CARE HOMES FOR OLDER PEOPLE
Seely Hirst House Care Home 62-68 Mapperley Road Mapperley Park Nottingham NG3 5AS Lead Inspector
Andrew Sales Unannounced Inspection 19th January 2006 10:00 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 Seely Hirst House Care Home DS0000002218.V278605.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. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Seely Hirst House Care Home Address 62-68 Mapperley Road Mapperley Park Nottingham NG3 5AS 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) 0115 960 6610 0115 9856283 The Trustees of Seely Hirst House Miss Lynda Dyer Care Home 38 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (38) of places Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Seely Hirst House is registered to accommodate up to 38 older people some of whom may be suffering from dementia. The accommodation is provided over two floors with a passenger lift providing independent access. The home is maintained to a very good standard with well-maintained enclosed gardens. Seely Hirst House is situated in a residential area with good public transport links to the city centre. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted by A.J. Sales on 18 January 2006. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used is ‘case tracking’ which involves selecting residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The inspector spent time talking to four residents in the home and three member of staff. There was plenty of opportunity to observe interaction between staff and residents throughout the inspection. Overall the feedback was excellent. Residents were very keen to express their views about the home, they were extremely positive in terms of the attitude and commitment of the management team, the skills and attitude of the staff and of the overall standards of care, food, social recreation and the environment. What the service does well: What has improved since the last inspection?
Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 6 The feedback from residents suggests that the home continues to improve what is already a quality service. Evidence suggests that this is achieved by continuous improvement through a comprehensive training program for staff, which identifies invidual strengths and weaknesses and sources appropriate training courses for them to attend. The manager and staff group are well established and experienced and from the residents experiences strive to ensure that the residents feel it is their own home. The responsibilities within the risk assessment framework has been changed to include more staff, delegate responsibilities and improve the Health and Welfare of residents. 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. Seely Hirst House Care Home DS0000002218.V278605.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 Seely Hirst House Care Home DS0000002218.V278605.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): 3,4,5,6. Residents and family are able to visit and stay at the home prior to making a decision. Thorough assessments of need have been carried out prior to admission and the residents were fully involved in the process. Residents’ quality of life has been enhanced through the services provided by the home. Residents are confident that the home is able to meet their needs. EVIDENCE: Two of the homes residents were case tracked and a number of others spoken with. All of the homes assessments are comprehensive and contain sufficient information to enable staff to ensure that they could meet the residents assessed needs. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 9 Residents spoken with felt the staff were competent, friendly and were always in safe hands. Discussions with staff demonstrated they had a thorough understanding of the needs and emotional support individual residents may need and were able to describe how they support residents with different personal care and practical tasks. Observations were made of professional interaction with residents, which supported resident’s comments that they feel well respected and supported. Staff spoke of a number of care specific training subjects and courses they have attended, which evidence that the staff team is well equipped with a range of skills and experience to meet the needs of residents. Two residents described how they were able to visit the home a number of times prior to moving in. Staff confirmed that this is a useful time to get to know them and their preferences. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10. Residents receive a comprehensive assessment. Assessments are updated following a review. The home is able to meet the healthcare needs of it’s residents. Medication issues are managed appropriately. Residents are treated appropriately. EVIDENCE: Assessment plans are well set out and detail each area of need and an action plan is drawn up to meet this need. Risk assessments are also observed to be well documented. Particular attention is placed in the need to prevent pressure sores, falls and safe working practices. Daily records are well maintained by care staff and professional input from district nurses and GP’s is well documented. Evidence gained from speaking to residents and staff suggested the care planning process was accurate and outcomes satisfactory. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 11 Resident’s plans contain details of each individual’s health care needs, including tissue viability and continence risk assessments. There is evidence that people have been appropriately referred to health care professionals. Care plans contain records of visits by district nurses, General Practitioners and other professionals. Healthcare professionals were observed visiting on the day. The inspector was informed that residents can register with a GP of their choice. Staff training records evidenced that medication training was provided for staff responsible for the administration of medication. The homes medication administration systems have been well maintained. There is a policy and procedures for receiving, recording, storing, handling, administering and disposing of medicines. The home is registered with the local Boots pharmacist and support and advice is obtained as and when needed. The most recent pharmacist audit of the homes medicines was observed. Staff were observed during the visit interacting positively with individuals.A resident spoken with, reported staff provide a good standard of care and areas of concern would be discussed with the registered manager. All residents who spoke with the Inspector commented very positively on the conduct and attitude of the staff. