Inspection on 25/04/05 for Seymour House

This inspection was carried out on 25th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Seymour House 14/08/07

Seymour House 13/09/06

Seymour House 27/09/05

Seymour House 19/01/05

Seymour House 19/08/04

Seymour House 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Seymour House Monkton Park Chippenham Wiltshire SN15 3PE Lead Inspector Sally Walker Unannounced 25th April 2005 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. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Seymour House Address Monkton Park Chippenham Wiltshire SN15 3PE 01249 653564 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) The Orders of St John Care Trust Vacant Care Home Only 43 Category(ies) of MD(E) Mental Disorder - Over 65 (8) registration, with number OP Old Age (35) of places Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19th January 2005 Brief Description of the Service: The home is situated on the outskirts of Chippenham near to the park. The building was originally built by the local authority in the 1970’s and is the subject of an ongoing programme of redecoration and refurbishment. Service users’ accommodation is to the ground and first floors accessed by a lift and two staircases. The 43 registered beds provide accommodation for older people, eight of which are registered for older people who have mental health problems. The home provides 2 of these beds for respite care. All of the service users’ accommodation is single bedrooms. The home also provides a 12-place day service during the week which is separately staffed. The staffing rota provides for a minimum of 4 care staff and a care leader for the mornings, 3 care staff and a care leader for the afternoon and evenings and 2 waking night staff with one member of staff sleeping in. The home has been without a registered manager since the end of August 2004. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Val Runyeard-Hunt who is the proposed manager was on leave and Sue Carter, Caroline Wodecki and Sonia Blackwood, Care Leaders, assisted with access to records and providing information. Six service users were spoken with in some detail together with one relative. Service users files were examined, as was the fire logbook and staffing rota. A tour was made of the communal areas. What the service does well: 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. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 6 The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 standard(s) 3 & 5 Service users now benefit from having a full assessment of their needs carried out before moving to the home so that staff were able to prepare for their admission; in particular for those service users known from their time at the day service. This had been a requirement form the last inspection. Service users or their representatives had good experiences of the admission process. EVIDENCE: Those service users recently admitted had assessments on file from a variety of sources including hospital and information from visits by staff. Two care leaders gave examples of assessments that they had carried out. Service users relayed their own experiences of coming to live at the home; one had known the home by reputation and another had had favourable reports following family visits on their behalf. One service user showed their service users guide giving details of what they could expect from the home. Staff were clear to social workers about whether potential service user’s needs could be met, based on care management assessments. The home does not provide intermediate care. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 standard(s) 7, 8, 9 & 10 Although service users can expect to have a care plan in place on the day that they arrive, there was no guarantee that their care plan would be regularly reviewed and revised as their needs changed. Current staffing levels do not allow staff sufficient time to ensure paperwork is up to date. Staff rely on their detailed knowledge of service users care needs and little time is set aside to review and revise the care plans. Health care needs are being met although the records do not always show evidence of this; staff rely on district nurses notes. Lack of training in tissue viability, required at the last inspection, does not allow staff to properly assess service users risk of developing pressure sores. Service users who hold their own medication were protected by safe storage policy as required at the last inspection. Those service users within the Registration Category of mental health could not guarantee that their often complex care needs would be fully planned for and documented. Staff uphold and respect service users privacy as one of their principles of good care practice. EVIDENCE: Two service users recently admitted to the respite service had care plans dated for the day of their arrival. All the other service users had care plans but there Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 10 was some information in their daily reports about changes in need which had not prompted a review of their care plan showing how this need was to be met. The care plans were being reviewed monthly. Those service users under the category of Registration of Mental Health did not always have their often complex care needs identified in their care plans. Service users who had no speech did not have a communication care plan although it was clear from talking to staff that strategies were used for decision making and choice. Some service users were receiving treatments from the district nursing service and although this fact was recorded, there was no written evidence in the home’s records of progress. Staff said the district nurses had their own notes kept in the service user’s bedroom. Service users with diabetes need to have their care planned and monitored formally. Staff were advised to document any such treatments in the care plan and record progress in the daily records, including body maps as further evidence of progress. It was clear from information given at the shift handover and from conversations with service users that any concerns were promptly referred to healthcare professionals, including physiotherapists, community psychiatric nurses and consultant psychiatrists. Tissue viability training had not yet taken place as required at the last inspection. Staff said that it was planned for the very near future. No formal assessments had been carried out with regard to service users developing pressure sores. Although there was a pre-printed form being used for this purpose, it did not allow staff to properly plan care for those service users at risk. However, pressure relieving equipment was in place and nutritional monitoring was recorded in daily reports. There was a requirement from the previous report for a clear written policy and protocol on which treatments were able to be delegated to named staff by the district nurse following agreement and training. There was no policy or protocol in the new organisational handbook. Staff said they did not do any invasive treatments which were carried out by the district nurses. However staff were advised that they should receive training on the safe handling and disposal of injection syringes where they were observing service users self administering diabetic injections to avoid needle stick injuries. