Inspection on 17/09/07 for Seymour House

This inspection was carried out on 17th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Seymour House 07/01/09

Seymour House 08/01/08

Seymour House 17/05/06

Seymour House 04/01/06

Seymour House 05/09/05

Seymour House 11/01/05

Seymour House 24/08/04

Seymour House 17/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Seymour House 13-17 Rectory Road Rickmansworth Hertfordshire WD3 1FH Lead Inspector Jeffrey Orange Unannounced Inspection 17th September 2007 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 Seymour House DS0000019520.V348032.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 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. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Seymour House Address 13-17 Rectory Road Rickmansworth Hertfordshire WD3 1FH 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) 01923 778 788 Mr M Rhemtulla Ms Yasmin Rhemtulla Care Home 38 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (38) of places Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home may accommodate one (named) female service user currently 59 years old. The manager must inform the CSCI when the above (named) service user leaves the home or reaches the age of 65, whichever comes first. This variation applies only to this (named) lady and ceases to be in force when the lady leaves the home or reaches 65, whichever comes first. 19th March 2007 Date of last inspection Brief Description of the Service: Seymour House is a care home providing personal care and accommodation for 38 older people who may also require dementia care. The home was opened in 1997 and consists of a purpose built three-storey building. All the bedrooms are single and have toilet and wash hand basins en suite. There are two passenger lifts to access all floors. The home has a small garden and paved patio accessible to people living in the home. The home is located close to the centre of Rickmansworth, within walking distance of shops, the post office and other community facilities. There is parking available to the rear of the home and the home is also readily accessible by public transport. The current weekly placement fee for each service user is between £407 and £470. Additional charges apply for newspapers, personal toiletries and hairdressing and also for chiropody, opticians and dentistry services where people living in the home do not qualify for free treatment under the NHS. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection site visit took place over seven hours and provided an opportunity to meet people living in the home, members of the staff team and the home’s manager and to observe the home’s routines and care provision. Key records were examined including those for staff recruitment and medication and a brief tour of the premises was undertaken. This report also draws on information submitted to the Commission for Social Care Inspection (CSCI) by the home in their annual quality assurance assessment, together with any other information, received by the CSCI about Seymour House since the last key inspection in May 2006. An unannounced inspection visit to the home took place in March 2007 in order to monitor progress with requirements made following the earlier key inspection as well as to discuss some concerns about the home that had been raised with the CSCI. The current inspection visit provided an opportunity for progress in meeting any requirements made following the inspection of March to be assessed. As part of the ongoing regulation of Seymour House a series of surveys of people living in the home and health and social care professionals associated with it will be undertaken. Any information received will be used to inform the process of regulation for this service. The CSCI are committed to raising the standard of care experienced by people in residential care settings such as Seymour House. Wherever possible this is achieved by working with care providers where they demonstrate a willingness, commitment and capacity to improve and develop their services. Positive conversations with the manager throughout this inspection visit provide a good basis for confidence that this can be the case at Seymour House. What the service does well: Overall the standard of care is satisfactory and people living in the home were positive about the care they receive; “The carers are very kind” was one typical comment received. The atmosphere in the home is relaxed and calm and the interaction between staff and the people they care for is good. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 6 The home is comfortable and safe and provides a pleasant environment for people who live and work there. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 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 Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 4 (Standard 6 does not apply to Seymour House) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to Seymour House unless a full needs assessment has been carried out which has established that the home is capable of meeting the assessed needs of the prospective resident appropriately. EVIDENCE: Pre-admission assessments were seen for several recent admissions and these were adequately thorough and robust to ensure that only those people whose needs could be met are admitted. The feedback received from people living in the home was that their basic care needs are being met appropriately. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 9 Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home have access to healthcare services both in the home and in the community. Care plans contain basic details of healthcare needs and how these are met. The format of care plans could be reviewed to ensure that it meets the developing requirements of the current service user group. Medication practice does not always comply with the home’s medication policies and procedure and this could put people living in the home at some risk from the inappropriate administration of medication. People living in the home are treated with respect and their right to privacy is generally well respected. EVIDENCE: Care plans contain evidence of the involvement of a range of healthcare professionals with people living in the home, including general practitioners, dentists and opticians. