visitors and the manager were spoken to. A sample of records was examined and a partial inspection of the building was carried out. Throughout the inspection positive and professional relationships were observed between staff and residents. The inspector wishes to thank the manager, staff and residents for their time and co-operation throughout the inspection process. What the service does well:
There was a relaxed and friendly atmosphere within the home. Residents were comfortable to talk about the care that they received. Residents spoke positively about the staff team and described them as “very friendly” and “very good”. Residents said that the routines within the home were flexible commenting, “I can do as I please”. Two relatives commented that the home was “excellent” and that their mother was “well cared for”. The home was very clean, tidy and odour free. All areas seen were very well maintained and pleasantly decorated. There were homely touches of pictures and flowers and it was evident that the manager and staff took pride in providing a homely environment for residents. All areas seen were very clean and a very good standard of cleanliness was observed. All residents spoke positively about their environment and the level of cleanliness commenting: “the home is perfectly clean” and “It’s homely”. Residents spoke positively about the attitude of the staff and the service that they received. Resident meetings took place and residents were regularly surveyed enabling them to comment on how the service could be improved. A good choice of menu was offered and special dietary needs were catered for. In addition to the daily menu fresh fruit was available for residents in the lounges at the home. The home had been awarded a ‘Silver Award’ in recognition of the quality and nutritional content of the food offered. Residents were satisfied with the choice and quality of food commenting “its lovely” and “always plenty”. The lunchtime meal observed was organised and relaxing. DS0000018277.V278707.R01.S.doc Version 5.1 Page 6 Staff commented that a good range of training was available appropriate to their job role. In addition to this the manager conducted monthly training sessions to ensure that the staff were up to date with all the statutory training required by the regulations. Staff morale was good and all staff spoke positively above the management team. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000018277.V278707.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 DS0000018277.V278707.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 and 5 Residents were not admitted to the home without their needs being assessed, to ensure the home was able to meet their health, social and care needs. Prospective residents and their relatives were invited to visit the home to assess the quality, facilities and suitability of the home. EVIDENCE: A full needs assessment was carried out for all residents prior to their admission. Staff from the home also visited prospective residents prior to their admission. This confirmed that the service was appropriate for the resident and provided staff with the information to formulate an individual plan of care. Several residents confirmed that their relatives had been invited to visit the home prior to their admission. DS0000018277.V278707.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 and 10 Care plans were in place for all residents. These were detailed and were reviewed frequently. Nutritional assessments required completing in two of the care plans checked. Resident’s physical and emotional needs were met. There was evidence that a range of healthcare professionals regularly visited the home to meet the resident’s needs. Residents spoke positively about the healthcare that was provided and all said that their healthcare needs were met. Residents received personal support, which promoted their privacy, dignity and independence. A policy and procedure to ensure that staff adhered to the safe administration of medication was in place. DS0000018277.V278707.R01.S.doc Version 5.1 Page 10 EVIDENCE: Care plans were in place for all residents. Two care plans were checked and both set out in detail the action that was required by staff to ensure that all aspects of the residents care needs were met. Nutritional assessments had not been completed. The deputy manager stated that nutritional assessments were included in care plans where an issue with nutrition had been identified. However, these need to be completed to identify that the nutritional needs of the resident have been assessed and that there are no specific needs at this time. The care plans were reviewed on a monthly basis and a weekly review was also carried out ensuring that the changing needs of the residents was reflected in their plan of care. The files checked were tidy, well organised and the information provided was easy to track. Healthcare records were well maintained and demonstrated that residents were receiving regular visits from their general practitioner, chiropodist and dentist. All residents spoke positively about the care that they received and were able to describe in detail the visits that they had received. One commented, “I receive good support”. There was a policy and procedure to ensure that staff adhered to safe practices regarding medication and the protection of residents. The recording and storage of medication was checked on a sample basis. One medication administration record checked did not record the amount of medication that had been received. The residents care record did record that the medication had been prescribed. However, the specific amount of medication received should be recorded to ensure that clear records are maintained. Staff responsible for administering medication received regular training to ensure their competence, promoting the safe administration of medication to residents. Throughout the day staff were observed to treat residents with dignity and respect. One resident who preferred to spend time in their bedroom confirmed that their privacy was respected commenting, “night or day the staff will always knock”. DS0000018277.V278707.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, 13 and 15 The daily routines within the home were flexible to the needs of the residents. Residents were encouraged to spend their day, as they preferred. A programme of activities was in place that was appropriate for the needs of the residents. Residents were able to receive visitors at any reasonable time. A good choice of menu was offered and specific dietary needs were catered for. The lunchtime meal was well organised and relaxed. EVIDENCE: There was a relaxing atmosphere within the home. Residents were observed to be following their preferred routines. The majority of residents were spending time in the lounge areas, socialising with other residents. Three residents said that they preferred to spend the majority of their time in their bedroom and that the staff respected their choice. Residents said that the routines within the home were flexible commenting, “I can do as I please”. DS0000018277.V278707.R01.S.doc Version 5.1 Page 12 A programme of activities was available. The manager said that professional entertainers also visited the home on a regular basis. On the day one relative had brought her two dogs to the home. The relative said that they visited the home on a weekly basis and that the residents always enjoyed their visits. Residents said that their relatives and friends were able to visit the home at any reasonable time. A good choice of menu was offered and special dietary needs were catered for. In addition to the daily menu fresh fruit was available for residents in the lounges at the home. The cook had a good knowledge of resident’s dietary requirements. She confirmed that menus were reviewed on a regular basis with the involvement of residents. The home had been awarded a ‘Silver Award’ in recognition of the quality and nutritional content of the food offered. Residents were satisfied with the choice and quality of food commenting “its lovely” and “always plenty”. The lunchtime meal observed was relaxing. The dining area was pleasant. The tables were set with cloths, cruet, cutlery and teapots and weekly menus were displayed. Residents were given sufficient time to eat their meal. Carers were observed to be assisting residents who required assistance to eat in a respectful and patient manner. DS0000018277.V278707.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): 16 and 18 The complaints procedure was clear and accessible. Complaints made by residents and their relatives were listened to and action was taken to deal with complaints promptly. There was an adult protection procedure in place at the home. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home. EVIDENCE: The complaints procedure ensured that residents and their relatives were aware of how to make a complaint and who would deal with them. The manager kept a central record of all complaints. No complaints had been received since the last inspection. All residents spoke positively about the attitude of the manager and the staff team. They stated that they had “no complaints” yet felt that the staff team were approachable and that they would always listen to any concerns that they may have. There was an adult protection policy and procedure that promoted the protection of service users from harm or abuse. All staff had attended Adult Protection and Protection of Vulnerable Adult (POVA) training, enabling them to identify and the procedure to follow should they suspect any abuse at the home. Residents spoke positively about the care that they received one commented, “I feel safe”.