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 standard(s) 12, 13, 14 & 15 Service users controlled their own routines as far as they were able. Service users benefited from an improved activity programme instigated by Mrs Runyeard-Hunt since coming into post following a requirement made at the last inspection. Service users relied on their family taking them out, as current staffing levels would not support regular community activities. Service users do not benefit from the appointment of a specialist activities post as provided in some of the organisation’s other care homes. Service users were very positive about quality and variety of meals. EVIDENCE: All service users spoken with were asked about their routines and how they spent their day. Service users had their own routines which were respected by staff. Support was offered as needed. Although the amount of activities provided had improved with forthcoming events published in the main entrance, some service users still said there was not much to do. Care staff were expected to provide activities as well as care. The organisation had piloted specialist posts for activities in some of its other care homes with noticeable benefits for those service users. Service users could join in with the activities provided by the day service. There was a healthy amenities fund with monthly accounts published. Some fundraising activities were for charity. Some service users chose to watch their own televisions in their bedrooms or continue with knitting and other handicrafts they had done at home. Service Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 12 users talked about the church services held in the home on a Sunday. Some service users said they could go for a walk in the grounds in the better weather. Others spoke about the visiting library and clubs they went to. Service users said their visitors could come to the home at anytime and were always made welcome. Most of those service users spoken with regularly went out with families on a regular basis. Those service users who were able, said they felt that they still retained a degree of control over their lives. Staff were seen to talk with service users about certain options and there was some degree of comment on this in the daily reports. There were a number of events planned with service users invited to visit other care homes in the organisation for activities. All of those service users spoken with made very positive comments on the quality and variety of the food provided. Service users said they could have all their meals in the dining room or in their bedrooms as they wished. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 & 18 The home’s complaints procedure and positive attitude to complaints allows service users to voice concerns without victimisation. Service users are not always protected from potential abuse. EVIDENCE: Most of the service users said that they had not had anything to complain about but if they did they would talk to their keyworker or their family. One service user said that staff regularly failed to make their bed. One relative complained about the standards of cleaning in their relative’s bedroom and was advised to take the matter up with the manager and the details were passed to the Care Leaders to resolve. The care leaders response to being given this information was positive. The home worked to the local Vulnerable Adults policy entitled “No Secrets in Swindon and Wiltshire”. The care leaders said they had attended training but had not had time to cascade the information to staff as expected. Whilst it is recognised that a school project to interview service users about their experiences is valid and should go ahead, the home must ensure that service users and, or, their representatives have formally agreed to service users being interviewed on their own. The home must evidence that service users are protected under the same legislation that applies to staff or volunteers with regard to Criminal Records Bureau certificates. There must be clear guidelines on how this project shall operate for the protection of service users and indeed the protection of those carrying out the interviews. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 14 Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 standard(s) 19 & 26 Efforts have been made to maintain a safe and secure environment for service users. Cleaning staff shortages may have compromised infection control standards. The home did not smell unpleasant. EVIDENCE: There was a keypad lock to the front door and callers had to ring to gain access. All those service users spoken with said they could have a key to their bedroom. Central heating radiators had been guarded to ensure low surface temperatures. Service users said they were very satisfied with the standards of cleanliness of their bedrooms. The home was generally very clean and no unpleasant smells detected throughout the inspection. However, there were deposits of black matter under the bath seat in one of the bathrooms identified to one of the care leaders who said they would arrange for deep cleaning of the seat as a matter of infection control. None of the other bath seats had this deposit. Staff said that one cleaner was on long term sick leave and one vacancy remained unfilled. Night staff were helping out with some cleaning duties Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 16 which did not impact on service users sleep or night time support. Staff said a new carpet shampooer had improved the cleanliness of the carpets which were regularly cleaned in certain areas. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 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 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 & 30 Service users do not benefit from sufficient care staff on duty to fully meet their assessed needs and accomplish delegated administrative duties to a good standard. However staff were committed to delivering quality care and had very good relationships with service users. The organisation is committed to training its staff. EVIDENCE: The care staffing rota provided for a minimum of one care leader and 4 care staff during the day and 3 waking night staff. Significant efforts had been made to recruit care and support staff since the last inspection. During the inspection there were 2 care leaders and 3 care staff. The care leaders had many administrative and organisational tasks to achieve throughout the day, including allocating working with service users, 2 reviews with social workers, answering every telephone call of which there were many, achieving the tasks written in the diary, greeting visitors, administering medication, answering queries and the demands of the inspector. This left only 3 care staff to attend to the needs of service users. The care leaders were very reluctant, when pressed, to admit that they had very little time to spend with service users during the day shifts but they did work with them during an evening shift when there were fewer administrative and organisational demands. Care Leaders were having to assess some NVQ work in their own time. The 2 care leaders were very competent, achieved all that they had set out to do and did not appear to be stressed by the constant demands on them. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 18 Care staff also had delegated areas of responsibility. Staff felt they had good access to training, regular supervision and staff meetings. One staff said they had been trained in: the vulnerable adults procedure, first aid, food hygiene, moving and handling and had just started their NVQ Level 2. One newer member of staff talked about their positive experience of their induction into their role. Service users made very positive comments about the staff and especially their keyworkers and the good relationships they had. Some service users said there were not enough staff to give them a bath when they wanted and had to fit in with their availability. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 19 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) 33, 36, 37 & 38. Service users and staff have not benefited from having a permanent manager to be registered since August 2005. Service users best interests have been safeguarded by staff and indeed senior staff, continuing to support them by ensuring day to day continuity of care. Many of the criticisms of this report are a symptom of the home not having one person to manage the home on a long term permanent basis. EVIDENCE: Staff, and in particular senior staff have made great efforts to ensure good standards of care are maintained and that service users needs were met on a daily basis. The requirement of the last inspection that Mrs Runyeard-Hunt had a proper induction into the role of manager could not be assessed as she was on leave. An application to register her as manager is being processed by the Commission at the time of writing. However staff said that another manager Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 20 was to commence at the home in September 2005. Since the previous manager left in August 2004 the home has had 4 managers from other care homes in the organisation run the home on a temporary basis. Whilst it is recognised that all of these managers have had significant input into ensuring the continued running of the home, by the nature of their temporary status, they could not realistically hope to achieve any long term aims which a permanent manager would. Whether the requirement from the previous inspection that fire drills were carried out and recorded could not be determined as the handyman was on sick leave. The drills were not recorded but the rest of the tests and checks were all recently recorded. It was assumed that the drills may have been recorded elsewhere as staff confirmed that fire drills had been occurring. All wheelchairs were fitted with footrests for the protection of service users in transport. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x 3 2 3 Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 22 yes 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 OP 7 Regulation 15 Requirement The person registered must ensure that care plans are reviewed and revised as care needs change. The care plans must direct the care. The person registered must ensure that service users social interests and access to the communiyt facilities are maintained as per their wishes. (Actioned in part at 25th April 2005). The person regisitered must ensure that all staff are trained in tissue viability to assist them in documenting risk assessments, monitoring pressure areas and nutrition and interventions required. (Not actioned at 25th April 2005). The person registered must ensure that a policy and protocol are available to staff detailing those treatments which can be delegated by the district nurse to named staff following agreement and training. (Not actioned at 25th April 2005). The person registered must ensure that comprehensive records are kept of the indicence Timescale for action 31st July 2005 2. OP 12 16(2)(m) &(n) 31st July 2005 3. OP 8 13(1)(b) &18(1)(c) (i) 31st August 2005 4. OP 8 12(1)(b) 31st August 2005 5. OP 8 17(1)(a), Schedule 3 para 25th April 2005 Page 23 Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 3(n) 6. OP 27 18(1)(a) 7. OP 38 23(4)(e) &17(2), Schedule 4 para 14 13(3), 16(2)(j)& 23(2)(d) 13(4)(b) &19, Schedule 2 8. OP 26 9. OP 18 of pressure sores and other wounds, detail in the care plan of how they are treated and monitoring of progress. The home must not rely on nursing notes which may not always be kept in the home. The person regisitered must consider the allocation of staffing hours to ensure that service users care needs are met, with full provision of care and support staff. Management and administrative duties must be excluded from the caring hours. (Not actioned at 25th April 2005). The person registered must ensure that regular fire drills are carried out and recorded as per the requirements of the Chief Fire Officer. (Not actioned at 25th April 2005). The person registered must enure that adequate cleaning is carried out to infection control standards, including those areas which may not always be visible. The person registered must ensure that when schoolchildren carry out any projects in the home and are having significant contact with service users that they come under the same legislation that applies to staff or volunteers for the protection of service users and themselves. 25th April 2005 25th April 2005 25th April 2005 25th April 2005 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. Seymour House D51_D01_S28133_SEYMOURHOUSE_V220954_250405_Stage4.doc Version 1.20 Page 24 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 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. 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