CARE HOMES FOR OLDER PEOPLE
Sandstones 9 Penkett Road Wallasey Wirral CH45 7QF Lead Inspector
Inger Moynihan Unannounced 25 August 2005 9:30 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. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Sandstones Address 9 Penkett Road Wallasey Wirral CH45 7QF 0151 691 1449 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) Anchor Trust Ms Julie Harwood CRH PC 35 Category(ies) of OP - 35 registration, with number of places Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 26 January 2005 Brief Description of the Service: Sandstones is a purpose built property owned by The Anchor Trust. It was registered to accommodate and provide residential care for 35 older people. The home is close to Liscard town centre and New Brighton. A bus terminal in Liscard gives easy access to other parts of the Wirral and Liverpool. Accommodation is provided in single occupancy flat-lets, this being bed-sitting rooms with a fridge and snack making facility. All of the rooms have an ensuite facility comprising of a hand wash basin and toilet. On the ground floor there is an open plan communal area which comprises of a lounge / dining area. There is a smaller sitting off the lounge were service users may sit if they wish privacy. This area is not however, a separate room. There are two toilet facilities on the ground floor provided for people with mobility needs. There are four bathrooms and a shower facility. The home is furnished and decorated to a high standard throughout. There is a garden at the front of the home but not at the back. There are no parking restrictions within the immediate vicinity of the home. Security lighting has been installed around the building. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 3 hours and was the statutory announced inspection for 2005/2006. A partial tour of the premises took place and staff and service users records were inspected. Four staff and five service users were spoken to during the inspection. What the service does well:
Service users health care needs are met with evidence of multi-disciplinary working taking place on a regular basis. Service users said they were treated with respect and their right to privacy is upheld. A range of social activities are provided which creates a lively and interesting environment for the service users to live. The routines within the home are flexible which enables service users to exercise choice and control over their lives. A varied and nutritious diet is provided which ensures service users good health and interest. A complaint procedure is in place to ensure service users views are taken into account with regard to the care they receive. All of the service users spoken to during the inspection said they were very happy with the standard of care they received and had no complaints to make. An adult protection procedure is in place to ensure service users safety and welfare. The standard of decoration throughout the home remains very high and provides a comfortable and pleasant environment for the service users to live. The required staffing levels and skill mix are provided to meet service users assessed needs. Staff are provided with a range of appropriate training to ensure they are suitably qualified and competent to care for vulnerable adults. The staff have a positive attitude towards their work with one member of staff stating the Anchor Trust is a good organisation to work for, I feel well supported in my role. This was supported by another member of staff who praised the organisation on the standard of care they provided to service users. This
Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 6 person also commented we have good staff team and I enjoy my work. This is a very positive aspect of the home and contributes to creating a positive working environment were high standards of care are set and maintained. There are clear lines of management and accountability within the home which is run for service users best interest. Staff spoken to confirmed the registered manager and senior staff were always available for advice and support when necessary. Effective quality assurance systems are in place to ensure the high standards of care provided at Sandstones are maintained. The health, safety and welfare of the service users is well promoted throughout the home. 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. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 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 standard(s) 1, 3 and 4 No progress has been made on the completion of the Statement of Purpose therefore prospective service users may not be given all the information they to make an informed choice about where to live. A detailed assessment of service users care needs has been carried out, although more detailed information needs to be collated to ensure it accurately reflects service users full care needs. EVIDENCE: The statement of purpose does not address all of the necessary issues as outlined in the Care Homes Regulation 2001, Schedule 1. This issue has been ongoing for the last three inspections and to date has not been completed. The registered person is required to address this issue as a matter of priority to ensure service users are given all the information they need to make an informed choice about where to live. An assessment of service users care needs has taken place. Service users are fully involved in the assessment process which ensures the package of care provided meets their individual care needs. The registered person must
Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 9 include the service users history of falls and mental health within this assessment process. Through discussion with the registered manager and a tour of the building, the inspector established that service users’ care needs were met by way of the following: • • • • • The provision of the necessary equipment and facilities to assist service users with their mobility such as a passenger lift, hand rails, specialist baths. staff training in relation to health and safety. the provision of a range of social activities including monthly social events, scrabble, quizzes and bingo. access to the necessary health care professionals such as GP, District Nurse, Chiropodist etc. a vicar and priest visit the home on a regular basis to administer communion and conduct a service. All of these issues contribute to ensuring service users are cared for in accordance with good practice and their individual care needs. Sandstones F52_F02_s18936_Sandstones_v245092_260805_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 More detailed information needs to be included in the care planning process to ensure service users care needs are fully met. It was not entirely possible to establish whether service users health care needs were being met. Improvements need to be made to the medication administration procedures to ensure service users good health and safety. Service users said they were treated with respect and their right to privacy is upheld. EVIDENCE: A document plan of care, by way of a lifestyle agreement, has been compiled for each service user. The care plans cover a range of issues relating to service users care needs and offer staff guidance on how to look after the service users in accordance with these identified needs. The care plans in place did need to record more detailed information and needed to be reviewed more often to ensure they accurately reflected service users current care needs. Service users have access to a range of health care professionals to ensure their physical and mental health needs are met. However the daily diary
Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 11 sheets that monitor service users welfare on an ongoing basis, did not always hold detailed information of the reasons behind any health care appointments. To ensure service users welfare, the registered person is required to address this matter. Staff monitor service users welfare on the daily basis with effective communication systems being in place to support this monitoring. Improvements need to be made to the medication administration procedures within the home and a system of auditing all medication coming into the building and that being returned to supplying pharmacist must be implemented. In light of this, arrangements will be made for the CSCI pharmacist inspector to visit the home in order to discuss the issues in more detail and give advice on how to improve the systems in place. Observations made during the inspection indicated that service users are treated with respect and dignity. This was evidenced by staff knocking on service users bedroom door before entering and the manner in which service users were spoken about. Service users spoken to during the inspection spoke highly of the staff team and said they always respected their right to privacy particularly when carrying out personal care. A number of service users had a telephone in their own room and a public phone is also available. Sandstones F52_F02_s18936_Sandstones_v245092_260805_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, 14 and 15 A range of social activities are provided and contribute to creating a lively and interesting environment for the service users to live. The routines within the home are flexible which enables service users to exercise choice and control over their lives. A varied and nutritious diet is provided which ensures service users good health and interest. EVIDENCE: The service users spoken to confirmed that a range of social activities are provided which they may participate in if they wish. A number of service users confirmed the activities were appropriate and enjoyable. They confirmed a service user meeting takes place on a regular basis when they are consulted on what activities should be provided. The service user spoken to during the inspection confirmed the routines within the home are flexible and they could go about their day as they wished. This is a positive aspect of the home which ensures service users can exercise choice and independence. During discussion they confirmed their friends and relatives could visit the home at any time. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 13 Mealtimes are flexible and service users dietary requirements are met. A varied and balanced diet is provided to ensure service users interest and good health. Service users medical needs are catered for in the menu planning. Most of the service users spoken to commented on a high standard of food provided and said they always had enough to eat and drink. One service user commented the food is lovely and I am always given an alternative if I do not like what is offered that day. One service user was not happy with the way in which her meals were being prepared and offered; the registered manager addressed this issue immediately during the inspection. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 14 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 A complaint procedure is in place to ensure service users views are taken into account with regard to the care they receive. An adult protection procedure is in place to ensure service users safety and welfare. EVIDENCE: The home’s complaint procedure is displayed. Service users spoken to were aware of who they should contact in the event of them wishing to make a complaint about the care provided. A notice board in the hallway displayed a lot of information on the different agencies service users could contact in the event of them wishing to make a complaint or express concerns about the standard of care they receive. The home should be commended on the approach they take with regard to the issue of protection. All of the service users spoken to during the inspection said they were very happy with the standard of care they received and had no complaints to make. Staff have been provided with training in relation to the protection of service users from abuse by way of work books provided by the Anchor Trust; this issue is also discussed during staff meetings. The registered manager has made plans for all staff to update their training in this area. Information relating to the protection of vulnerable adults from abuse is in place although a copy of the Wirral Adult Protection Procedures was not available. The registered person is required to ensure that a copy of these procedures is available at all times. This will ensure staff have the appropriate support and guidance on the action that must be taken in the event of an incident of abuse.
