CARE HOMES FOR OLDER PEOPLE
Seymour House 13-17 Rectory Road Rickmansworth Hertfordshire WD3 1FH Lead Inspector
Ms Louise Bushell Unannounced Inspection 5th September 2005 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 Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 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.V259229.R01.S.doc Version 5.0 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 Miss Yasmin Rhemtulla Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 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 NCSC 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. 11th January 2005 Date of last inspection Brief Description of the Service: Seymour House is a care home providing personal care and accommodation for 38 older people. A variation to the registration allows the home to accommodate one service user who is below the age of 65. It is privately owned by Mr M Rhemtulla and Miss Y Rhemtulla. The home is located close to the centre of Rickmansworth, within walking distance of the shops, post office and other community facilities. It was opened in 1997 and consists of a purpose built three storey building. All the home’s bedrooms are single and all have en-suite facilities. There are two passenger lifts. The home has a small garden and paved patio that are well maintained and accessible. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of the year and took place early morning to mid afternoon. The majority of time was spent talking to service users within the home, actively seeking their individual views and feedback concerning the running of the home, meals, activities, choices, care plans, decoration and any other environmental issues. This visit focused on only a number of the key inspection standards and also formed part of a complaints investigation What the service does well:
From the areas that were inspected, there were a number of positive aspects being achieved. In the main, staff have supported service users to ensure that their individual personal spaces in their bedrooms are as homely as possible. Many other rooms contained personal effects and furniture that service users were able to being in from their previous residency. This helps the service users form memories and a sense of comfort. Many of the service users commented that they like the communal decoration of the home, as it felt homely and comfortable. Main areas were well maintained, with a bright, airy atmosphere. Clear risk assessments have been completed around the service users ability to self medicate. This practice is a pro-active method that is being adopted and actively empowers the service users skills and independent living being maintained as much as possible. Detailed assessments have been completed of service users prior to admission and during the probationary and trial period within the home. These are kept clearly in the service users file and have helped to formulate the basic care plans. Health and safety management systems are well organised and structured. In particular the fire log was well maintained with relevant checking systems in place. During the inspection, the staff on duty were observed to interact and support the service users in a person centred way. Positive feedback was received from a number of service users regarding the quality of care that they receive. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
There are a number of areas that have been identified during this inspection that require actions. With reference to the complaint investigation, a requirement has been made to ensure that the complaints procedure is suitably displayed within the home to promote an active, transparent approach to the management of complaints. The complaints procedure requires up dating ensuring that it includes information and the process for complainants to follow if they wished to make a direct complaint about the management of the home. Feedback mechanisms must be in place for the solutions and resolutions of the complaints to be adequately fed back to the complainants. A central recording system is required for all details and records of the complaints to be logged and held. The Statement of Purpose requires updating to include full details of the services that the homes provides, this includes, the arrangements for the general maintenance and cleaning of service users rooms in their absence. The cook is required to complete a recognised food hygiene and safety certificate and manual handling training. The chipped crockery in use, to be replaced, promoting effective infection control management. Feedback from a number of service users determined that an effective system for meal choices must be implemented to promote choice systems. There is a need for the home to implement a detailed fire premises risk assessment. Details and relevant contacts were provided for the manager. The last inspection report is also to be on display, so all service users and visitors have access at all times. A number of carpets were malodourous, even following carpet cleaning; these require further cleaning or replacing, alternative flooring can be provided instead of carpet to dignify and respect individual service users needs. The carpet area in the front area of the home requires replacing, as this is very worn. Following discussions with the manager, this is placed for renewal and replacement in the next financial year. At the time of the inspection, a number
Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 7 of door wedges were being used on specific fire doors. Alternative suitable means must be introduced to ensure safety of staff and service users is maintained. The home provides support to a service user who requires the use of oxygen in their room. There is a need for an appropriate oxygen safety sign to be on display where the oxygen is located and this to be further identified on the site plans in case of a fire emergency. 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. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 A comprehensive Statement of Purpose is in place, however this requires minor amendments thus ensuring that all service users have all the information they require to make an active informed choice. Each service user has a plan of care that is based on a full assessment completed by the home thus ensuring an understanding that all service users know that the home can meet their needs. EVIDENCE: The home provides a Statement of Purpose, outlining the services available within the home. The Statement of purpose requires minor adjustments, to ensure that service users are provided with all information regarding the services that the home provides. Assessments are completed prior to admission to the home as per the company’s admissions and referral procedure. Prospective service users are invited to look around the home. Relatives invariably visit the home prior to admission of their next of kin to the home. The initial admission would be on a trial period for a mutually agreed
Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 10 length of time, which can be extended if need be. This allows the staff ample opportunity to further assess the service user’s needs and to formulate a care plan. Feedback from service users determined that their basic needs are being met. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 11 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 & 10 Care plans reflect health, personal, and social needs of service users ensure needs are being meet. Records are held appropriately ensuring that the confidentiality of the service user is maintained. Service users are consulted with as part of the quality assurance system of the home. However, service users meeting are not taking place and should be intoduced. EVIDENCE: All service users care plans were generated from the pre admission assessment and provides the basis of care to be offered to the individual. All care plans detail specific actions to be taken by the staff to ensure all aspects of the service users health, personal and social care needs are met. All service users have an individual care plan and an allocated key worker to support them in the home. Individual daily notes and guidelines for the service users where observed within the home. All service users are supported within the Care Management Framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. All care plans are reviewed periodically to ensure monitoring and changing needs can be addressed. All service users spoken with appeared well cared for clean. Self-care is promoted within the home where ever possible. Appropriate risk assessments are in place to ensure an appropriate level of support is offered. All necessary equipment is provided within the home to meet service users needs. Following
Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 12 discussions with service users is was confirmed that the staff are very caring and supportive, encouraging them to make decisions about their lives with appropriate assistance provided. Service users commented that they felt respected at all times. There is a need for service users meeting to commence within the home to ensure that service users are given suitable opportunity to express their views, issues, topics of discussions and concerns on a regular basis. This will also encourage and further empower the service users to be involved in the running of the home. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 13 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 The home supports all service users to maintain family, representative and community links as they wish, thus empowering and encouraging service users to maintain, respect, dignity and personal autonomy over choices in their lives. Wholesome, adequate meals are provided within the home presenting a wellbalanced nutritious diet for all service users supporting them to maintain a healthy life. Meal choices are restricted and does not reflect or enable positive encouragement for choices to be made. EVIDENCE: All service users are actively encouraged to maintained positive links with family, friends and or representatives. The home has a policy and procedure regarding visitors to the home, which promotes service user selfdetermination. Following feedback from a number of service users positive comments were received regarding the meals within the home. A number of service users feedback that choices over meals was very limited. The registered manager determined that meal choices require developing within the home and a working party is to commence to develop an internal system within the home that actively promotes and encourages choice and independence for all service users. Services users confirmed that the daily routines within the house support and promote their independence. One
Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 14 service user discussed that she felt respected and dignified by the staff, stating that they were very kind and considerate. Staff and service users were observed to interact within each other well, providing mutual respect for one another. Service users were not restricted to access to the home and grounds. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 15 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): Service users views are listened to, changes are required to the complaints procedure to ensure that views and clear actions are taken. Robust policies, procedures are in place to ensure service users are protected and safe. Training must be arranged and cascaded to all staff in order to raise staff awareness in the protection of service users. EVIDENCE: The complaint procedure is not suitably displayed within the home to promote an active, transparent approach to the management of complaints. The complaint procedures requires up dating ensuring that it includes information and the process for complainants to follow if they wished to make a direct complaint about the management of the home. Feedback mechanisms must be in place for the solutions and resolutions of the complaints to be adequately fed back to the complainants. A central recording system is required for all details and records of the complaints to be logged and held. Robust procedures are in place to ensure that service users are protected from abuse and harm. The home must ensure that staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 16 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, 20, 21, 22, 23, 24, 25 & 26 The home is in need of some continued maintenance and general redecoration to ensure it functions as a homely, comfortable, safe environment for the service users showing compliance with relevant legislation. Each service users individual space within the home is well maintained, reflecting individual choices and preferences. EVIDENCE: The home offers bathing adaptations to meet the needs of individual service users. Specialist equipment was observed through out the home and included, hoists, pressure mattresses and height adjustable beds. Individual rooms are extremely personalised reflecting the individual characters of the service users. Shared space is appropriate to the needs of the service users. Some areas within the home have been redecorated and a plan of works is in place to ensure this is completed. Areas that are complete
Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 17 within the home are airy, bright, clan and hygienic promoting a homely functioning environment for the service users. There is a need for a number of carpets to be replaced. The manager stated that there are plans in place to replace the foyer carpet in the next financial year. A number of service users bedroom carpets were malodourous, there is need for these to be clean or suitably replaced, The home offers suitable light, heat and ventilation. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 18 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): None Not Inspected EVIDENCE: Not inspected Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 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 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): The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. Systems for effective health and safety management are in place, works are still required to ensure the safety is maintained within the home. EVIDENCE: The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere, staff and service users spoken to commented that they feel extremely supported and they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The service users appeared to benefit from this well structured and well run home. Service users
Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 20 spoken to during the inspection appeared to be happy with the home and appeared to be relaxed in their environment. There are a vast range of policies and procedural guidelines in place. Staff are requested to read and sign risk assessments and polices. All records required by regulation were available and maintained. All records are secure within the home and were up to date and held in accordance with the Data Protection Act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. The cook is required to complete a recognised food hygiene and safety certificate and manual handling training. The chipped crockery in use, must be replaced, promoting effective infection control management. Feedback from a number of service users determined that an effective system for meal choices must be implemented to promote choice systems. There is a need for the implementation of a detailed fire premises risk assessment. Details and relevant contacts were provided for the manager. The last inspection report is also to be on display, so all service users and visitors have access at all times. The home provides support to a service user who requires the use of oxygen in their room. There is a need for an appropriate oxygen safety sign to be on display where the oxygen is located and this to be further identified on the site plans in case of a fire emergency. Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 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. 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 2 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 2 3 3 3 3 3 3 2 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 3 3 3 X X X X 2 Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 22 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 OP1 Regulation 4 (1) (b) Requirement The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users’ guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the home’s service user’s guide. The Statement of Purpose must contain information as to the facilities and services, which are to be provided by the registered person for the service user, including the arrangements for cleaning a service users room in their absence. The registered person conducts the home so as to maximise service users’ capacity to
DS0000019520.V259229.R01.S.doc Timescale for action 31/10/05 2 OP14 12 (2) & (3) 30/11/05 Seymour House Version 5.0 Page 23 3 OP15 16(2)(i) 12(2)&(3) exercise personal autonomy and choice. Service user meetings to commence to ensure effective consultation. The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. Effective meal choice systems must be implemented and effectively working within the home. The complaints procedure must be displayed within the home. The complaints procedure must detail guidelines for making direct complaints regarding the management of the home. Information regarding the method for complainants to receive feedback must be contained within the procedure. All actions taken, letters and other relevant correspondence must be held centrally for clear tracking to occur. The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. Training must be completed by 31/12/05 4 OP17OP16 22 31/10/05 5 OP18 13 (6) & 18 (1) (a) 15/01/06 Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 24 6 OP26OP19 23 (2) (d) 7 OP38 13(3)& (14),18 (1) all staff to ensure service user protection. The home must complete a detailed redecoration and renewal programme to ensure a minimum standard internal and external decoration is maintained. Foyer and malodours carpets to be replaced. The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. • A detailed premises fire risk assessment to be completed. • The cook to complete food hygiene and manual handling training. • Chipped crockery to be replaced. • Oxygen sign to be erected on rooms where it is stored. 01/04/06 15/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Seymour House DS0000019520.V259229.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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