Inspection on 22/02/08 for Seahorses

This inspection was carried out on 22nd February 2008.

CSCI found this care home to be providing an Adequate service.

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 30/04/07

Seahorses 17/10/06

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 Debra Allen Unannounced Inspection 22nd February 2008 10:00 Seahorses DS0000032541.V360253.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.V360253.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.V360253.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 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Huntingtons Disease and other Neurological Disorders Date of last inspection 30th April 2007 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 eight adults with Huntingtons Disease or other neurological disorders. All bedrooms are single, on the ground floor and contain a washbasin. People living at Seahorses have communal use of a bathroom, toilet, lounge and 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 also a qualified nurse. Seahorses 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 in the region of £1,200 per week. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 judgements for each outcome group. This inspection was carried out over a period of six hours, during which time a number of people living at the home were met with and in-depth discussions were held with the matron and three staff members. A tour of the premises was also carried out. Care plans, staff files, health and safety information and other records required for regulation were also examined as part of the inspection process. One person living at Seahorses, two relatives and three staff, returned completed surveys, all of which contained mostly positive and constructive comments. An Annual Quality Assurance Audit (AQAA) document was also completed by the manager and submitted to the Commission upon request. A total of five requirements and one recommendation were made as a result of this inspection. What the service does well: Prospective service users and/or their families are provided with the information they need to make an informed choice about the home and their needs are assessed before moving in. The people living at Seahorses are involved in decisions about their lives and have opportunity to be actively involved, as much as possible, in planning the care and support they receive. People who use the service are able to make choices about their lifestyle and are supported to participate in various activities, which suit their individual needs and choices. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 6 The people living at Seahorses feel their views are listened to and acted on and they are protected from abuse, neglect and self harm as much as is possible. Seahorses provides a homely, comfortable and safe environment, for people to live in, which is clean and hygienic. Staff are well trained. Seahorses is generally a well run home, in which people’s overall health, safety and welfare is promoted and protected. What has improved since the last inspection? What they could do better: Respect for people’s personal space, such as bedrooms must be upheld at all times. People must refrain from smoking in communal areas, which infringes other people’s rights, and should be supported to smoke in their own bedrooms or, alternatively, a completely separate room should be allocated for people to smoke in. Information and advice should be sought from a relevant health professional, and a protocol implemented, with regard to some people possibly benefiting from some kind of nicotine-withdrawal therapy or treatment. All staff must have clear, enhanced, CRB disclosures prior to working unsupervised and POVA 1st checks must be completed prior to new staff commencing supervised or ‘shadowed’ work. The following up of quality assurance issues still needs to be addressed. Water temperatures for baths and sinks must be checked and recorded weekly, to ensure the people living at Seahorses are fully protected against the possibility of the regulators not working, resulting in the water being too hot or too cold. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 7 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.V360253.R01.S.doc Version 5.2 Page 8 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.V360253.R01.S.doc Version 5.2 Page 9 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. Prospective service users and/or their families are provided with the information they need to make an informed choice about the home and their needs are assessed before moving in, to ensure that the home is suitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were looked at in detail during the inspection and each was found to contain thorough needs assessments and personal profiles, which had been completed prior to people moving to Seahorses. Areas within these assessments included maintaining a safe environment, communication, breathing, eating & drinking, elimination/continence, personal hygiene & dressing, controlling body temperature, mobilising, social care, expressing sexuality, sleeping, fears for the future/dying, family involvement and mental health requirements. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 10 Information was seen to have been received from families and other healthcare professionals to support the pre-admission needs assessments and a discussion with the matron confirmed that people were invited and able to visit the home before moving in, if they wanted to. Each person living at Seahorses was noted to have received a copy of the Statement of Purpose/Service User Guide and contract. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 11 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, 9 & 10 Quality in this outcome area is good. The people living at Seahorses are involved in decisions about their lives and have opportunity to be actively involved, as much as possible, in planning the care and support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the information seen in the care plans, it was evident that people are supported to make decisions about their lives wherever possible. One example was where a previous resident had been supported to make the arrangements for their relative’s funeral and their request to change bedrooms had also been accommodated. The risk assessments that were looked at were found to be clear and detailed and included areas such as moving and handling, outings, smoking, eating, drinking, swallowing, choking, speech & expression, mobility and falls. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 12 Care plans were also noted to have been reviewed and updated regularly, in order to keep in line with people’s changing needs. All the service users’ records and personal information was seen to be stored securely, thereby ensuring confidentiality is maintained. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. People who use the service are able to make choices about their lifestyle and are supported to participate in various activities, which suit their individual needs and choices, although respect for their personal space is not always upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans looked at were seen to contain good evidence of ‘person centred’ support with regard to how people wanted to spend their time. Some of the activities noted included pub visits, walks along the seafront, bowling, picnics, cinemas and the zoo. Information was seen to have been recorded for people in respect of their likes, dislikes and responses to various activities/outings, which ensured that people didn’t have to revisit areas they did not enjoy. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 14 The matron explained that, due to the nature of people’s illnesses, holidays were generally very difficult to organise and quite impractical, although this was an area that was always given consideration on an individual basis. General observations during the inspection confirmed that the care staff spoke to people in a caring and professional manner and, on the whole, people were treated with respect and dignity. However, it was also observed that, due to the office being occupied, a member of staff proceeded to use a resident’s bedroom to carry out some administration work, which was unrelated to the person whose room it was, and consent had not been sought. Although the staff member responded immediately to the objection raised by the inspector, a requirement has been made regarding the issue of respecting people’s privacy. The menus were also looked at as part of the inspection process and the lunchtime meal was observed on the day. Although a number of people currently require their food to be pureed and the content to be of a high calorie/fat nature, this was observed to be provided in a respectful and dignified manner by the care staff and the meals were noted to be wholesome and nutritious. Meanwhile, the matron confirmed that the two-week ‘rolling’ menu is currently being reviewed to offer more variety for the people living at Seahorses. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 15 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 good. The health and personal care that people receive is mostly based on their individual needs, to ensure the principles of dignity, respect and choice are put into practice. However, people’s choices and abilities around areas such as smoking need to be given more consideration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans and other relevant records looked at provided good evidence of people receiving personal care according to their individual needs and wishes and records of visits to, or from, various healthcare professionals, such as doctors, community nurses and dentists were also noted. Smoking was an issue that was raised as part of the inspection process; one person, who lives at Seahorses, was observed enjoying a regular cigarette, which they currently smoke in the conservatory and, although it is commendable that staff support this person to exercise their choice to smoke, it is not acceptable for this to take place in a communal area, which infringes other people’s rights. A requirement has therefore been made for people to be Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 16 supported to smoke in their own bedrooms or, alternatively, a completely separate room should be allocated for people to smoke in. A further discussion with the matron highlighted the fact that some people require physical support or aids to enable them to continue enjoying a cigarette for as long as possible but often just ‘don’t smoke anymore’ when they can no longer physically manage. A recommendation has been made for information and advice to be sought from a relevant health professional and a protocol to be implemented with regard to some people possibly benefiting from some kind of nicotine-withdrawal therapy or treatment. Seahorses use a Monitored Dosage System (MDS) in respect of medication and the records looked at during the inspection were found to be in order, with no errors or omissions noted. The controlled drugs were observed to be kept in an appropriate locked cupboard and the matron undertakes a weekly audit of all medication, which also helps to ensure that people are protected by the home’s policies and procedures. Other information seen in the care plans, as well as discussions with staff, confirmed how service users have been supported during times of ill health or death and this information indicated that people had been treated with dignity and respect. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 17 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 good. The people living at Seahorses feel their views are listened to and acted on and they are protected from abuse, neglect and self harm as much as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no formal complaints received by the Commission since the last inspection and the records looked at on the day of inspection also confirmed this. Discussions with the matron and staff confirmed that any internal issues were raised and discussed during staff meetings. The questionnaires returned by the service users and relatives/friends, all confirmed that they knew how to make a complaint. Staff spoken to on the day had a clear understanding of adult abuse and protection. Training records and discussions with the matron also confirmed that the staff have received training in adult protection and understanding abuse. Seahorses DS0000032541.V360253.