CARE HOMES FOR OLDER PEOPLE
Seaswift House Sea Hill Seaton Devon EX12 2QT Lead Inspector
Teresa Anderson Announced 2 August 2005 10:00hrs 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 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. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Seaswift House Address Sea Hill Seaton Devon EX12 2QT 01297 24493 01297 21149 Telephone number Fax number Email 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 Kathryn Sara Jackson Ms Carole Rundle-Drew Care Home 14 Category(ies) of OP old age (14) registration, with number of places Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 4 March 2005 Brief Description of the Service: Seaswift is made up of 3 houses converted into one care home. The home provides accomodation and personal care for up to 14 service users who have needs associated with old age. Accommodation is provided over three floors and floors are linked by stair lifts. All bedrooms are single occupancy and 10 have en-suite facilities. There is a communal lounge/conservatory and two dining rooms, all situated on the ground floor. The home is close to the centre of Seaton and the seafront. The front aspect overlooks a bowling green and gardens. The rear of the home has a small patio style garden. Seaswift does not have dedicated parking. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place as part of the normal programme of inspection between 10.00am and 2.00pm. Seven residents, two members of staff, the owner and manager were spoken with. Eight comments cards were received by CSCI. Three residents were ‘case tracked’ (that is National Minimum Standards were measured against the care and accommodation received by these three residents). Eight comments cards were received from residents and relatives. The owner and manager completed a preinspection questionnaire. What the service does well:
The residents at Seaswift really enjoy living there. They say the staff are kind, helpful and that the house is like a home. The atmosphere is informal, relaxed and service users say that staff treat them with respect. The inspector observed many examples of this and of staff making great efforts to ensure residents privacy was respected. One comment card said ‘I would recommend it (Seaswift) to any of my friends’. Another said ‘I am very happy here.’ Prior to being admitted to Seaswift, residents meet with and have their needs assessed by the manager and/or owner. This ensures that staff at Seaswift and the person entering the home can be confident that their needs can be met. Care plans contain good information regarding residents’ daily routines, preferences, likes and dislikes. Staff have a good knowledge of residents needs and care plans demonstrate that healthcare professionals are appropriately involved. Visitors are free to visit, with the resident’s permission, and comments cards say that they are always made welcome and kept informed of important matters. One comment received stated ‘a very friendly and homely home where my mother is very happy’. Meals and mealtimes are a time that residents particularly enjoy. There is ample variety and choice of well-cooked and appetising foods. Special dietary needs are catered for. Residents talked of mealtimes as a social occasion, where sherry is served and the tables are attractively dressed. Staff are well trained and really appreciated by residents who feel they treat them as individuals. Residents say they feel safe and that any little niggles are dealt with quickly and appropriately.
Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
Care planning could be improved with additional risk assessments and the details of actions agreed to minimise identified risks in relation to a service user who challenges the service. Those care plans written by district nurses should be reviewed as appropriate and should demonstrate that actions have been taken according to the plan. In this instance a care plan with a clear time limitation of 5 days was still in use nearly two months later. Medication procedures in relation to storage of medications (refrigerated, self administered and controlled) should be improved. The inspector has asked the CSCI Pharmacy Inspector to visit and advise. One area outside the home needs re-cementing where slabs have lifted. Three radiators required guards to prevent scalding and baths should have thermostatic valves fitted. Records should include the names of staff who have received fire training to ensure that records demonstrate that all staff receive this training at regular intervals. Records should also show who is on duty during the night. Some residents would benefit from the fitting of chair raisers to further promote independence and mobility. Criminal Record Bureau and POVA checks are not being carried out on all staff prior to being employed. Systems for ensuring maintenance and checks are carried out should be improved. The inspector is concerned that systems for managing this home are letting the home and residents down. The manager has sole responsibility for the implementation and review of all management systems. However, her time is divided into two days management and three days providing hands on care. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 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. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Prospective residents receive comprehensive assessments prior to admission to ensure the home and staff can meet their needs. EVIDENCE: Care plans and documentation demonstrate that the home manager and/or owner meet with prospective residents prior to admission. Information is collected from the resident and from any agencies involved in assessment of needs or provision of care. Some residents said they had visited the home prior to admission. They said they had received all the information they required prior to admission which was supplemented and reinforced after admission. