CARE HOMES FOR OLDER PEOPLE
Rushley House 327 Lancaster Road Morecambe Lancashire LA4 6RH Lead Inspector
Joy Howson-Booth Unannounced 26 May 2005 10:00am
th 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. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Rushley House Address 327 Lancaster Road, Morecambe, Lancashire, LA4 6RH 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) 01524 417405 01524 406253 Thackray Care Services Ltd Mrs Fay Lucille Thackray CRH Care Home 13 Category(ies) of OP Old Age 13 registration, with number of places Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered manager must achieve the Registered Managers Award by 2005 - This has now been obtained. 2. Radiator covers must be installed on all radiators in the home by 31st March 2005 3. The home is registered for a maximum of 13 service users in the category OP (Older Persons) Date of last inspection 8th February 2005 Brief Description of the Service: Rushley House is a small home situated in a residential area of Morecambe, accessible to local shops and amenities. The home is a large detached house built over two floors. The home is set within its own very plesant grounds which residents can access. There is one main lounge, a dining room and the hallway provides a pleasant and roomy thoroughfare. There is also a separate conservatory. All the rooms are single and six have ensuite facilities. There are toilets and bathrooms on both floors and a range of aids, including a stairlift and bath hoist. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over two days by two inspectors from the Commission who inspected against the National Minimum Standards. There were 13 residents in the home, and, as well as speaking with a number of these residents, two staff on duty and the owner/manager were also spoken with. Three care files were examined, along with other documentation including medication administration records and healthcare records. Staff records were also examined. All the residents spoken with said that they liked living at the home and felt well cared for, with the staff treating them well and providing care with privacy and respect. Individual comments made by residents included “we’re spoilt to death” and “the staff are gems”. From discussions with the members of staff on duty it was found that they feel supported and the home is well managed. The inspection lasted for approximately 7 hours. What the service does well:
Rushley House is a pleasant and homely environment which has a relaxed and friendly atmosphere. The owner/manager works at the home on a daily basis which gives an opportunity to talk with the residents and pick up immediately on any concerns or issues. A number of staff have worked at the home sometime and know the residents well. The home has achieved the Investors in People Award. Residents are able to maintain their own lifestyles and daily routines and staff support is provided, when needed. From discussions with the residents and staff on duty the owner/manager is proactive in ensuring the home is maintained to a high standard and is approachable for any ideas and suggestions. One comment card was received from a relative which confirmed that they are welcomed to the home at any time, can visit their relative in private, they are
Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 6 kept informed of important matters and are satisfied with the overall care provided. What has improved since the last inspection? What they could do better:
The care plans are due to be fully reviewed and completed in the next few weeks which will mean all staff will have a full picture of each residents needs, likes, dislikes and lifestyles. Once completed, these will need to be updated on a monthly basis.
Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 7 Whilst much improved, some attention is still required to the medication system within the home to make sure residents medicines are handled safely. Although the owner/manager is at the home on a daily basis, there needs to be a record of any complaints/comments received and the action taken to address these so that it can be confirmed that the residents are listened to and concerns dealt with. The arrangements for asking people about the service at Rushley House needs to be looked into so that the people who live at the home and people like Doctors, District Nurses and relatives can be asked for their comments. Residents said that the home does not provide any outings which is something that should be developed. The two radiator covers need to be put in place as soon as possible. Training for staff has been noted as being an area for development, including refresher training in the home’s fire procedure and any training which will help staff do their day to day care work better. As part of their care role staff are given advice and guidance from the owner/manager on a daily basis. Staff need to be given the opportunity to sit down and discuss their care role and training needs in a more planned way. As staff have not had the opportunity to go onto training courses in the past, the training should go ahead as planned by the new owner/manager. 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. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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) 1, 3, 4 and 5 There are good arrangements in place which mean that prospective residents can visit the home and are provided with information. The needs of the residents and information about their individual lifestyles is obtained before they come into the home so that the home is clear that these needs can be met. EVIDENCE: The home has a comprehensive assessment form which is used alongside any other professional assessment provided. From speaking with a visiting relative it was confirmed that they had been provided with the Statement of Purpose, Service User guide and the complaints procedure for the home. It was also confirmed that they had visited the home and were aware that a trial period was available. Another resident also confirmed they had visited the home prior to making a decision to move in. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 The reviewed care plans seen provide a clear and detailed plan to enable staff to fully meet residents individual needs. The healthcare needs of residents are well met with evidence of appropriate interventions on a regular basis. The systems of administration of medication are generally good which means residents medication needs are being met, although some improvements have been recommended by the Pharmacist Inspector. EVIDENCE: Care plans are currently being reviewed to ensure they provide much more detail on their own lifestyles, preferences, routines, likes and dislikes which will then enable the home to tailor the care in an individual way and, from the completed care plans seen, these are now much more improved and comprehensive. Through discussion with residents and from examining records held by the home it was clear that the home is proactive in ensuring residents healthcare needs are met. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 11 The Pharmacist Inspector visited the home and provided advice and guidance over current good practices regarding medication. A separate detailed letter has been forwarded regarding this. All the residents spoken with felt that the staff treat them with dignity and respect and their privacy is maintained at all times. One residents said “we’re spoilt to death” and another said “the staff are gems”. A comment card received from a relative confirmed that they are kept informed of important matters affecting their relative and they are consulted about the care the home provides to their relative. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 14 Residents benefit from maintaining their own lifestyles, family and community contacts. The range of activities provided is currently being developed and residents will benefit from this as these will be based on individual needs and wishes. EVIDENCE: Residents at the home are mainly independent enough to be able to follow their own lifestyles and routines, with some support from staff. A number of residents access the local community independently. Various activities take place in the home, including Tai Chi, Chinese Hand Massage, Hairdresser and a range of games. Residents spoken with felt happy with the range of activities provided, and spoke positively of the newly introduced Tai Chi. Planned social outings are not currently held although the manager will take the opportunity to use hospital appointments to add on a social element. A relative spoken with, along with residents, confirmed that they are able to visit the home freely.
Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 standard(s) 16 and 17 Residents know who to complaint to and are confident they will be listened to. Residents rights are upheld as the home enables them to take part in the voting process EVIDENCE: The home has a formal complaints procedure and receipt of this was confirmed by a visiting relative. Residents spoken with confirmed that they would speak with the owner/manager if they had any worries or concerns and issues that have been raised have been dealt with satisfactorily. The pre-admission assessment and care plans both indicate the preferred form for voting for the resident concerned. Residents have previously confirmed that they are enabled to vote, either in person or by postal voting. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 standard(s) 19. 20. 21, 22, 23, 24, 25 and 26 The standard of the décor within this home is very good indeed with evidence of improvements through maintenance and future planning. The home presents a homely, comfortable and pleasant environment for the residents who live there. EVIDENCE: Each resident has their own bedroom which is well decorated and furnished to a good standard. Residents are able to bring in personal and treasured items to make their rooms homely and familiar. There is an ongoing redecoration programme in place, with the new owner/manager prioritising areas for redecoration and re-carpeting. All the rooms in the home are well maintained and provide a pleasant and comfortable environment for the residents to use. There is a separate conservatory, which the residents said they enjoyed using.
Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 15 The grounds are well maintained and pleasant to sit in and residents said that now that the warmer weather is here they are looking forward to sitting out again, watching the world go by. The toilet and bathroom facilities remain as agreed by the registration authority. There are a range of aids within the home, including a stairlift, handrails, bath hoist. Two radiators remain without radiator covers, although these are on order. The home has no offensive odours. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 and 30 The level and calibre of staff is very good. Residents are cared for by a dedicated team of staff which means that residents needs are well met. Recruitment practices are good which means residents are protected. EVIDENCE: Staffing levels have been increased during the morning to meet the needs of the residents in a dignified and individual manner. Staffing for the remainder of the day is above the minimum standard required, although the care staff do undertake some domestic duties. Residents spoken with were very positive about the care provided by the staff at the home. One resident said “the staff are gems”. A comment card received from a relative confirmed that they felt there are always sufficient staff on duty.l The home’s recruitment procedures have improved, the staff files examined demonstrated that all the required checks are being made prior to the start of employment. Staff training is currently being developed by the owner/manager and the staff spoken with appeared positive about being provided with training. It was advised that individual training record be maintained and an overall training matrix put in place. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 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) 31, 32, 33, 36 and 38 Residents live in a well managed and safe home. Health and safety arrangements are generally good, although training for staff needs to be updated to ensure both staff and residents are not at risk. The home has introduced a formal quality assurance system but this is not fully implemented which means only limited feedback is obtained over the services provided. EVIDENCE: The home is managed by an owner/manager who is both a qualified Registered General Nurse and has achieved the National Vocational Qualification Level IV, the Registered Managers Award, the Intermediate Certificate in Health and Safety, Infection Control and Safe Handling of Medicines. Staff and residents confirmed that they felt the owner/manager was very approachable and would act on ideas and suggestions.
Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 18 The home has a formal external quality assurance system in place (ISO 2000), but this system needs to be utilised fully to be effective. At present, no surveys take place, which are recommended and should include relatives, visitors to the home and external professionals. However, the owner/manager is planning to hold both regular staff meetings and residents meetings. The owner/manager was also advised that a complaints/comments book should be implemented so that residents comments can be recorded, along with any action taken to address the issue raised. Although regular hands-on supervision is provided, there is no formal staff supervision system in place and this is something that needs to be developed. The health and safety of residents and staff is maintained and confirmation received that regular servicing of equipment takes place. There are radiator covers on all but two radiators in the home and all water outlets have thermostatically controlled valves fitted. Update fire drill training must also take place for all staff. Mandatory training and any update mandatory training must also take place for staff, as required. Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 x 3 3 2 x x 2 x 2 Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 20 yes 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 OP7 Regulation 15(1) Requirement Residents care plans to be reviewed and updated to provide clear guidance over needs and how these are to be met (Previous timescale of 30.4.05 not met) Requirements and recommendations made by the Pharmacist Inspector must be addressed within the timescale provided A complaints book must be implemented and record complaints or comments, along with actions taken to address these The two remaining radiator covers to be installed Update mandatory training to be organised for staff, including fire procedure training for the home Formal supervision to be put in place for all staff (Previous timescale of 30.4.05 not met) Quality assurance procedures must be implemented, these should include regular staff meetings, residents meetings, and contact with outside professionals/relatives Timescale for action 30.6.05 2. OP9 13(2) 14.7.05 3. OP33 17 (Schedule 4(11) 13(4)(a) 18(1)(a) 18(2) 30.6.05 4. 5. 6. OP25 OP30 OP36 30.6.05 30.6.05 30.6.05 7. OP33 24(1) 30.6.05 Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 21 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. Refer to Standard OP12 OP28 OP10 Good Practice Recommendations Outings should be organised for residents The National Vocation Training should be continued so that the home meets with the 50 of staff trained The Residents Access to Files policy should be included Statement of Purpose and Service User Guide Rushley House F57 F09 S62629 Rushley House V225296 260505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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