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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 and 26 The standard of decoration throughout the home remains very high and provides a comfortable and pleasant environment for the service users to live. EVIDENCE: Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 16 The standard of the décor throughout the home remains very high and a planned programme of maintenance is in place. The home has an open plan lounge and dining room. The design of this area, even though it is open plan continues to have clearly defined areas. The outdoor space is easily accessible by wheelchair users. There are sufficient bathing facilities for the number of service users living at the home. All bedrooms have en-suite facilities, which comprise of a wash hand basin and toilet. Each of the rooms is supplied with a small refrigerator and drink making facilities. All of the bedrooms inspected were clean and comfortably furnished and service users had personalised their rooms with their own belongings. Equipment and facilities are provided to assist service users with their mobility and to ensure their safety within the home. On the day of the inspection the home was clean, tidy and comfortably warm. The domestic staff are clearly working very hard to ensure a comfortable environment is provided to the service users. Policies and procedures for the prevention of cross infection are available for staff to refer to. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 17 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 and 30 The required staffing levels and skill mix are provided to meet service users assessed needs. Staff are provided with a range of appropriate training to ensure they are suitably qualified and competent to care for vulnerable adults. EVIDENCE: The staff rota indicated staff are evenly deployed across the week and that the required staffing levels, as agreed by the Registering Authority are provided. The staff spoken to confirmed they had completed a range of training relating to the care of older people and stated the organisation always encourages them to become involved in any training relevant to the care of older people. This is a positive aspect of the home and ensures the service users are being cared for in accordance with their particular needs and in line with current good practice. The staff have a positive attitude towards their work with one member of staff stating the Anchor Trust is a good organisation to work for, I feel well supported in my role. This was supported by another member of staff who praised the organisation on the standard of care they provided to service users and the way in which the staff were supported. This person also commented we have good staff team and I enjoy my work. This is a very positive aspect of the home and contributes to creating a positive working environment were high standards of care are set and maintained.
Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 18 The staff group is stable. Again this is a positive aspect of the home as this provides consistency in the care provided and enables positive working relationships to develop. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 19 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, 33 and 38 There are clear lines of management and accountability within the home which is run for service users best interest. Effective quality assurance systems are in place to ensure the high standards of care provided at Sandstones are maintained. The health, safety and welfare of the service users is well promoted throughout the home. EVIDENCE: The registered manager demonstrated she was aware of her responsibilities with regard to the management of the home, supervision of staff and the care of service users. Through discussion she demonstrated her commitment to supporting the staff within their role and demonstrated an open and positive style of management. Staff spoken to confirmed the registered manager and senior staff were always available for advice and support when necessary.
Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 20 Effective quality assurance systems are in place to ensure high standards of care are set and maintained. Safe working practices are promoted throughout the home and staff have completed appropriate training to ensure service user safety. Regular fire safety checks are carried out on all equipment and staff have been provided with regular fire safety training. The temperature of the water was tested in several places around the building and was within the recommended safe limits. The home is subject to its own health and safety inspection from within the organisation and all accidents are monitored. To further promote service users health and safety, the registered person is advised to keep up to date with the information provided on the Health and Safety Executive and Medical Devices Agency websites. Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 21 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 2 x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 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 x 3 x x x x 3 Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 22 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 1 Regulation 4 Requirement The registered person is required to ensure the statement of purpose includes all of the information as outlined in the Care Homes Regulation 2001. The registered person is required to ensure a detailed assessment of service users’ care needs is carried out when service users are first admitted into the unit. The registered person is required to review and change the medication adminstration procedures. The registered person is required to ensure more detailed information is recorded in service users care plans and that this information is reviewed more often. The registered person is required to ensure all parts of service users care plans are up to date. In this instance that the daily diary sheets accuratly reflect all aspects of service users ongoing care needs and any contact with health care professionals. The registered person is required to esure all staff are aware of the Wirral Adult Protection Timescale for action 1/12/05 2. 3 14 1/12/05 3. 9 17 1/12/05 4. 7 15 1/12/05 5. 8 15 1/12/05 6. 18 13 1/12/05 Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 23 Procedures. 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. Refer to Standard Good Practice Recommendations Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 24 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Sandstones F52_F02_s18936_Sandstones_v245092_260805_Stage_4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