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, 29 & 30 Quality in this outcome area is good. Seahorses provides a homely, comfortable and safe environment, for people to live in, which is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises showed Seahorses to be clean, hygienic and pleasantly decorated throughout most areas, with numerous improvements noted. It also had a very comfortable and homely atmosphere. The bedrooms looked at were seen to be very personal and people have the opportunity to personalise them as they wish. Specialist equipment was seen to be available and in use, such as hoists, adjustable chairs and beds. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 19 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): 32, 34 & 35 Quality in this outcome area is poor. The people living at Seahorses are supported by competent and qualified staff but the home’s recruitment policies and practices are not robust, which means the people living there aren’t fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff files were looked at for the three people who were on shift at the time of inspection and each of these was found to contain all the relevant records such as application form, references and clear, enhanced, Criminal Records Bureau (CRB) disclosures. However, the files for two new/bank staff were also looked at and, although both staff had already worked ‘shadow’ shifts, CRB disclosures had not yet been received for either person nor had POVA 1st checks been carried out. In addition to this, although references had been requested, these had not yet been received at Seahorses. A repeated requirement has therefore been made to this effect. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 20 Training records were also looked at and evidence was seen of courses attended such as Boots medication, first aid, fire safety, health & safety, moving & handling, food hygiene, safeguarding adults, understanding Huntington’s disease and palliative care. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 21 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, 39 & 42 Quality in this outcome area is adequate. Seahorses is generally a well run home, in which the service users’ views are taken into consideration and their overall health, safety and welfare is promoted and protected, although the following up of quality assurance issues still needs to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The matron at Seahorses is a registered nurse with a number of years experience and discussions confirmed that she commenced her Registered Manager’s Award course in October of 2007. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 22 A summary of the results and findings of the most recent Quality Audit was still not available when requested during the inspection and so a repeated requirement has been made. The regulated health and safety checks for areas such as fire alarms, emergency lighting, Legionnaire’s disease, and electrical testing were found to be satisfactory and cleaning materials/hazardous chemicals were seen to be stored appropriately. A recent inspection by the Environmental Health Officer resulted in Seahorses receiving a star rating of four out of five. However, it was noted that water temperatures for baths and sinks are not currently checked or recorded, as the matron stated that they all have regulated thermostats and cold water is not required. A requirement has therefore been made to ensure the people living at Seahorses are fully protected against the possibility of the regulators not working, resulting in the water being too hot or too cold. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 23 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 3 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 2 X 2 X X 2 X Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 24 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 YA34 Regulation 19 Requirement Complete recruitment safety checks must be carried out on staff prior to commencement of work. Repeated Requirement The matron must complete the registered manager’s award (RMA). A summary of the findings and an action plan of improvements must be produced from the completed quality assurance audit and made available to stakeholders and CSCI. Repeated Requirement. (Previous timescales of 31/03/07 and 31/08/07 not met.) Respect for people’s personal space must be upheld at all times and service user’s bedrooms must not be used by staff without their permission. People must refrain from smoking in communal areas, which infringes other people’s rights. People should be DS0000032541.V360253.R01.S.doc Timescale for action 22/02/08 2. YA37 10 30/09/08 3. YA39 24 31/05/08 4. YA16 12 22/02/08 5. YA28 13 31/05/08 Seahorses Version 5.2 Page 25 6. YA42 13 supported to smoke in their own bedrooms or, alternatively, a completely separate room should be allocated for people to smoke in. Water temperatures for baths 30/04/08 and sinks must be checked and recorded weekly, to ensure people are fully protected against the possibility of the regulators not working, resulting in the water being too hot or too cold. 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 YA19 Good Practice Recommendations Information and advice should be sought from a relevant health professional, and a protocol implemented, with regard to some people possibly benefiting from some kind of nicotine-withdrawal therapy or treatment. Seahorses DS0000032541.V360253.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V360253.R01.S.doc Version 5.2 Page 27 - 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. 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