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 11 The format of the care plans, for example in the way that weight is recorded and care plan details, including risk assessments are reviewed has not been recently evaluated to take account of potential improvements and developments that might be made in order to improve them. The temperature of the home’s central medication storage area is not being recorded to ensure it remains within the recommended temperature for the medication stored there. Where medication is prescribed in variable dosages, e.g. “one or two tablets to be taken as required”, the exact dosage given on each occasion is not always being recorded. Medication prescribed for one person was being used for another person, which is a serious breach of safe practice. The medication concerned was also beyond its best before date. The home does not have a controlled drugs cabinet and Temazepam, which is one of the schedule 3 controlled drugs that should be stored in a controlled drugs cupboard, is being stored in a standard medicines cupboard. (Although not a legal requirement, it is also considered good practice to record Temazepam in a controlled drug register) People spoken to during this visit confirmed that they felt that care staff treated them respectfully and that their privacy was respected. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in Seymour House are provided some opportunities to take part in activities within the home or in the wider community. Although the home recognise the challenge in providing meaningful group activities, especially for mixed dependency levels, they need to look at ways to meet that challenge taking account of a range of good practice information and research that is now available to care providers, in order to broaden and increase the quality and frequency of activities within the home. The way that choice is presented to people living in the home and the steps taken to involve them explicitly with the day to day routines and planning of the home needs to be further developed and recorded. The absence of regular service user meetings makes it difficult for the home to demonstrate how people living in the home influence decisions. This is not to say that they do not, but any approach appears to be informal and based on previous knowledge of the individual concerned. (For example a garden parasol was provided following a request from one person living in the home) Visitors are welcomed into the home and meal times for people living in Seymour House are generally sociable and comfortable occasions. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 13 EVIDENCE: Following concerns raised with the CSCI steps have been taken to ensure that visits to the home can be made at any reasonable time. Quite rightly, the home is not prepared to permit visits late at night by people who appear to be under the influence of alcohol. People living in the home were uncertain about their ability to choose the food they ate; “It is just plonked down in front of you” was one comment made. Lunch was observed to be a reasonably pleasant experience, although some food was still being served onto cold plates and pureed meals were served in bowls rather than on plates. Regular service user meetings are not currently taking place. The home does not have an activities organiser or a comprehensive activities programme but relies on one to one sessions, which are of necessity limited by the staff resources available. Individuals are enabled and supported to access community activities, for example one person goes to yoga classes. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure and records are kept of any complaints made and the outcome of them. Staff are aware of what constitutes abuse and what to do if it is seen or suspected. This should ensure that people living in Seymour House and those responsible for them can be confident that they are protected from actual or potential abuse. EVIDENCE: The home has always co-operated with the CSCI and other agencies when complaints or concerns have been addressed to the home. The manager states that she has an open door policy for people living in the home, and those people spoken to during this inspection visit indicated that they felt able to raise issues of concern with the manager. Staff induction records seen included safeguarding training. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 24 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The built environment is generally well maintained and decorated and provides a pleasant environment for people who live and work in the home. Whilst there are adequate numbers of toilets and washing facilities for people living in the home there is not always adequate soap provided and the quality of some hand towels is disappointing. EVIDENCE: Substantial amounts of carpet were being replaced on the day of this inspection. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 16 It is understood that contacts have been signed for the laundry to be refitted. Two bathrooms were without any soap during part of this inspection and the hand towels available in some rooms were very frayed and thin. There was a used incontinence pad in the rubbish bin in the first floor bathroom. There was a faulty window fastener in room 35 and a fire door to one linen cupboard although marked “keep locked shut” was not. Several service users’ bedrooms were unusually bare and lacking in personalisation. Clearly this could be a matter of choice for the individuals concerned and is quite acceptable, provided they are able and encouraged to make their rooms individual to themselves if they choose. On the day of the inspection the home was clean and free from unpleasant smells. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The current staffing levels appear adequate in order to provide sufficient numbers of suitably qualified and experienced staff on duty in order to meet the care needs of people living in the home. This will have to be kept under review as the numbers and dependency of people living in the home changes. The recruitment procedure of the home is basically sound and should ensure that only people suitable to do so provide personal care to people living in the home. EVIDENCE: People living in the home expressed themselves to be satisfied with the standard of care they receive and the observed response time to alert calls was satisfactory. Staff spoken to felt that they were well supported with training and supervision. Staff recruitment records were essentially sound and included the required information in most cases. Levels of NVQ have markedly improved since the previous key inspection. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are several key areas of this outcome group where the management of the home has achieved good performance, for example staff are well supervised and supported and the manager has a personal knowledge of and interest in the care needs of individual service users. The manager has been registered by the CSCI as a fit person to manage a care home and has undertaken additional appropriate training to maintain and build her skills, for example in the provision of dementia care. However what would otherwise be an overall good standard is compromised by failures in some specific areas, for example in the storage and administration of medication and a degree of failure to put in place monitoring of some routine housekeeping issues. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 19 Record keeping is generally satisfactory, the evaluation of records could however be improved in a way that would enable the manager to more readily identify trends and patterns in falls for example. EVIDENCE: Staff say that they are well supported and regularly supervised and records seen confirm this. People living in the home expressed satisfaction with the way that the home is managed. The particular failures in medication practice recorded elsewhere in this report could have been picked up with a more robust management and monitoring system in place. Routine household matters such as provision of soap, disposal of incontinence pads and minor maintenance should be identified and rectified through a system of routine monitoring. The contact details for the CSCI have remained unaltered on some notices displayed in the home and the home’s mission statement refers to being registered by Hertfordshire County Council, which has not been the case for some years. There is no falls audit undertaken which would help the manager to be readily able to monitor the incidence of falls and the contributory factors to them. Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 20 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 2 Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement The temperature of medication storage must be monitored and recorded to ensure that at all times medication is stored within the recommended range for it. Medication must only be administered to the person for whom it was prescribed. Where medication is prescribed in variable dosages, the exact amount administered on each occasion must be clearly recorded. Temazepam must be stored in a designated controlled drug cupboard and due consideration must be given to any good practice recommendations with regard to the recording of its administration. The home must ensure that all service users have the opportunity for regular and consistent stimulation through leisure and recreational activities in and outside the home taking into account their needs, preferences and capacities including those service users DS0000019520.V348032.R01.S.doc Timescale for action 17/09/07 2 3 OP9 OP9 13(2) 13(2) 17/09/07 17/09/07 4 OP9 13(2) 31/10/07 5 OP12 16(n) 17/09/07 Seymour House Version 5.2 Page 22 6 OP14 12 & 16 7 OP21 16 with dementia. The registered manager must review the process of consultation with people living in the home and/or their representatives, in order to ensure that their wishes and preferences can be obtained and taken into account when planning the daily routines and activities of the home. Suitable soap must be provided at all times in all communal bathroom and w. c. facilities 17/09/07 17/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP12 Good Practice Recommendations A review of the care plan format in use should be carried out to evaluate whether the current format is the best and most effective available to the home. The registered manager should research the availability of resources, information and advice on the provision of activities within care homes, particularly in respect of people with dementia. This information and advice should then be used to inform the future development of activities within Seymour House. The registered manager should obtain a copy of the CSCI report “Highlight of the Day” to see if any changes or improvements to the mealtime routines at Seymour House could be made. (In consultation with people living in the home). An audit of the home’s linen and towels should be carried out and any items found to be in need of replacement should be. The manager should remind all service users that they can personalise their own bedrooms if they would like to do so and this should be facilitated where they do now wish to. The manager should consider reviewing the reference request form and the health declaration section of the DS0000019520.V348032.R01.S.doc Version 5.2 Page 23 3 OP15 4 5 6 OP19 OP24 OP29 Seymour House 7 OP37 application form currently in use to provide more useful information in a more structured format. The registered manager should consider if the effective management of the home would be assisted by the development by a falls audit tool in conjunction with advice from the local falls prevention service (If available) Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area 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 Seymour House DS0000019520.V348032.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!