CARE HOMES FOR OLDER PEOPLE
Sarah Ann Rest Home 15 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX Lead Inspector
Mrs Julie Garrity Unannounced Inspection 27th September 2005 11:00 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 Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 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. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sarah Ann Rest Home Address 15 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX 0151 476 8500 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) Mrs Pauline Joan Mary May Mr James Frederick May Mrs Pauline Joan Mary May Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 13 OP. Date of last inspection Brief Description of the Service: Sarah Anne is registered to provide personal care for a maximum of thirteen Older People of both sexes. The home has been opened for fifteen years and is privately. There are nine single and two double rooms, a lounge, and dining room. A large basement contains the kitchen, laundry, office and a staff flat. The home does not have a ramp from the outside, there is a lift to all floors and alarm call systems in all rooms, toilets and bathrooms. Sarah Anne is a converted building in a quite residential area, close to a number of amenities including easy access to public transport both trains and buses and local shops within walking distance. The home has a mini-bus for transport of residents where required. There are gardens at the front and back are secure and accessible to service users when weather permits. Parking is available at the front of the building and there are double yellow lines outside the Home, which have recently been put into place. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 1 day and was a total of 4 and half hours. It was a routine unannounced inspection. A tour of the premises took place, thirteen residents and three staff were spoken with and care records reviewed. Interviews were held with the manager and two owners. Care records of residents, medication records and medication storage were reviewed. What the service does well: What has improved since the last inspection? What they could do better:
The acting manager has made sure that the Home maintains a friendly atmosphere and has reviewed the care plans in the Home. Unfortunately some of the advice received from CSCI has resulted in confusion on behalf of the manager as to what to write in the residents care plans, subsequently care plans have not been updated or fully reflect the needs of the residents. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 6 The manager has been advised to review standard seven regarding care plans and to make sure that care plans reflect the needs of the residents are written in agreement with the residents and reviewed on a monthly basis. The current arrangements for giving out medications is unsafe and has resulted in one of the residents receive the incorrect dosage of medication. The acting manager was not aware of the best practice surrounding medications and will be reviewing the medications in the home including, receiving, transportation and giving out of medications. 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. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 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 Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 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): 3 Sarah Ann makes sure that the staff are aware of the needs of the residents before they move in order to make sure that the staff can provide the right care. EVIDENCE: All the residents are assessed before they move into the Home. The manager keeps the assessments in order to help decide what needs the residents have and how the Home intends to meet these needs. Information for the assessment is from a variety of different sources including the resident, social services and the resident’s families. A resident spoken with said, “staff can understand what I need and want and do their best to make sure that I get it”. Another resident said, “I don’t really remember, but I do remember feeling very happy to come and live here”. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 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): 7, 8, 9, 10 The manager and staff make sure that residents health care needs are fully met and contact the relevant health care staff as and when needed. Residents are dealt with, with respect and dignity. The staff in Sarah Ann tend to discuss the residents needs, with information passing from one carer to another. This is not good practice as it based on an assumption of what the residents need are rather than clearly written records. The current arrangements for receiving and giving medications is unsafe and has resulted in a resident not receiving their medication in accordance with the GP’s prescription. EVIDENCE: Sarah Ann is a fairly small care home with staff that have worked there for several years. As a result a relaxed “jokey” manner is very evident. One resident said “` I like the laughing and joking that happens every day. I love that the staff treat as though I’ve got something to say”. Staff spoken with were able to clearly detail how they dealt with maintaining residents dignity and respect on a daily basis. Each resident has a separate set of notes, which contain their care plans.
Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 10 There has been some confusion with past advice, this has resulted in the acting manager not being fully aware of the needs to make sure that care plans contained details on how to meet residents needs and keeping the care plans under review. Care staff do not read the care plans. The staff in the home have generally worked their for many years and in most cases their knowledge of the residents is based on what they tell each other rather than good written records. This practice runs the risk that incorrect information will result in incorrect care being given to a resident. Residents spoken with said, “ I go to doctors appointments and hospital appointments. The staff always make sure that there is some-one to come with me “. Records in the Home although difficult to locate within the daily records detail a variety of health care services including GP’s, Opticians and dentists. The Home is very good at maintaining residents independence and supports those residents who wish to keep and take their own medications. Unfortunately the risks around this activity have not been assessed and recorded. The Home has the poor practice of giving out medications, to the residents from medicine pots labelled with the resident’s names. This is known as “potting up” and is an illegal practice that results in staff not reading the medication administration records. This practice had resulted in one of the residents not being given the correct dosage of medications. The lack of records regarding medications arriving in the Home prevents the Home from knowing the amount of medications that they have in the Home or checking that it has been given correctly. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 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): 12, 13, 14, Staff try to be aware of the residents individual choices and make sure that they provide the residents with their choices. Relatives are supported to visit the residents, as the residents would wish. EVIDENCE: The residents in the Home were very happy with the daily activities. One resident has books available to read, as he needs another has strong aspect of their religion catered for on a daily basis. Information regarding resident’s choices is not fully detailed in their care plans and is contained in information through out the Home. The staff and manager said that they “know what the residents like” but without clear records they run the risk of getting it wrong. Families are encouraged to visit the Home, as they and the residents would like them too. All of the residents spoken with said that their relatives were made to feel “welcome” when they came to visited. Sarah Ann is a family run Home the acting manager has worked in the care home for many years and is the daughter of the owners this is reflected in the daily routines of the residents several of who said that they were treated “like a member of the family”. All of the residents spoken with felt that they were able to “do what I want, when I want”. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 12 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): There are no judgments to be made on these standards at this time. EVIDENCE: None of the standards listed above were assessed at this inspection. It was noted that a complaints procedure is available within the Home. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 13 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): 19, 26 Sarah Ann is a well maintained and well decorated home. The owners and manager make sure that maintenance issues are addressed as they occur. The Home is clean, pleasant and welcoming. EVIDENCE: The home is maintained to a high standard. All of the residents spoken with said that they “liked” the “comfortable” decoration in the home and was just “like a really nice family home”. The Home is regularly cleaned and was clean and tidy on the day of inspection. Residents had positive comments on the staff’s efforts to keep the home clean. One resident said that their bedroom was particularly kept clean and tidy and was appreciative of the fact. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 14 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): There are no judgments to be made on these standards at this time. EVIDENCE: None of the standards listed above were assessed at this inspection. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 15 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): 31 There is an acting manager in post who is applying to become the registered manager. She has suitable qualifications and experience to undertake the role of acting manager. EVIDENCE: The home has an acting manager, who has been in post for several months. The owner was the previous manager and it has been decided that her daughter who has worked as a carer in the Home for several years become the manager. This will maintain the family run ideals behind the management of Sarah Ann. The Acting manager has completed an training qualification in care and management suitable to her role. An application to become the registered manager has been sent to the manager for completion. The residents spoken with were “very happy” with the manager and said that she was “thoughtful”, “kind” and “easy to get on with”. Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 16 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X x Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) (2) (c) (d) Requirement Timescale for action 27/03/06 1 OP31 8 The manager must ensure that the care plans contain up to date information and are properly reviewed with the involvement of the residents and/or their representative. (Outstanding from the previous report) The manager must make an 27/10/06 application to CSCI for her approval as registered manager of the home. (Outstanding from the previous report) Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 18 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 OP7 Good Practice Recommendations A review of residents risk assessments should be undertaken and all residents who leave the Home or undertake the management of their medications should have an individual risk assessment in place. The manager should review the policy and procedure regarding medications and make sure that medications are given to residents in a safe manner. Medicines received into the Home should be recorded. 1 OP9 Sarah Ann Rest Home DS0000005389.V254617.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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