Inspection on 17/10/06 for Seahorses

This inspection was carried out on 17th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seahorses 04/11/09

Seahorses 09/09/09

Seahorses 03/03/09

Seahorses 22/02/08

Seahorses 30/04/07

Seahorses 13/01/06

Seahorses 16/08/05

Seahorses 19/01/05

Seahorses 03/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Seahorses 8 Park Road Gorleston Gt Yarmouth Norfolk NR31 6EJ Lead Inspector Linda Wells Unannounced Inspection 17th October 2006 02:30 Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 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 Seahorses DS0000032541.V316785.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 Adults 18-65. 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. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seahorses Address 8 Park Road Gorleston Gt Yarmouth Norfolk NR31 6EJ 01493 655731 F/P01493 655731 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) Mr John Hallam Mrs Gillian Rose Hallam Mrs Wendy Bain Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Huntingtons Disease and other Neurological Disorders Date of last inspection 13th January 2006 Brief Description of the Service: Seahorses is an older style, chalet bungalow that is run as a residential care home providing twenty-four hour nursing care to six adults with Huntingdons Disease. All bedrooms are single, on the ground floor and contain a washbasin. Residents have communal use of a bathroom, a toilet, lounge and a conservatory that contains the dining area. There is a well-kept garden to the rear of the property and roadside parking to the front. Qualified nurses are part of the staff team and the manager is a qualified nurse. The Home is within walking distance of the sea front, close to healthcare facilities, local shops, hotels and pubs and has its own mini-bus. The current fees for living at the home are between £800 - £1,150 per week. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. What the service does well: What has improved since the last inspection? What they could do better: The requirements and recommendations from the last inspection have been nearly all complied with but there is still more to do to completely ensure that residents are fully protected, consulted and the environment well maintained in all areas. The following six requirements and two recommendations were made to further improve the experience of living and working at the home for residents and staff. • Accurate and complete medication administration records must be held to ensure residents are protected. (Repeated requirement) Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 6 • • • • • • • Replacement of the damaged bath and stained toilet flooring is required to ensure that the health and safety of residents is fully protected. (Will be carried out as final stage of building works). Staff members must receive supervision at least six times a year to ensure that they are aware of the needs of residents, are competent and to plan their training needs. All staff must complete training in protecting vulnerable adults from abuse to ensure they are aware of how to prevent, recognise and report incidents of potential or actual abuse. The matron must undertake the RMA in Management award to ensure that she has the knowledge necessary to manage the home. (Will commence training in January 2007) A summary of the findings and an action plan of improvements must be produced from the quality assurance audit carried out and made available to stakeholders and CSCI. It is recommended that the stained and worn bedroom carpets be replaced. (Will be carried out as last stage of building work) It is recommended that a dedicated staff member undertake the ‘training the trainer’ training in moving and handling to ensure they have advanced knowledge in carrying out short term moving and handling risk assessments on service users. 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. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The written information available about the home is complete and enables residents and staff to make a decision on whether the home will meet the needs of anyone wishing to live there. EVIDENCE: Case tracking confirmed good practice. The matron had visited service users prior to admission and had carried out a thorough assessment of their care needs. Information was also held, that had been collected from the service user, family members and other professionals and together with the home’s assessment made a full and comprehensive assessment of the health, social, emotional and personal care needs of each service user. The Statement of purpose, Service users Guide and terms and conditions contract is one document and is available in pictorial format to assist service users in their understanding on the terms and conditions of the home. None of the six service users living at the home were able to sign the terms and conditions contact but the matron said that every effort was made to explain it Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 9 to service users, their family member or advocate and that everyone had a copy. Two service users said that they had been informed of the costs, facilities and conditions of living at the home, that their family had been involved and had brought them to visit the home and that staff members had ‘shown them the ropes’ and had helped them to settle into the home. