CARE HOMES FOR OLDER PEOPLE
Salvete 15/17 Rothsay Place Bedford Beds MK40 3PX Lead Inspector
Andrea James Announced 9 June 2005
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. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Salvete Address 15/17 Rothsay Place, Bedford, Mk40 3PX 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) 01234 261991 01234 405600 Mr Tushar Bhatt Mrs Beverley Catlett Care Home 27 Category(ies) of OP Old Age - 27 registration, with number PE(E) Physical Disability over 65 - 27 of places DE(E) Dementia over 65 - 27 Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Mental Disorder, excluding learning disability or dementia - over 65 years of age (27), Old age, not falling within any other category (27), Physical disability over 65 years of age (27) Date of last inspection 2.12.04 Brief Description of the Service: Salvete Residential Care Home is registered to provide residential services for 27 older people who may have physical disabilities and/or dementia. The home has been created from the combination of two, two-storey high houses with an internal link corridor through a garage. The garage is used for the home’s office as well as a drug cupboard. The home is situated on a quiet culde-sac road. The main road leads to the river. There is also ready access to local shops and the town centre. The building includes a large communal lounge with a new conservatory. The home has all the necessary facilities and staffed to operate well. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place over a 6 hour period. The registered manager was present for the duration of the inspection. The inspection was carried out 6 months after the last unannounced inspection. The inspection followed a case tracking methodology where a sample of the service users files were viewed and those service users spoken to at length. The report also reflects the views of other service users, current staff on duty, visitors to the home, the pre- inspection questionnaire and the views of the manager and external professionals. The home had 21 service users including 1 service user who was on respite care. The care staff consisted of 23 care staff and 11 ancillary staff. A partial tour of the premises took place to ensure outstanding requirements from the last inspection were met. What the service does well:
The home provided a satisfactory standard of care that all the service users spoke positively about. There were 7 service users who were very able and were encouraged to access the community resources unsupported by staff on a daily basis. One service user spoken to said the staff were “ incredible” others spoken to said “it felt like home”, “ It’s lovely” and they felt the staff do their best. It was evident through observation that the service users were happy. Service users were seen laughing with each other. The inspector observed service users leaving the home to purchase their personal belongings and others informing staff that they were going to the local pub. Some service users who were not as able to leave the home independently, were escorted by the care staff. The inspector observed staff escorting service users to have walks to the town centre during the inspection. The home also provided a wide range of activities, a list of which was displayed in various areas in the home. The service users spoke of the activities they had and on the different artists that were allowed to come to the home to entertain Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 6 them. They were also looking forward to their summer trip to Yarmouth in a few weeks. The home was also due to celebrate their 50th anniversary as a care home and the service users were encouraged to participate in the preparation of this event. The meals provided for the service users were of a good standard and the service users spoke of the different meals they were offered. The catering staff were also seen asking service users if they enjoyed their meals. The service users said they received choices and all their dietary needs were met. One service user had recently introduced his own choice of meals that he purchased while out in the community and the cook also prepared this meal. The quality assurance system displayed on the wall suggested 99 of the service users and staff were happy with the care. 100 were happy with the management of the home, 99 were happy with the environment, 100 happy with the meals provided and 98 were happy with the daily activities provided. What has improved since the last inspection? What they could do better:
The home should ensure that that service users are encouraged to maintain their independence where possible. One example of this was one service user Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 7 felt that he could self- medicate and would prefer to manage his own medication. The care staff should consult with the service users when writing their care plans to ensure compliance where possible. All areas of need identified in the care plans where staff needed to intervene in the care should be recorded in the care plans. The care plans should record service users weight especially when this is of particular need to the service users. External professionals should be involved when necessary in the health care needs of the service users for example referrals should be made to dieticians when the service users dietary needs results in rapid weight gain or weight loss. The care staff should be trained in abuse awareness to ensure they understand the Protection of Vulnerable Adults policies and procedures. The inspector would like to thank the service users, staff and manager for their co-operation in the inspection process. They were very welcoming and a pleasure to inspect. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 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 Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 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) 1,2,3,4 and 5 The service users were well informed about the service the home provides, and the needs of the service users were identified before admission. The home ensured the service users were able to make an informed choice about the services available. EVIDENCE: The service users spoken to said they received a service user’s guide upon arrival in the home and were informed verbally about the care the home provided. They also said they were able to make any request about the care they would like. One service user said she was allowed to have her own hairdresser and chiropodist. Relatives spoke positively about how the home was able to meet the needs of their relative. They felt that the staff really cared and on all visits to the home the service users had planned activities and events to look forward to. The relatives said they were always made to fell welcome. The care plans showed that the service users health care needs were also addressed on a regular basis.
Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 10 Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 11 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 and10 The service users health care needs were identified satisfactorily in the care plans and the care staff were meeting the identified needs of the service users. EVIDENCE: The home had made significant improvements to the care plans. The plans inspected had an assessment of need and the needs were identified in the care plans. There was a need for further improvements to include consultation with the service users, the recording of weights and some identified needs seen in assessment were not recorded in the care plans. This was recommended as the staff had to intervene in those aspects of the service users care. The home had visits from district nurses to meet the healthcare needs of the service users. The district nurse commented that one service user was being transferred without a handling belt but the staff explained that this was causing the service user extreme pain and it was felt that it was not necessary. The safety aspect of the handling belt was explained and the staff agreed to use the equipment in accordance to the manual handling procedures. The homes medication procedures were in place and the stocks and administration was satisfactory. One service user said he would prefer to selfmedicate.
Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 12 Service users said they were treated with respect and dignity. On observation the care staff were seen ensuring service users dignity was not compromised when performing personal care. Staff spoke courteously and attentively to the service users. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 13 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) 12,13,14 and 15 The activities the service users received was of a high standard. The home ensured all service users received daily activities to meet with their needs and wishes. EVIDENCE: The home ensured the service users lifestyles met with their expectations. Several service users were able to access the community on a daily basis and encouraged to have close contact with their family members. Service users were able to visit the local pub and market places. One service user said the care staff allowed him to maintain his independence and it was better than living at home because he had everything done for him. The relatives were encouraged to take part in the in- house activities and those spoken to said they felt the home offered a good level of stimulation to the service users. There were several pictures displayed on the wall with service users enjoying various activities both in-house and externally. The home offered a wide variety of meals and the service users were able to choose the meal they wanted. One service user was able to make changes to the menu to incorporate other foods that were not common in the home. The
Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 14 meals provided on the day of the inspection tasted nutritious and were attractively presented. The service users appeared to have enjoyed their meals. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 15 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 18 The home had satisfactory complaints procedures in place that would ensure if service users complained they would have a satisfactory outcome. The care staff’s understanding of the Protection of Vulnerable Adults policy and procedure was poor and as a result service users safety could be compromised. EVIDENCE: The home had no complaints since the last inspection but the correct procedures were in place to ensure all complaints would be dealt with in a satisfactory manner. The home had an abuse policy but the care staff were not trained in how to identify and report such incidences using the correct procedures. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 16 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) 19,20,22,24,25 and 26 The home provided a safe and comfortable environment that meets the needs of the service users. Further improvements were also being made to make more space for the service users. EVIDENCE: The environmental standards of the home met with the requirements of the standard. This ensured that the service users were safe and comfortable. The proprietor of the home had recently built additional rooms to ensure more space was provided for the service users. The service users had individual rooms that were decorated to meet the needs of individual service users. The home had sufficient lifting equipment to meet the needs of the service users and bathrooms and toilets were equipped in accordance with the requirements of the national minimum standards.
Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 17 The home was clean and no offensive odours were identified. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 18 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 home provided sufficient staff that had the experience and training to meet the needs of the service users. The recruitment procedures also ensure the protection of the service users. EVIDENCE: The home had 23 care staff and 11 ancillary staff that had been in the home for more than 2 years. The staff appeared dedicated to meeting the needs of the service users. Those spoken to said the atmosphere in the home generated a good working environment and everyone was friendly. The home had a mixture of care team leaders, senior carers, care staff and ancillary staff. The home had satisfactory recruitment procedures. The files inspected met with the requirements of the national minimum standard. The staff said they had untaken a variety of training that had equipped them in meting the needs of the service users. These included moving and handling, care of medicines and Infection control. There was a need for more staff to undertake their NVQ level 2 in care as only a small number of staff had achieved this qualification. There was also a need for further training in understanding other areas of need relating to the elderly, including dementia, strokes, pressure care and dietary needs. The preSalvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 19 inspection questionnaire highlighted the training undertaken for 2004-2005 and those to be undertaken in the future. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 20 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 The home appeared to be satisfactorily managed . EVIDENCE: The service users, relatives and staff spoken to said they felt the home was satisfactorily managed. Staff said the manager created a good sense of leadership and she was firm but fair. Visitors said the manager was approachable and always willing to listen. The inspector observed that the manager was approached several times during the day by the care staff and service users. The staff said they received regular supervisions ad staff meetings. The home’s policies and procedures were updated and changes made where necessary.
Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 21 The home had a health and safety policy and the procedures were satisfactorily maintained. The inspector viewed the fire log book which had all relevant entries. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 3 3 Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 23 No 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 op8 Regulation 12 (1) ( a) Requirement Arrangements must be made for referals to be made to the dieticians in order to maintain the service users health care needs. All staff must have adequate training in order to meet the needs of the service users. Timescale for action 30.07.05 2. op30 18 (1) (i) 30.08.05 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 op2 op7 op9 op18 Good Practice Recommendations All contracts should be signed by both the home and the service users. All needs identified in the assessment tool where care intervention is required should also be identified in the care plan documentations. Arrangements should be made to ensure those service users wishing to self-medicate should be allowed to do so. All staff should be trained in understanding the procedures to follow if an abuse occurs. Salvete I51 S14962 Salvete V213089 090605 Stage4.doc Version 1.20 Page 24 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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