CARE HOMES FOR OLDER PEOPLE
Sea Point 14 Adelphi Road Paignton Devon TQ4 6AW Lead Inspector
Peter Wood Unannounced Inspection 22nd November 2005 10:15 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 Sea Point DS0000018423.V268238.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. Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Sea Point Address 14 Adelphi Road Paignton Devon TQ4 6AW 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) 01803 556899 Paignton Guild of Social Services Housing Associations Limited Mrs Glenis Mary Rees Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability over 65 years of age of places (12) Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7&8 June 2005 Brief Description of the Service: Sea Point is a Home for up to twelve older people, who may have physical disabilities, run by the charitable foundation Paignton Guild of Social Service Housing Association Limited. The house is a four storey semi-detached building on a quiet road close to Paignton sea front, shops and cafes. There are five steps to the front door, but the back door is in general use and is accessible. There is a small shaft lift that services all floors, and level access on each floor. The house is domestic in style, the rooms are attractive and most have good views. There are ten single rooms, seven with en suite facilities, and one double with en suite. There are two bathrooms, one of which has a Bathmaster hoist. The enclosed rear garden has benches for summer use, and a gate leading into the park. There is a level walk to Paignton sea front. Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on over one weekday in November 2005. A tour of the home was undertaken with specific reference to hot water and surfaces. The medication administration system was also specifically examined. A sample of relevant documentation including the complaints book, accident book and that relating to client care implementation was examined. The Registered Manager was on holiday though popped in at the time of the inspection and agreed to stay for an hour or so to assist with the inspection. The six staff members on duty at some time during the day were informally interviewed to a greater or lesser extent during the day. All residents were interviewed and asked for their views of their experience of living at the home. Additionally a visiting relative was consulted for his views of the home. What the service does well: What has improved since the last inspection?
Eight requirements and three recommendations were made at the previous inspection, four of which had been made on several previous occasions. The manager claimed that five of these have been actioned or partly actioned, though some of those claims require further testing: The homes own staff now promote and carry out social and recreational activities with residents. Design solutions are now in place to protect residents from scalds from hot water from bath and wash hand basin taps. Radiator covers have been manufactured and will be installed next week in order of risk assessment priority. The manager has recently obtained guidance on induction training, though this still needs implementing. The manager now ensures that night care staff do not sleep while on duty.
Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 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. Sea Point DS0000018423.V268238.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 Sea Point DS0000018423.V268238.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): 1, 3, 4, 5, 6 The home does not yet have a suitable Statement of Purpose or Service User Guide to help prospective residents and their families make an informed choice about where to live. However, they are able to visit and assess the suitability of the home. Reasonably thorough systems for admission allow prospective residents and their families to be confident that their needs can be met. EVIDENCE: The manager’s plans to produce a Statement of Purpose and Service User Guide have not yet come to fruition, despite repeated requirements being made. The manager has plans for a brochure, but must produce the required Statement of Purpose and Service User Guide to include full and accurate information about the accommodation and service provided. These need to be made available to prospective and incumbent residents and their relatives. The house is not suitable for wheelchair users, and the service is not designed or registered for people with dementia. The home does not offer intermediate care. Sea Point DS0000018423.V268238.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 Residents’ health, personal and social care needs are being met and they are treated respectfully. The home’s practices relating to medication administration need modification to protect the service users from risk. EVIDENCE: The home uses good formats for care planning and risk assessment. Residents said they could not be treated better and described living in the home as “lovely” and “excellent”, saying that nothing was too much trouble for the staff. Care plans detailed residents’ care needs. Medication administration by members of staff employed since the last inspection revealed poor practice pills and capsules were pre-potted and records signed prior to the medication being given to residents. Proper medication administration training should be given to all staff who administer medication. Residents are able to selfmedicate if they wish following a risk assessment. Residents were seen to be treated with respect by staff, knocking on their bedroom door and awaiting a response before entering, and talking gently to but without patronising the residents. Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 10 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, 15 Residents appeared to be happy living at this home. Residents were able to maintain contact with family and friends. Food provided by the home is wholesome and mostly to each resident’s liking. EVIDENCE: Many residents have lived in the Paignton area all their lives and chose this home, either directly or via their relatives, because the style of the home matched their social and cultural expectations and preferences. All residents consulted appeared to be happy living at this home, and most confirmed that was the case. Further to comments from some residents at the last inspection that they would like more to do, the manager has now enabled staff to promote and carry out social and recreational activities with residents. This includes bingo (regularly called by a relative), board games, and also taking residents out. The home has an unrestricted visiting policy. Residents said that the food was good and plentiful and should the menu not be to their taste, alternatives were always available. Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 11 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): 16, 18 Complaints and suggestions from service users, relatives or other visitors to the home, are treated seriously. Service users are listened to and issues resolved promptly. EVIDENCE: The home has a simple complaints procedure on display in the hall. Residents said that the staff, manager and committee were very approachable and they were confident that any issues of concern would be listened to and dealt with. The home maintains a complaints book, properly recording the three or four complaints from residents since the last inspection, together with the action taken, which seemed appropriate. One complaint had been received by the Commission from the relative of a previous resident, via Torbay Council’s contracts department. Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 12 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 Residents live in a pleasant home that is comfortable and warm and which provides sufficient facilities to meet their needs. However, the home is still not entirely safe due to the risk of scalds and burns from hot water and radiators EVIDENCE: The home is still not entirely safe due to the risk of scalds and burns from hot water and radiators. No radiators have yet been covered. At the last inspection some radiators were so hot that immediate action was required to protect residents from burns. The manager said that each radiator has since been measured for a cover and that covers have been manufactured which will be fitted next week. The manager also claimed that thermostatic valves have been fitted to all hot taps accessible to residents. It is obvious that some have been fitted, but the water from both the basin and bath in the middle floor bathroom was still so hot that it turned the “Hotspot” thermometer device bright pink, indicating a temperature greater than the recommended 37 degrees centigrade, and was far too hot to the touch. Either a device has not been fitted or it is not working properly. This must be rectified.
Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 13 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): 27, 28, 29, 30 Residents are usually cared for by caring staff in sufficient numbers to meet their needs. Recruitment processes need to be modified to protect residents. EVIDENCE: Residents described the staff as very kind and caring and confirmed they usually responded promptly to requests for assistance. The rota indicated that there are usually three carers plus the manager together with a chef and general assistant on duty. However, at the time of the inspection neither the manager nor senior carer were on duty. Two care staff (who were together bathing a resident), the chef and a general assistant were in charge of the home at the beginning of the inspection. New staff shadow experienced staff rather than undergo a proper induction process. Staff seen during the inspection appeared confident and competent, despite two being quite new. No staff were recorded in the Pre-Inspection Questionnaire prepared for the last inspection as having NVQ qualifications to ensure that they have the skills to care for older people. Training in the past year has been confined to Food Hygiene and Care of Medicines. Food Hygiene and Moving and Handling is the only training planned. Staff files in respect of the two last employed were examined. These contained application forms, written references and job descriptions. However, neither contained Criminal Record Bureau disclosures or photographic identification. One did not contain a photocopy of a birth certificate and one reference was from a friend rather than the last employer. The Home’s procedure for recruiting staff does not meet this standard or the list as per Schedule 4.
Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 14 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, 32, 33, 36, 37, 38 Sea Point is a homely environment run in the best interests of the residents. However, the management committee and registered manager need to clarify their respective roles to ensure that the home is run properly. EVIDENCE: Sea Point is owned by a charitable foundation run by a committee. The committee and manager should clarify their respective responsibilities to ensure that the home is run properly and safely and complies with the National Minimum Standards. For example, the committee needs to allow the manager sufficient funds to protect residents from burns and scalds, and needs to ensure that the registered manager is doing her job properly. Although very experienced and quite well qualified she has consistently failed to undertake some of her management tasks, such as creating necessary documentation and staff recruitment, training and supervision. This needs rectification.
Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 15 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 2 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 N/A 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 2 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X 2 2 2 Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 16 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 OP1 Regulation 5 Requirement The Home must produce and make available a Statement of Purpose and a Service Users Guide in a suitable format. The first deadline for this was 14/02/03. The home’s practices relating to medication administration need modification to protect the service users from risk. Design solutions must be put in place to protect residents from scalds from hot water from bath and wash hand basin taps. Radiators need to be covered. This was first required by 14/11/03. The Registered Manager must develop induction training. This was first required by 14/05/03. Committee members who make visits to the Home to fulfil the duties of regulation 26 must send a report to the CSCI. Events which adversely affect the well-being or safety of any Service User (reg 37e) must be reported to the CSCI. Timescale for action 22/01/06 2. OP9 13 22/01/06 3. OP25 13 22/01/06 4. 5. 7. OP25 OP30 OP3 13 18 26 22/01/06 22/01/06 22/01/06 8. OP31 37 22/01/06 Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 17 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. Refer to Standard OP2 OP31 Good Practice Recommendations The Homes Residents Agreement should be read and signed by each Service User at the time of admission. The committee and manager should clarify their respective responsibilities to ensure that the home is run properly and safely and complies with the National Minimum Standards. Sea Point DS0000018423.V268238.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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