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15. Residents are supported to pursue, religious and social interests. Residents are helped to exercise choice and control over their lives. Residents receive good quality food and a balanced diet in a relaxing atmosphere with support from staff where required. EVIDENCE: The manager, residents and staff confirmed that the routines of the home are flexibly implemented to suit the preferences of individuals. Residents feel they are kept well informed about local events and available activities. There are weekly and monthly planned events, which the manager showed details of to the inspector. Singers and musicians visit the home regularly, trips out in the homes transport are arranged monthly. One day each week has a dedicated staff member to facilitate activity and stimulation. Residents and staff described how there is always a meber of staff on hand in the main lounge to provide practical and recreational assistance. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 13 Residents spoke of how their choices are respected, one described how she planned her day, socialised and went out into the local community. Two residents rooms that were observed were well furnished and personalised and they confirmed they are able to bring in their own possessions. All of the residents confirmed they were very satisfied with the food provided by the home. They described the choices of cooked breakfasts, a varied lunch menu and that fruit and snacks are available at all times. Lunch was observed by the inspector, the food appeared of excellent quality and plentiful. Staff support was unhurried. Quite a large number of relatives were observed visiting. Residents confirmed how relatives are actively included i.e. at Christmas and other events and confirmed there are no restrictions on visiting. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has satisfactory procedures in place to deal with adult protection and complaints. Measures are in place to protect residents. EVIDENCE: The home has a comprehensive complaints procedure, which is appropriately displayed, throughout the home. According to records observed, one complaint have been received since the last inspection, this complaint was unfounded. The manager supplied appropriate policies relating to the employment of exoffenders, Whistle Blowing and Adult Protection Procedures. The home’s policies and procedures for responding to suspicion or evidence of abuse, are all satisfactory. Residents spoken with, stated they would raise concerns with the registered manager if they felt the need to. Training certificates in respect of Adult Protection were observed on staff files, staff stated that this is also covered during the induction process. Staff spoken with demonstrated a sound understanding of Adult Protection issues and procedures.
Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26. The home has been maintained to a very high standard. The home provides a safe and comfortable environment. EVIDENCE: All parts of the home were observed to be extremely well furnished and maintained. All residents spoken with stated how impressed they were with the homes décor and furnishings. A housekeeper and two domestic staff were on duty during the inspection. The housekeeper showed the inspector the recently renovated laundry facilities. They are very well organised and hygienic, with appropriate equipment and systems in place for the effective cleaning of residents clothes and the home. The residents and staff explained how some residents preferred to manage their own housekeeping, with support where necessary. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Staff are recruited and employed in suitable numbers. Staff are trained in mandatory subjects required by this standard and for care specific support. Residents are in safe hands with competent staff on duty. EVIDENCE: On the day of inspection there were observed to be, five care staff, one senior care staff, the registered manager, the house keeper, one cook and two domestic staff on duty There are suitable recruitment policies and procedures that were observed. One staff file was sampled at random. These contained evidence of applications, interviews, pre-employment checks, criminal declarations, confidentiality agreements, supervision and training plans. This file also contained an enhanced CRB. The staff file examined, contained evidence of training in a number of health and safety subjects, dementia awareness, NVQ level 2. There was also evidence of staff supervision and appraisal plans. Staff spoke of the induction and training provided at the home and said it was excellent and relevant to their work. Residents spoken with stated that they felt support was timely and there were sufficient staff to provide unhurried assistance. They all commented how professional, competent and friendly the staff were.
Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38. The home is very well managed with residents interests put first. Health and safety management is well documented. Staff are well supported and supervised. EVIDENCE: Residents said they felt the home was extremely well run and the management team were always on hand for support and advise. Staff spoken with confirmed that they felt supported by the managers and that they are approachable to discuss any issues. They confirmed that there is an open management approach and a positive culture within the home, which promotes development of new initiatives and individual staff development. The staff confirmed they receive monthly supervision and attend regular team meetings.
Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 18 The manager stated that the staff have received training updates in the last year on moving and handling, first aid, basic food hygiene, administration of medication and health and safety issues including hygiene control. Certificates and individual training profiles supported this. The care staff spoken with also confirmed this. The manager confirmed that the home does not manage any finances on behalf of residents. It was observed that equipment is serviced and maintained on an annual basis by agreed contracts. There is a written health and safety policy to guide staff. The inspector was told an assistant manager is responsible for the risk assessment of activities of residents and the manager is responsible for the overall risk management framework throughout the home. In addition to individual risk assessments for residents, there are risk assessments recorded on the use of equipment inside and outside the home. Records of fire system tests, water temperatures and other health and safety records were observed and were found to be carried out at the required intervals. Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 4 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 3 Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Seely Hirst House Care Home DS0000002218.V278605.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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