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of service users are met and service users and staff are fully protected by the information and the moving and handling risk assessments held. EVIDENCE: Case tracking confirmed improved practice. A professional moving and handling risk assessment had been carried out by an Occupational Therapist and Physiotherapist on all service users and records showed that complete and up to date risk assessments were held on actual and potential moving and handling risks. The additional assessments supported staff in moving and handling service users in a safe manner and added to the information and risk assessments already held in the plans of care on all aspects of assistance Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 11 service users required on health and social care, feeding and promotion of their independence. Residents said they were well looked after and that staff members gave them all the care and attention they required. This was observed and examination of plans of care revealed that they were improved and contained personal health and social care information, history, choice, assessments, hospital reports, daily report, moving and handling assessment, a swallowing review, nutrition, involvement with other professionals, medical assessment and appointments, key worker reviews, risk assessments, social and leisure activities and a photograph of the resident. This resulted in service users receiving a level of nursing care that met their care needs and preferences. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are consulted, records support preferences and leisure interests and the rights of service users are fully promoted and protected. EVIDENCE: Case tracking confirmed improved practice. Records held in the plans of care showed that service users had been consulted and their choice of when to have a cigarette re-negotiated with each service user to ‘as they requested’. Service users said that they enjoyed the meals, that the daily routine in the home was flexible and allowed them to individually choose their own lifestyle and the leisure activities they took part in. They also said that staff encouraged them to take part in activities and community events and to maintain friendships and relationships. Service users had free access to and Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 13 made full use of the communal areas of the home and were offered choice around the time of the meals they ate and whether to join in with other service users or to remain in their bedroom. This meant that their wishes were respected and their rights promoted. Service users have access to community leisure activities organised by the senior care assistant who said that activities were based on the interests and wishes of everyone living at the home. Records were seen to demonstrate that service users enjoy both indoor and outdoor activities and took part in shopping, bowling, going for walks along the beach, outings and community events such as the theatre. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Personal support is given to residents in the way they prefer, their needs are met but they are not fully protected by the homes medication procedures. EVIDENCE: Case tracking confirmed that service users were offered personal healthcare and support in the manner they chose and that their needs were met. Service users said that staff treated them with dignity and that they were assisted with decision-making. Staff said that they included service users in discussions on changes to their care and in the home and assisted service users with limited communication skills by understanding their response to questions and preferred manner of communication and observation. This was recorded in the plans of care. Trained nursing staff were responsible for the administration of medication and records demonstrated that staff had undertaken training in medication Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 15 administration, medication was stored correctly, policies and procedures were held but had not been fully complied with on three occasions when medication administration records were seen to be incomplete. A requirement was made. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are listened to, complaints are dealt with and records are held, however not all staff have completed training and updated training in protecting vulnerable adults from abuse. EVIDENCE: Case tracking confirmed improved practice. Since the last inspection, one allegation of poor care practice, restrictive practice and lack of professional specialist assessment on moving and handling had been received and investigated by CSCI. This resulted in one immediate requirement, three further requirements and one recommendation being made. The home showed that they took immediate action to comply with the requirements and recommendation and that service users are now protected. Residents spoken to said that if they wished to complain they would tell staff members, the matron or the owner and all agreed that they would be listened to and appropriate action taken to resolve the problem to the satisfaction of all concerned. Residents are protected from abuse, neglect and self-harm by the objectives, policies and procedures of the home, however not all staff have undertaken training or updated training in Adult Abuse to help them recognise, prevent Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 17 and deal with any potential abuse. A requirement was made and is dealt with in standard 35. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is reasonable providing residents with an attractive, safe and homely place to live, however some areas require attention. EVIDENCE: A tour of the main building confirmed that the home was clean and free of offensive odours. Work has begun at the back of the home to extend the home to provide two additional bedrooms, a bathroom, a replacement laundry/sluice room and a replacement kitchen. Service users said that the disruption of the building works were kept to a minimum, that the home was comfortable, they could have their bedroom decorated as they chose and had their own personal things in their bedrooms. The decoration in the main building is reasonable however the bathroom and toilet needs refurbishing and Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 19 some bedroom carpets are stained and need replacing. The owner said that this would be carried out as the final phase of the build. A requirement and a recommendation were made. Service users said that there was adequate communal space and that the designated area for them to smoke was in the conservatory. They gave examples of being consulted and involved in the changes planned for the home and said that they had chosen the colour of the new conservatory furniture. This was recorded in the resident meeting minutes. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff members are competent and the procedure for the recruitment of staff had improved and provides safeguards to offer protection for the people living at the home, however, some training was not complete or up to date. EVIDENCE: Case tracking confirmed improved moving and handling records and recruitment practice. A list of the training and updated training that each staff member has completed has been produced and all staff members have now completed moving and handling training. Service users said that staff were competent, treated them well, were respectful and were aware of their healthcare needs. They gave examples of how staff supported them and encouraged them to be independent. This was recorded in the individual plans of care. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 21 Staff members said that they felt supported by the matron and Mr Hallam, handover, staff meetings and were aware of their role and responsibilities. Records showed that service users were protected and that all staff recruitment checks were carried out and CRB, proof of identity, references and personal details were held on each member of staff. However, staff had not received supervision at least six times a year, not all staff had completed training in protecting vulnerable adults from abuse and a dedicated staff member had not completed the ‘training the trainer’ course in moving and handling. Two requirements and a recommendation were made. The records held demonstrated that nursing staff held a current NMC PIN and that they and care staff had undertaken basic training such as induction, foundation, food hygiene, emergency aid, medication, fire safety, moving and handling, challenging behaviour and peg feeding. Six of the nine care staff are currently undertaking NVQ2 and one already holds NVQ2, two are undertaking NVQ3 and one has completed NVQ3. This means that on completion all staff will hold a qualification in nursing or NVQ2 or 3. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The matron is supported by the nursing staff, in providing leadership, guidance and direction to staff to ensure that residents receive a good standard of care and support. EVIDENCE: Case tracking confirmed that service users received the care they need and that policies and procedures promoted their rights, choices and well being. Service users said that the home was well run, that the staff, matron and Mr Hallam were approachable, supportive, friendly and well organised. They said they felt safe living in the home and that they were consulted and included in discussions about the home and anything that affected them. Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 23 Staff said that the home was run in the best interests of service users and gave examples of how they ensured that service users had constant choice and access to equal opportunities. This was recorded in the records held. The owner had developed a quality assurance system and had produced questionnaires that he had sent to service users, relatives, other professionals and staff members twice a year but he had not produced a summary of the findings or made the results available to stakeholders and CSCI. The matron, who is a trained nurse, had not commenced the RMA award but said that she would start an ‘Open University’ course in January 2007. Two requirements were made. To ensure that the health and safety of residents is protected the servicing and testing of all equipment had been carried out, relevant and timely certificates were held and records were stored securely. Seahorses DS0000032541.V316785.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 Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 3 2 3 3 3 3 Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13.2 Requirement The registered person must ensure that records are completed for all medication administered or not administered. (Previous timescales of 1st January 2006 and 01st October 2006 not met) Timescale for action 01/02/07 2. YA24 23.2.b 01/04/07 The registered person must ensure that the repaired bath in the bathroom and the flooring in the toilet are replaced. (Previous timescales of 30th November 2005 and 01st October 2006 not met) The registered person must ensure that all staff complete training in protecting vulnerable adults from abuse. The registered person must ensure that all staff members receive formal supervision at least six times a year. The registered person must undertake RMA in management training. (Previous timescale of 01st October 2006 not met) 01/02/07 3. YA35 18.1 4. YA36 18.2 01/02/07 5. YA37 10.3 01/05/07 Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 26 6. YA39 24.1.2.3 The registered person must ensure that a summary of the findings and an action plan of improvements are produced from the quality assurance audit carried out and made available to stakeholders and CSCI. 31/03/07 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 YA24 Good Practice Recommendations It is recommended that the stained and worn bedroom carpets be replaced. (Will be carried out as last stage of building work) It is recommended that a dedicated staff member undertake the ‘training the trainer’ training in moving and handling to ensure they have advanced knowledge in carrying out short term moving and handling risk assessments on service users. 2. YA32 Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 © 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 Seahorses DS0000032541.V316785.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!