CARE HOMES FOR OLDER PEOPLE
Seaton Hall 10 The Green Seaton Carew Hartlepool TS25 1AS Lead Inspector
Mrs Pat English Unannounced Inspection 4th January 2006 09:30 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 Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 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. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Seaton Hall Address 10 The Green Seaton Carew Hartlepool TS25 1AS 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) 01429 260095 01429 222785 Arnold George Barrington Wilks Mrs Carmel Dawson Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: Seaton Hall is situated in a residential area on the green in Seaton Carew. It has an open aspect with views over the sea. The home is registered as a care home providing care for 35 older people. Accommodation is provided on two floors with access to the upper level provided by two passenger lifts. There is an adequate number of assisted toilet and bathing facilities and one bedroom has an en-suite bathroom. The home has spacious recreational and dining facilities and there is a large enclosed courtyard garden area to the rear of the home. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately eight hours and the Manager assisted during the inspection. During the inspection three care staff, eight residents and three visitors gave their views. On this occasion the inspector looked at a total of ten core standards which were not assessed on the last inspection, these mainly concerned Choice of Home, Health and Personal Care, Daily Life and Social Activities, Meals and Complaints and Protection. What the service does well: What has improved since the last inspection?
A programme of staff supervision has been introduced and progress in this area is ongoing. A considerable amount of work has been done to comply with fire regulations and the Fire Safety Officer’s recommendations to update the homes fire standards. All residents have had a device fitted to their doors which complies with fire regulations and allows them to keep their doors open. A programme to rewire the building to comply with current standards is almost complete and the refurbishment plans are continuing. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 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. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 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 Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 The home’s admission procedures are satisfactory, and prospective residents have their needs assessed by a qualified person prior to entering the home to ensure that the home can adequately meet their needs. EVIDENCE: Individual records are kept of each resident and a sample of these records were inspected. Residents had been appropriately assessed prior to their admission to the home, and copies of these assessments were on the files. Relatives visiting the home during the inspection all said that they or another family member had been given a copy of the “Service User’s Guide” and that they visited the home prior to agreeing the admission. They were involved in the initial assessment process and that the manager had been very supportive and “helpful and approachable”. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 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 and 10 Although there is some room for improvement, there is a consistent care planning system in place to provide staff with the information they need to satisfactorily meet residents’ needs. There is evidence of good contact with health care professionals in the community that ensures residents’ health care needs are met. Policies and procedures for dealing with medicines have not been strictly followed resulting in some unsafe practices. EVIDENCE: Each resident’s care plan identified all aspects of their health, mental health and personal care needs and clearly specified the action to be taken to meet the assessed needs. However, there was no evidence of how residents’ social care needs would be met, (this is covered in more detail under Daily Life and Social Activities in this report). Records showed details of daily progress reports and monthly evaluations of each resident’s care plan and were updated to reflect changing needs. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 10 Most of the information recorded was in good detail although not all areas of risk were being clearly identified or how these risks would be managed. Specific records were kept of any involvement or intervention from health care professionals e.g. GP, District Nurse, Dentist, Optician, Chiropodist etc. and these showed that the home was taking the necessary measures to promote and maintain residents’ health care needs. Comments from the manager and staff indicated that they had good working relationships with the Primary Care Team who also provide some of the training for staff. Relatives/friends visiting the home during the inspection commented that the residents were being “well looked after” and that they were kept well informed of the residents’ progress. They said that the manager and staff were “friendly and accommodating” and that they would “bend over backwards to help”. A high proportion of residents chose to stay in their rooms where their privacy was respected. Residents commented that they “had everything they need” and that the staff were “very kind and caring”. The home’s procedures for the receipt, recording, handling and administration of medicines were difficult to follow. A number of discrepancies were noted in the sample of residents’ medication administration records inspected. Staff were signing the records in advance and transferring medication into unlabeled containers. Records of each resident’s prescribed medication were not consistently kept updated where changes occur. The medication administration records did not clearly or consistently identify who had administered the medication or the time it was administered. The manager agreed to immediately address the issues raised. The current system of keeping several records relating to each person’s medication could have contributed to the errors and should be reviewed. A more foolproof method would be to replace it with a Monitored Dosage System and this is recommended. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Social activities are creative and provide stimulation and interest for residents in the home. Residents’ individual abilities, expectations and preferences are taken into account when planning activities and social events both inside and outside of the home. However, more recorded evidence of residents’ individual social and recreational needs is needed for care planning purposes. The meals in the home are good offering both choice and variety and catering for special dietary needs. However, special diets are not being recorded consistently and this meant that it could not be determined whether the diet is satisfactory. EVIDENCE: There are good links with the local community and numerous visitors came in during the inspection. Visitors who gave their views commented on how “they are always made welcome and offered a cup of tea” and that staff are “very friendly”. Visitors’ comments indicated that residents are encouraged to retain links with the community and that staff spend time chatting with residents in their bedrooms. Some residents are able to go to the local social club to play bingo and during the Christmas period choirs from the local church and school came to the home to sing carols. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 12 Residents spoken to said that they were able to choose how to spend their time and a number had gone on the recent Christmas shopping trip and joined in a Christmas cake decorating session. There was plenty of good written and photographic evidence of the home’s activities kept in a file. It showed that there have been a number of social events both inside and outside of the home. Social activities were creative and provided stimulation and interest for residents in the home. However, there were no records of an assessment of each resident’s social and recreational needs or of the daily activities they engage in. These records are needed as part of the care planning process and to show that each resident’s social, cultural, religious and recreational interests and needs are being met. Positive comments were received about the food and all residents spoken to said that they enjoyed their meals and that there was always a choice. Residents are consulted every day about their choice on the menu and a number chose to eat some or all of their meals in their room. Their personal likes and dislikes were accommodated particularly for those who chose not to have what was on the menu. However, the menu did not show the alternative choices available for lunch or what was provided for breakfast or supper. It was also noted that not all special diets were being recorded or risk assessments completed for residents on these diets. This information is needed for care planning purposes and to determine if the diet is satisfactory. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18 The policies and practices of the home ensure that residents are safeguarded from abuse or harm. The home has a satisfactory complaints system with some evidence that residents and relatives feel that their views are listened to and acted upon. EVIDENCE: There have been no serious complaints to record but minor concerns had been recorded and appropriate action taken to address the concerns. Visitors remarked that “the manager and staff were very approachable” and they would always take action if they raised any queries or problems. They also said that they were kept informed of the residents’ progress and could contact the home at any time to discuss matters. Comments from residents indicated that there were good relationships within the home and that staff were “kind, friendly and helpful”. The staff training programme included appropriate training courses in the safety and protection of vulnerable adults and it was evident that all staff were enrolled on these courses as a matter of priority. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 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 the following standard(s): These standards were assessed on the last inspection EVIDENCE: Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 15 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): Not assessed EVIDENCE: These standards were assessed in full on the last inspection where a requirement was made regarding recruitment procedures. It was noted on this inspection that the requirement had been partially addressed. An issue over obtaining two satisfactory references for new employees prior to commencement of employment remains outstanding. The manager agreed to take immediate action to address the issue. A recommendation to keep accurate and detailed records of the planned staff training programme and of individual care workers training achievements also remains outstanding. Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 16 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): These standards were assessed on the last inspection EVIDENCE: Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 18 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 OP29 Regulation 18/19 Schedule2 17 Schedule3 Requirement Two satisfactory references must be obtained prior to appointment (timescale of 03/08/05 not met) • Medication Administration Records must only be signed at the time the medication is administered and the time must be recorded; if the medication is not administered, an entry must be made as to the reason why. Medication must not be administered from unlabeled containers A risk assessment must be carried out on each resident who is selfadministering The current medication procedures must be reviewed Timescale for action 04/01/06 2. OP9 04/01/06 • • • 3. OP12 12/16 • A record of each resident’s social, cultural, religious and recreational interests and needs must be included in their assessment and care plan
DS0000047718.V264439.R01.S.doc 24/02/06 Seaton Hall Version 5.1 Page 19 4 OP15 17 Schedule4 Records must be kept of all special diets in order to determine if the diet is satisfactory 11/01/06 Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 20 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. 3 Refer to Standard OP7 OP9 OP15 Good Practice Recommendations Any areas of risk identified in the care needs assessment should be recorded in a risk assessment Replace the current medication procedures with a Monitored Dosage System Risk assessments should be completed for residents who are on special diets Breakfast and supper and the alternative choice for lunch should be added to the menu Accurate and detailed records should be kept of the planned staff training programme and of individual care workers training achievements (carried forward from last inspection) 4 OP30 Seaton Hall DS0000047718.V264439.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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