CARE HOMES FOR OLDER PEOPLE
Santralla 8 The Crescent Scarborough North Yorkshire YO11 2PW Lead Inspector
Karen Ritson Key Unannounced Inspection 10:00 13 and 20th June 2006
th 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 Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Santralla Address 8 The Crescent Scarborough North Yorkshire YO11 2PW 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) 01274 487207 Pennine Care Services Ltd. Mrs Linda Jane Lunn Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd December 2005 Brief Description of the Service: The service is registered to care for up to twenty- two service users of either sex who are over the age of 65. It is situated in a large terraced house set in The Crescent in Scarborough and is conveniently placed for the main town shopping area, local and national transport including the mainline railway station and is a short walk from the ‘cliff lift’ service to the sea front. The home has steps to the front of the building where a ramp has been installed. There is a garden area where residents can sit out in the warmer weather. The home has a passenger lift to some levels and a stair lift, however some areas may only be accessed by stairs. The provider has produced a statement of purpose, which gives information about the home and the services offered. The standard weekly charge for new admissions is £390. The manager is developing a newsletter, which will also provide information about planned events and other information about the home. The current inspection report is available on request at the office. Additional charges are made for chiropody, hairdressing and dry cleaning. The home runs a tuck shop where toiletries and sweets may be purchased. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection for this service took 16 hours. This includes time spent gathering information and examining documentation before and after two site visits and in writing the report. The first site visit took place on 13th June between 10:00am and 2:30pm. A tour of the premises was made and health and safety documentation was examined. Medication records and supplies were examined also. At this point the inspection was halted and an immediate requirement notice issued regarding the handling of medication. A further site visit took place on 20th June where four service users and all staff on duty were spoken to. Four service users were case tracked and their files with all related documentation were examined. Policies and procedures relating to the key standards were looked at and all key standards were assessed at this inspection. Written feedback was gained from Social Services Care Managers and relatives of the service users. The manager was present throughout the site visits and the registered provider visited the home and spoke to the inspector on both days. The manager has recently been registered with CSCI. What the service does well: What has improved since the last inspection?
Following the site visit on 13/06/06 the home has improved the way in which medication is recorded and administered in order to safeguard service users health. The fire authority has attended the home since the last inspection and made a requirement for the fire alarm system to be replaced, this was done in January of this year. A manager has been registered in respect of the home since the last inspection. The manager has begun to improve the use of Pennine Care documentation, particularly with regard to assessment and care planning. The home has improved the way in which substances hazardous to health are stored in order to safeguard service users. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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 Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive an assessment of care so that their care needs may be met. EVIDENCE: An assessment of care is completed prior to or on admission. This covers all main areas of care. It also gives details of family relationships, interests, hobbies, likes, dislikes, food preferences and any religious or other beliefs which the service user would wish to continue observing. The manager said she was in the process of improving the risk assessments and needs assessments to include more detail. Staff said that finding out about the lives service users had lived before they came to the home allowed them insight into the way they may wish to be treated now and gave them things to talk about together. A service user said. ‘They know all about me.’’ Staff and service users interaction was observed throughout the day, and it was clear that service users needs were understood. However, staff were often too busy to chat to service users. One service user said. ‘They do their best, but they don’t have the time.’ The home does not offer intermediate care.
Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Documentation and practice on the whole ensure that service users health care needs are met, however there are issues regarding privacy and dignity. Medication handling must be monitored in order to maintain regulatory compliance. EVIDENCE: A care plan is written for each service user. Since her appointment the manager has been rewriting care plans to include all required areas of care Health care professionals are consulted where necessary and guidance is included in the plan. A service user said: ‘ They know that I need help with my bath.’ Another said. ‘I can dress myself but if I felt a bit ‘off it’, they would help, I’d only have to ask.’ The manager plans to develop a reviewing process for care plans soon. All health care consultations are carried out in private, and observations on the day of inspection showed that staff spoke to service users with regard to their dignity.
Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 10 A toilet door on the first floor next to room 16 regularly comes off its runner making it impossible for a service user to close, which compromises privacy. This door must be attended to. The manager has suggested a folding half door which would be easier to handle. On the first site visit medication was not being signed in, medications which did not come in Nomad systems were kept in such a way that it was impossible to ascertain current stock numbers of tablets. It was further discovered that medication was not being signed for at the point of administration but some time later, and there were a small number of instances where medication had not been signed for at all. This necessitated an immediate requirement notice and the inspection was halted until this situation had been remedied. On the second site visit, medication had been signed in, running totals of bottled and packets of medication were being kept and medication was being signed at the time of administration. All staff were interviewed and stated they were now aware of the requirements regarding the handling of medication and would follow procedure in future. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of service users daily lives is not enhanced through appropriate activities, tailored to individual needs, and meals, though satisfactory, do not have universal appeal. EVIDENCE: The manager said she was developing an activities action plan for each service user, using key workers and senior care assistants. Some activities take place at present but these are restricted due to the home being short staffed. The home receives a regular visit from a visiting music person. Some of the service users go out unaided and organise their own time. One service user said. ‘We do go out across to the park but it isn’t very often and then they can’t stay long with us.’ Another said ‘I would love to go out but they’re all so busy.’ Staff agreed that they did not have sufficient time to fully consult with service users about what they may like to do, nor did they have time to spend time with service users other than to tend to physical care needs. One service user said. ‘They do stop and have a chat when they can and they’re all nice.’
Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 12 Visitors are welcome at any reasonable time up until 10pm and all must sign in and out of the home. Service users said that they now had more choice of menu, however, all four service users spoken to said the meals could be better. One service user said: ‘It’s alright, I like most things they give us.’ Another said: ‘If I’d ordered this in a café I’d have sent it back.’ All were aware they could chose something different if they did not like a particular meal. The chef cooks lunch and then returns to offer a cooked tea. Menus were seen and these offered varied meals. However, choices of alternative meals were limited. The chef was spoken to and her documentation examined. All records were up to date and temperatures of fridges, freezers and cooked foods were acceptable. There had been no recent environmental health visit. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has robust complaints and abuse policies and procedures. Service users are listened to and any concerns are acted upon. EVIDENCE: The home has received no official complaints since the last inspection. One commendation has been received from a care manager regarding the care of a service user. One service users said: ‘We can always say if there is a problem and they do something about it.’ The home holds service users meetings and minutes are kept. This showed that service users so voice their wishes and any other issues. The manager is developing the way in which information is captured form these meetings in order to include items in the newsletter. The manager has had thorough training in abuse awareness and all staff have received in house training on this subject. Staff said they understood the forms which abuse may take and knew to report any concerns through the whistle blowing and adult protection procedures if necessary. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in pleasant surroundings and in the main are kept safe, however some service users are at risk from access to the laundry room. EVIDENCE: The fire authority has visited the home in order to assess fire safety and offer advice regarding fire risk assessing. A new fire alarm system was required as a result of this visit and this was fitted in January of this year. Fire exits are through service user bedrooms on the first floor, however, the fire authority has not made any requirement with regard to this and the exits are accessible. Whilst not ideal, the lay out of the building allows for little remedy to this. The environmental health authority has not visited since the last time this standard was inspected. The smoking room has an oil filled radiator, which is unguarded. Although not used at present this radiator must be made safe or removed, and an alternative method of heating provided. The home has been extensively refurbished since Pennine care acquired the home.
Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 15 New carpets and furniture have been provided and service user rooms have been re papered or painted when they have become vacant. Service users said they liked the way the home looked. The laundry room is accessible through the smoking room. This is a potential hazard to service users. The laundry room must be made inaccessible to service users from the main home. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs are not fully met by staff who are not employed in sufficient numbers. Staff are well recruited and adequately trained. EVIDENCE: Although all shifts are covered adequately, the home does not have sufficient staff to cover shifts comfortably. Staff, including the manager, are working too many hours per week and all staff interviewed said that they felt over worked but were working extra to help out. Service users said they were aware staff were working too many hours and that this showed in the time they had to spend chatting or engaged in leisure activities. The home has advertised for new staff and interviews have taken place. When new staff are recruited the situation should ease. 50 of staff have NVQ 2 in care or higher. Staff receive adequate training, and the manager said she was planning to develop the training programme, alongside Pennine care guidelines to improve it further, with individual training records for each member of staff, with training goals. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to feedback informally whilst a formal quality assurance system is under development and an equalities action plan is in place. Service users on the whole benefit from robust health and safety systems. EVIDENCE: The manager has recently been registered by CSCI. She has appropriate experience and is suitably qualified, demonstrating that she undertakes regular training to update her own practice. The quality assurance system is being developed. At present this takes the form of a questionnaire for service users. Service users said they were not aware they had been formally consulted. The manager is planning to widen the scope of requested feedback on service to include families, health care professionals and any other third parties, and is considering ways in which results of surveys may be made public.
Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 18 Service users said they did not feel they were formally consulted over their care, although they all said that staff were kind and thoughtful and would ask them their preferences for how care was offered on a one to one basis. An equalities action plan has been devised with equality issues outlined with proposed actions to be taken in areas such as, communication and language, food and diet, religious beliefs, physical environment, recreation and leisure. The home does not usually look after service users money; however, a written record is kept for the personal allowances of three service users. This record was examined and no discrepancies were found. Health and safety documentation was seen and most was in place, however, environmental risk assessments should to be developed from the basic format already in place. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 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 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13(2) Requirement The registered person must ensure that medication is handled safely according to procedure. The registered person must ensure that heating suitable for residents is provided in all parts of the care home used by residents, including the smoking room. The door to the first floor toilet must be changed so that service users can use it whilst retaining their privacy and dignity. Previous timescale not met. Service users must be consulted about a programme of activities tailored to individual need, and these activities offered with staff time made available. The laundry room must be made inaccessible to service users. The home must achieve adequate staffing. The manager must provide a comprehensive quality assurance programme based on obtaining the views of service users and others, developing an annual plan based on findings, publishing the results of surveys and reviewing. Timescale for action 13/06/06 2 OP25 23(2)(p) 11/07/06 3 OP10 12, (4) (a) 17/07/06 4 OP12 16. (2) (n) 31/07/06 5 6 7 OP26 OP27 OP33 23(a) 18(a) 24 31/07/06 31/07/06 30/11/06 Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 4 Refer to Standard OP38 OP30 OP15 Good Practice Recommendations Environmental risk assessments should be developed. It is recommended that foundation training be updated for existing staff and a clear separate record kept for each individual. It is recommended that service users are consulted further regarding the choice of meals available and that menus are adapted to take into consideration personal preferences and appetising alternatives. Santralla DS0000062594.V300294.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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