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 7, 8, 9 and 10. Residents would benefit from improved care planning and improved procedures in relation to medication. Residents are supported by a staff group who treat them as individuals and with respect and dignity. EVIDENCE: Three care plans were inspected. They contained good information regarding residents’ daily routines, preferences, likes and dislikes. They are well laid out and easily accessible. Staff demonstrated a good knowledge and understanding of residents’ needs and the actions which need to be taken to meet those needs. Health and personal care needs are identified and met. All three comments cards received from relatives said that they were appropriately involved in care planning and on important matters. Residents said that they thought their care was good and that their healthcare needs were well met. One care plan does not contain enough information or direction in relation to a resident who, at times, challenges the service. Whilst discussion with staff indicated that, in general, this behaviour is appropriately managed, risk
Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 11 assessments do not indicate consistent and agreed management strategies and do not include reviews of the strategies in place. Another care plan does not give details of when a form of restraint should be used and the reasons for using this restraint (door guard to prevent service user wandering). Another care plan included a plan written by a district nurse. This was written nearly two months previously, and was to be reviewed in five days. This review has not taken place and the treatment remains unchanged. A comprehensive inspection of medication procedures was not undertaken. However, having looked at the medication for three residents it was clear that guidelines recommended by The Royal Pharmaceutical Society are not being followed. Creams with a limited shelf life are not dated when opened. A Controlled Drug had been stored incorrectly. The Controlled Drugs Register does not meet the requirements of Misuse of Drugs Act 1971. Medication requiring refrigeration is not being stored safely. One resident requires a lockable space in which to keep her medication. It was agreed that the inspector would ask CSCI’s Pharmacy Inspector to carry out an additional inspection and offer advice. All residents spoken with said that they were treated with respect and their privacy was promoted. The inspector observed relaxed but respectful interactions. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 13 and 15. Service users benefit from strong links with the community and from meals which offer choice and variety and which cater from special dietary needs. EVIDENCE: All relatives who sent in comment cards said that they could visit Seaswift when they liked and could always visit in private. Residents said that visitors were always made welcome and could come and go with the residents permission. Seaswift is very close to the heart of Seaton. As such, residents have easy access to the town and to the seafront. Local events are attended (e.g. recent celebrations commemorating the end of WW2) and local performers are invited to come into the home for the benefit of those who cannot, or find it difficult, to go out. All residents were very complimentary about the food and meals offered at Seaswift. Sherry is served before lunch and both dining rooms are laid out attractively. Comments included ‘the food is lovely’, ‘you can always ask for something different if it doesn’t suit’ and many residents talked of lunch as a social gathering. One resident said he would like a copy of the menu.
Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 and 18. Residents are well protected by the complaints procedure and by the vulnerable adults procedures and training. EVIDENCE: Residents said they had no complaints but that any little niggles would be dealt with quickly. They felt they could speak to any of the staff and that their concerns would be hear and acted upon. Comments cards received all indicated that the respondents had no complaints. No complaints have been received by CSCI. Staff have received training in the protection of vulnerable adults and a copy of the procedures to be followed in the event of an allegation or disclosure is available to all staff. On this occasion the inspector did not speak with staff so cannot comment on their understanding of procedures. Service users said they ‘feel safe’ and ‘the staff are lovely’. They were obviously relaxed in the company of staff. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19, 22 and 26. Residents benefit from an internal environment which is clean throughout. They would benefit from the addition of further adaptations to promote mobility and independence. An area in the exterior of the property and three unguarded radiators pose potential risks to residents. EVIDENCE: Seaswift is clean and well maintained throughout. It is homely, light and bright. The majority of furniture is of a type used in a private home. Some of it has been raised to assist those people who are less mobile and/or flexible to sit and stand easily. The inspector noticed that some residents found it difficult to rise from those chairs that have not been raised, thus reducing their independence and potentially limiting movement. Three radiators have yet to be covered. These do not currently pose a risk to residents as the heating is not required in the summer months. An area outside the home is uneven and requires re-cementing. An officer from Devon Fire and Rescue has recently visited the building and all requirements made have been complied with.
Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 15 Residents say that their laundry is well cared for. Since the last inspection the manager has reviewed the policy relating to sluicing to further prevent the spread of infection. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Records do not demonstrate that service users can be confident their needs will be met at all times by the number of staff on duty. Resident’s benefit from care given by well-trained staff. Residents are not fully protected by the homes practices in relation to recruitment. EVIDENCE: Residents say that staff are busy but always respond to them quickly. The inspector observed good practice in relation to ensuring that residents had everything they might want or like to hand. Staff receive comprehensive training including induction and training relevant to residents needs. The duty rota shows that there are usually two members of staff on duty throughout the day until 8.00pm. The duty rota does not show who is on duty after this time. The owner and manager assured the inspector that the owner and her partner are on call after 8.00pm and during the night. They have agreed to amend the duty rota to demonstrate this. Three members of staff have not had Criminal Records Bureau checks or POVA 1st checks prior to employment, potentially putting residents at risk. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35 and 38. The management systems in place at Seaswift are inadequate to meet the needs of all residents. The safety of residents is not fully promoted. Residents are well protected by the system in place for managing their monies. EVIDENCE: Carole Rundle Drew who is trained to NVQ level 4 and is currently undertaking the Registered Managers Award manages Seaswift. She works as the manager for two days a week. On the other three days she provides hands on care. During the two days she manages the home she has full responsibility for the running of the home and for setting up and monitoring systems of management. There is evidence that this delegation of responsibility is not benefiting residents (see ‘what they could better’). Hot water is delivered at approximately 50C (as per control of Legionella guidelines). This poses a risk of scalding to residents because thermostatic valves have not been fitted to baths.
Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 18 Three radiators have not been covered and will (when the heating is turned back on after the summer months) potentially pose a risk to residents. Systems for ensuring that checks and controls have been carried out are not robust enough to identify when they have not taken place. Fire training is given but the names of those staff who have attended are not recorded. Staff who do not attend cannot therefore be identified and additional training provided. Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 2 x x 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 2 x x 3 x x 2 Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 20 No 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 7 Regulation Schedule 3 13 (2) Requirement The registered person must ensure that a record is kept in relation to any physical restraint used on a service user. The registered person must make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must ensure that the premises are of sound construction and repair (this relates to the outside area which needs recementing) The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated (this refers to those radiators which are not yet guarded). The registered person must keep a record of the duty roster of all persons working in the care home, and a record of whether the roster was actually worked. The registered person must carry out an enhanced criminal record and POVA First check on all carers working in home prior to Timescale for action 31/08/05 2. 9 30/09/05 3. 19 23 (2) 30/09/05 4. 19 13 30/09/05 5. 27 Schedule 4 31/08/05 6. 29 Schedule 2 31/08/05 Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 21 employment. 7. 38 13 The registered person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated (this refers to baths which require thermostatic valves). 31/08/05 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 7 Good Practice Recommendations The registered person should ensure that care plans set out detail the actions which need to be taken by care staff to ensure that all aspects of the health, personal and social care needs of service users are met. The registered person should ensure that service users have access to health care services in order that their health care needs can be met. The registered person should ensure that the home provides adaptations to suit service users needs. The registered person should ensure that the systems for managing the home benefit the health and safety of service users. 2. 3. 4. 8 22 32 Seaswift House D54 D06_s22024_seaswift_v234336_020805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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