DS0000018277.V278707.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 and 26 The home was very clean, comfortable and well maintained. Residents were provided with an environment that was safe, accessible and homely. EVIDENCE: The home was very clean, tidy and odour free. All areas seen were very well maintained and pleasantly decorated. There were homely touches of pictures and flowers and it was evident that the manager and staff took pride in providing a homely environment for residents. The manager said that she was provided with a good budget, enabling her to maintain the home to a good standard. She said that since the last inspection a new television had been provided and that ten bedrooms had been redecorated with new curtains and bedding purchased.
DS0000018277.V278707.R01.S.doc Version 5.1 Page 15 Several bedrooms were checked and all were clean and pleasantly decorated. All the rooms had been personalised by the resident. One resident said that she had been able to bring small items of furniture into the home with her and that “it reminds me of home”. All areas seen were very clean and a very good standard of cleanliness was observed. All residents spoke positively about their environment and the level of cleanliness commenting: “the home is perfectly clean” and “it’s homely”. DS0000018277.V278707.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): 29 and 30 Residents spoke positively about the attitude of the staff and the service that they received. Residents said that there was sufficient staff on provided to meet their needs. Some of the staff employed have worked at the home for several years and therefore know the residents well and can offer them a consistent service. Staff had received training to meet the resident’s general and specific needs. Residents were not fully protected by the recruitment policies and procedures. EVIDENCE: All residents spoke highly of the manager and the staff, describing them as “good”, “they will always do what you ask” and “when I call them they will always attend”. A training and induction programme for staff was in place enabling them to meet the assessed and changing needs of residents. Staff confirmed that they had attended various training courses that included food hygiene, adult protection, moving and handling and First aid. Staff commented that a good range of training was available appropriate to their job role. In addition to this the manager conducted monthly training sessions to ensure that the staff were up to date with all the statutory training required by the regulations.
DS0000018277.V278707.R01.S.doc Version 5.1 Page 17 Two staff recruitment files were checked. Residents were not fully protected, as one file did not contain two forms of identification. One file did not contain evidence that the staff member had undertaken a CRB disclosure prior to their employment. DS0000018277.V278707.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): 31,35, 36 and 38 Residents and staff benefited from the ethos, leadership and management approach. Staff morale was good and all staff spoke positively about the management team. Staff received informal supervision, but regular formal supervision was not currently offered. Residents’ financial interests were safeguarded by the procedures at the home. The homes policies and procedures promoted the health, safety and welfare of service users and staff. DS0000018277.V278707.R01.S.doc Version 5.1 Page 19 EVIDENCE: The manager had many years experience within the caring profession that enabled her to contribute to the care of service users and communicate a clear sense of leadership to staff. All staff and residents spoke positively about the manager and it was evident that all were confident in her abilities to manage the home. The home is accredited with the British standard ISO9000, which requires the home to be audited annually by an external systems assessor promoting that the service is managed in the best interests of the residents. Resident meetings were held on a frequent basis to enable them to contribute to the development of the service. Residents spoke positively about the service that they received commenting, “it’s the best of the bunch”, “homely” and “I am looked after very well”. Staff felt that there was good teamwork within the home. All staff spoken to said that they enjoyed working at the home. Several staff spoken to had worked at the home for many years, enabling them to provide a consistent service to residents. Arrangements were in place for residents who were unable to manage their monies due to their mental health. Monies were securely stored and records checked evidenced that service users were able to access their monies for hair care and personal items as they wished. The manager said that the staff received informal supervision and management support on a regular basis. Formal supervision was not taking place for staff to discuss issues relating to their role, work performance and training and development needs. DS0000018277.V278707.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 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 3 X 3 DS0000018277.V278707.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 OP8 Regulation 15 Requirement All residents care plans must include risk assessments relating to nutrition. (Requirement first made 07.09.05) Records of medication in stock at the home must be maintained Staff files must evidence that a satisfactory CRB, POVA check has been carried out prior to employment. Timescale for action 01/04/06 2. 3. OP9 OP29 13 19, Sch 2 01/04/06 21/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP31 OP36 Good Practice Recommendations The registered manager should have a level 4 NVQ qualification in management or equivalent. Staff supervision should include discussions relating to their role, work performance and training and development needs. DS0000018277.V278707.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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