CARE HOMES FOR OLDER PEOPLE
Santralla 8 The Crescent Scarborough North Yorkshire YO11 2PW Lead Inspector
Karen Ritson Key Unannounced Inspection 7th June 2007 09:40 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 DS0000062594.V335121.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. DS0000062594.V335121.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 DS0000062594.V335121.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2006 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 stair lifts have been fitted to allow access to all other levels. 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 current inspection report is available on request at the office. Additional charges are made for chiropody, hairdressing, newspapers and trips out. DS0000062594.V335121.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 12 hours. This includes time spent gathering information and examining documentation before and after an unannounced site visit and in writing the report. The site visit took place on 07/06/07 between 9:40am and 3pm. Information for this inspection was gathered from the following: • • • • • • • • • • • A tour of the premises Observations of care throughout the day of the site visit. Speaking with service users. Speaking with the manager Speaking with staff. Case tracking service users on the day of the site visit. Looking at information provided by the home in a pre inspection questionnaire. Notifications sent to the commission from the home since the last inspection. Examining policies, procedures and records kept at the home. Examining information regarding the home on the file kept by CSCI. Considering comments made by relatives, health care and social services staff. All key standards were looked at during this inspection. The manager was present throughout the day of the site visit. What the service does well:
Santralla provides a good level of care in a comfortable and homely setting. All service users receive the care they need. They commented that the care was offered from staff who were kind and caring. One service user said: ‘I think they do a very good job and the staff are all kind’ One relative said: `They are absolutely brilliant. My relative could not get better care anywhere else. I can’t praise them enough.’ The home writes down the care needed in a plan and involves the service user when it is updated. This makes sure that service users receive the care that is right for them.
DS0000062594.V335121.R01.S.doc Version 5.2 Page 6 Relatives wrote that they felt well informed and were made to feel welcome when they visited the home. Complaints are listened to and wherever possible put right. Service users said they were encouraged to say if anything was not to their satisfaction and if there were a problem it would be sorted out. Enough staff are on duty and service users said they had time to chat and offer care in an unhurried way. Staff are well recruited and trained. This makes sure that service users receive good appropriate care. The home is well managed by Linda Lunn. All staff said she was a supportive colleague and service users felt the care offered was at a high standard. Health and safety is a priority within the home and all policies are checks are in place. This makes sure that service users live in a safe and comfortable home. What has improved since the last inspection?
Much has been done to improve the service since the last inspection. A requirement was made regarding an uncovered heater in the smoking room. This has now been removed and an overhead heater installed. A sliding door, which would not easily close, has been replaced with a hinged door. This respects privacy. A lock has been placed on the laundry door so that service users cannot get into an area where they may be at risk from cleaning chemicals or falling hazards. The way in which medication is handled has improved. All tablets are checked into the home and an accurate record is kept of what medication is kept for each person and how much is left. This helps to keep service users safe. Service users are asked about what social and other activities they would prefer and the activities on offer have improved. This makes sure services users have the opportunity to have things to do which interest them. The numbers of staff on duty has improved, this helps service users get the care they need, when they need it. The manager has also improved the way people are asked about what care they are offered at the home, and the service has been changed in the light of what people have asked for. The meals have improved with the appointment of a new cook. One relative said: ‘The meals are fantastic, the cook has worked wonders.’ Service users enjoy these meals more and also those who have particular dietary needs are also well catered for which helps keep them healthy. DS0000062594.V335121.R01.S.doc Version 5.2 Page 7 Risk assessments have been drawn up for all areas of the home and staff all now have an individual training record. This makes it easier to see what training each member of staff needs and how best to meet the specific needs of each service user living at the home. 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. The summary of this inspection report can be made available in other formats on request. DS0000062594.V335121.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000062594.V335121.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The home does not offer intermediate care. People who use the service experience good quality outcomes in this area. Prospective service users and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and are clearly told about the service the will receive. This judgement has been made using a range of evidence including a visit to the service. EVIDENCE: Each service user receives a thorough assessment of care needs prior to admission to the home. This includes all relevant areas of care and risk assessments where necessary. A personal history is also compiled with each service user, which provides useful information about each person’s life, interests and family connections. This had proved very helpful for all service users and particularly those who have memory difficulties. DS0000062594.V335121.R01.S.doc Version 5.2 Page 10 One service user said: ‘They know just what I need and do a great job.’ A visitor said: ‘They have reassessed him while he has been ill and the care they’ve given him has been spot on.’ The Service users spoken to said they would have had the opportunity to look around the home prior to admission but a relative did this on their behalf with their consent. The home does not usually offer intermediate care. Clear documentation and focusing upon the needs of each individual ensures that each service user is appropriately placed within the home and that care needs are met. DS0000062594.V335121.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: Each service user has a plan of care, which is drawn up in consultation with either them or a representative and is regularly reviewed. The care plans are person centred, written in plain language, easy to understand and look at all areas of the individual’s life. Each care plan is detailed, but a quick reference care plan is also available for each person. This makes it easy for staff to check if recent changes have been made to the main care plan. A district nurse commented about the care of her patient on being discharged back to the home from hospital. DS0000062594.V335121.R01.S.doc Version 5.2 Page 12 ‘They have been absolutely brilliant. The pressure care has been really good; they’ve been turning (my patient) regularly. (The patient) has rallied, mostly due to the good care the staff have offered.’ The district nurse also said that the home consulted with her if they needed advice about care. All health care professional’s notes are recorded and stored separately. This makes is easy to track the changing care needs of each individual. A relative said: They are absolutely brilliant. They can’t do enough. (MY relative) couldn’t get better care anywhere else. I can’t praise them enough. All the staff are so kind and caring, they really care about him as well as caring for him. They keep me informed, I look at his care plan and they invite me to reviews.’ Medication is now stored and administered according to procedure. Staff have received suitable training in this. The deputy manager and the manager now carry out spot audits on the medication. These measures ensure service user’s safety. Throughout the day care staff were observed speaking with service users in a kind and thoughtful way. One resident was feeling unwell and she was offered reassurance and company, which clearly calmed her. All doors are knocked on prior to entry and service users said they were treated with respect. This sensitive and person centred approach ensures each service user receives the care they need. DS0000062594.V335121.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. People who use this service are enabled to make choices about their life style. Social cultural and recreational activities meet individual’s expectations. They have a balanced diet they enjoy. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: The home offers activities based on individual preferences. A separate programme and record is kept for each service user. Recent activities included flower arranging, video afternoons, quizzes, musical entertainment from a visiting performer, word searches, skittles, dominoes, board games, writing letters, general chat and reminiscence. The home now has its own car and service users can go out accompanied by a member of staff on a one to one basis. Pennine Care also has a minibus, which the home can use. The home has a newsletter where outings are reported. The local newspaper has recently reported on the great efforts made by service users to create Easter bonnets for charity. DS0000062594.V335121.R01.S.doc Version 5.2 Page 14 A service user said: ‘The staff do what they can to keep us entertained’. Another service user said: ‘They ask me if I want to get involved but sometimes the others won’t join in.’ The emphasis upon individual preference ensures service users are enabled to follow a lifestyle which meets their expectations. The home has visits from the representatives of several religious denominations enabling service users to actively follow their religion should they wish. Visits from friends and relatives are also recorded. Staff said they found this helpful in starting topics of conversation with service users. A relative said: ’They are very welcoming and friendly. I can call at any time within reason.’ Service users said they could have visitors at any time. One said: ‘You are really encouraged to treat the place as your home and invite who you want to come in.’ The manager has appointed a new cook since the last inspection and the service users and visitors all agreed the meals were now of a higher quality than before. The cook has completed a food safety course, and food and kitchen risk assessment were in place. Service users can choose from a full cooked breakfast, cereals, toast or any combination they prefer. There is a main meal with alternatives if service users do not care for what is offered that day and there is a choice at supper time. One service user said: ’The meals are very good now.’ A visitor said: ‘The meals are fantastic. The cook has worked wonders with liquidising and making things appetising. (My relative) also gets supplements which really help.’ DS0000062594.V335121.R01.S.doc Version 5.2 Page 15 A record is kept of what each service user chooses and how much is eaten which helps track nutritional intake and balance. The manager said this had proved helpful when a health care professional needed to check on diet. The cook also sometimes likes to offer meals, which are a little different from what service users would usually choose to encourage variation and interest in their diet. Some service users said they enjoyed these alternatives. This individual approach to diet ensures service users have enjoyable and appropriate meals. DS0000062594.V335121.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. This judgement has been made using a range of evidence which includes a visit to this service. EVIDENCE: Service users all said that any concern was listened to, acted upon and taken seriously by the staff. There had been no complaints since the last inspection. One service user said: ‘I have absolutely no complaints.’ A visitor said: ‘Linda has listened to anything I have commented upon that I think could be improved and she has done something about it straight away. There is never any doubt in my mind that any problem would be sorted out.’ DS0000062594.V335121.R01.S.doc Version 5.2 Page 17 Others said if there was ever even a small problem they had only to mention it and it would be quickly and politely sorted out. GP’s and health care workers wrote that they hadn’t had reason to complain. The home has a complaints procedure which is available to all service users in the home. All complaints would be fully recorded with outcomes, however, there have been none since the last inspection. The open culture of the home encourages service users to feel that their complaints will be acted upon. Service users are protected from abuse through well -trained staff. All staff understood the abuse policy and procedure and were aware of the procedure for the Protection of Vulnerable Adults. This ensures that Service users are safe and well cared for. DS0000062594.V335121.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. They live in a safe, well-maintained and comfortable environment. This judgement has been made using a range of evidence which includes a visit to this service. EVIDENCE: The home is well decorated and maintained. It complies with the requirements of the fire department environmental health authority. Improvements have been made to the environment since the last inspection. These include the removal of an uncovered radiator in the designated smoking room and an overhead heater fitted. Hinged doors have replaced sliding doors to the first floor toilet and bathroom. Health and safety hazard posters have been displayed in strategic areas of the home. Stair lifts have now been fitted to make all areas of the home accessible. DS0000062594.V335121.R01.S.doc Version 5.2 Page 19 The laundry facilities meet the needs of the service users. At the last inspection visit there was an access point through the smoking room where service users could walk into the laundry and be at risk from cleaning chemicals or falls. This area is now inaccessible to service users, ensuring their safety. Service users welfare is protected by a good infection control procedure and policy. DS0000062594.V335121.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. Staff in the home are trained and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: Rotas showed the home is well staffed. Staff reported having time to talk with the service users in addition to offering the care required. Service users said there were plenty of staff to carry out their duties without having to rush and that there was time to chat. More staff are on duty at peak times. The home does not use agency staff. This ensures that care is offered by staff who know the service users at a pace to suit them. Staff are recruited according to a good policy and procedure and receive all required training. Pennine Care no longer uses the services of an in house trainer and the manager has to source training locally. All staff have received induction and foundation training and updates were being arranged for the near future. Some distance learning is sourced from Selby College. DS0000062594.V335121.R01.S.doc Version 5.2 Page 21 About 50 of staff have achieved NVQ to level 2 in care. Each member of staff has an individual training plan. Two members of care staff were spoken to, they said they had received training in all foundation areas and that training needs are discussed in supervision. This approach to staffing levels, recruitment and a commitment to staff being adequately trained ensures that service users needs and wishes are met. DS0000062594.V335121.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use the service experience good quality outcomes in this area. The management and administration of the home is based on openness and respect. Service users views and preferences influence practice and they are protected by the health and safety procedures of the home. This judgement has been made using a range of evidence including a visit to this service. EVIDENCE: The manager has almost completed the Registered Managers Award and will then begin NVQ level 4 in care. Staff said that the manager was approachable and supportive. Service users and relatives agreed that she was helpful, kind and well organised. Staff said the morale was now much better than at the last inspection visit. The manager had recruited more staff and these were
DS0000062594.V335121.R01.S.doc Version 5.2 Page 23 suitable for the role. Staff felt they were valued and were able to work the hours they preferred rather than feeling they needed to work extra to cover shifts as before. The deputy manager said she now had a strong working relationship with the manager and that they supported one another. One relative said: ‘The staff all cooperate with one another. Linda creates a friendly and open atmosphere where she will do anything to help. She has a bubbly personality and is very helpful.’ This ensures that service users receive a good, well managed service. The manager has developed the quality assurance system. Feedback is encouraged from all service users and those visiting the home. The results are analysed and the results are fed back to service users and staff at regular meetings. The manager also carries out internal quality audits covering such areas as medication, accident forms, care plans, answering the telephone and cleaning. Again, results are fed back in meetings. This ensures that the service offered is based upon service users preferences and wishes. The personal allowance is kept for one service user, records were examined and there were no discrepancies in recording. Evidence was submitted on the pre inspection questionnaire that all relevant safety checks had been carried out. Several certificates of maintenance were seen and were up to date and in order. The home has comprehensive health and safety policies and procedures and a first aid trained member of staff is on duty at all times. This ensures service users are kept safe. The gas safety certificate was outstanding and a copy will be submitted to CSCI as evidence when received. DS0000062594.V335121.R01.S.doc Version 5.2 Page 24 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 2 X 3 X 3 X X 3 DS0000062594.V335121.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP31 Good Practice Recommendations The manager is reminded of the need to have NVQ Level 4 in care and management or equivalent. DS0000062594.V335121.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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