Inspection on 07/01/09 for Seymour House

This inspection was carried out on 7th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Seymour House 08/01/08

Seymour House 17/09/07

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Seymour House 13-17 Rectory Road Rickmansworth Hertfordshire WD3 1FH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marian Byrne     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Seymour House 13-17 Rectory Road Rickmansworth Hertfordshire WD3 1FH 01923778788 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): seymourhouse@boltblue.com Mr M Rhemtulla Name of registered manager (if applicable) Miss Yasmin Rhemtulla Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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 home may accommodate one (named) female service user currently 59 years old. 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. Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 25 care home 38 Over 65 38 38 0 0 Brief description of the care 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. Copies of the latest inspection report from the Commission for Social care Inspection (CSCI) are available in the home together with a service user?s guide. The current weekly placement fee for each service user is between #407 and #470 (due to be reviewed in April 2008). 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. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We inspected Seymour House on the 7th January 2009. The inspection was carried out over one day by three inspectors including a pharmacist inspector. We spent time in the lounge observing the day to day life of the home. We inspected records pertaining to the care of the residents, staff training and recruitment. We sent surveys to staff and residents at the home so that they could tell us about their experiences of the home. The Manager of the home returned our Annual Quality Assurance Assessment (AQAA) within the directed timescales. It is a legal requirement that the home do this. The AQAA is a self-assessment that looks at how well the home is meeting outcomes for the people who live there. It also gives some important numerical information.The Care Homes for Older People Page 6 of 25 AQAA tells us what has been happening in the home in the past year. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be confident that they will be appropriately assessed and will only be admitted to Seymour House if their care needs can be met. Evidence: We inspected five care plans and we found evidence that the prospective residents are offered a full assessment of needs. They are invited to the home to spend time there prior to being admitted. They are provided with a Service Users Guide and a Statement of Purpose to assist them in making a decision. The Service Users Guide and Statement of Purpose have been updated and we found that they reflect the service available to the residents. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be sure that their needs, wants and wishes will be identified and where possible met. They will be treated as an individual and care will be given in a manner that upholds their dignity. They can be sure that their medication will be appropriately stored and administered to ensure their safety and well being. Evidence: On the day of the inspection we noted that all the residents we saw were well presented in freshly laundered and ironed clothes. We spoke with many of the residents who told us that they were well looked after, they told us that the staff were kind and patient. We observed care being delivered in a manner that was respectful, kind and caring. Care plans were where possible drawn up with input from the service user or their representatives. The care plans contained good information for staff and clear directions for the delivery of care to the residents. Staff clearly know the residents and their needs. Notes are updated twice daily on handover at the change of Care Homes for Older People Page 11 of 25 Evidence: shifts. The home has a person centred care ethos. By this we mean the when care is given to the residents the staff focus on the person they are giving care to and not the task they are doing. This means that the residents dignity is promoted and their care is administered as they would wish it to be. The residents we spoke with verified this. They told us that they are not rushed and the staff follow their pace. The care plans contain detailed risk assessments and they identify where a resident needs two staff to assist them to mobilise. This is a small home and staff clearly know the residents and their needs so the outcomes for the people who live there are good. The inspection of the medication standard was conducted by the Commissions pharmacist inspector Mark Andrews. This follows previous similar inspections conducted 8th January 2007 and 9th June 2008. During the inspection we looked at how the home was storing, recording and administering medicines to people living there. We also examined associated records including staff training certificates and some peoples care notes. We found the arrangements for the storage and security of medicines to be satisfactory. Since the previous inspection the home has fitted additional security to the window of the room where medicines are stored. The medicine refrigerator was in use and the home was monitoring and recording daily temperatures. These were within the accepted range but the electronic display device showed the temperature slightly below range on the day of inspection. We discussed this with the manager who said the device may be showing the refrigerators minimum temperature. The home operates a clear system for medicine administration. Most medicines are supplied in and administered from 7-day cassettes. The medication charts are 7-day charts reflecting the contents of the cassettes. Some other medicines are prescribed and administered. These are recorded on 28-day medication charts. The home keeps additional audit records that enable a running total of medicines remaining which enables good monitoring and control of the medicines. There were similar 28-day medication chart records for the administration of external medicines such as creams. At the time of the previous inspection we were told medicines are not refused by people. During this inspection we saw records where people have refused their medicines. There were corresponding records where the these medicines had been returned to the pharmacy. Records we looked at enabled medicines to be accounted for in full. However, we did see a persons records who had recently been admitted to hospital recorded as R equating to refused where incorrect codes had been used to record the reason why the medicines had not been administered. We accepted that a further explanatory note had also been written on the medication chart. We noted that there were no oral medicines such as painkillers, laxatives, anti psychotic medicines (for the management of peoples psychological agitation) prescribed for administration only when required and at the discretion of people and members of staff. All are Care Homes for Older People Page 12 of 25 Evidence: administered routinely. The manager gave assurances that this was the prescribers intention and that each person received a minimum three-monthly review of medication by their GP. The home does not offer people non-prescription medicines such as paracetamol tablets for occasional use. The manager said in each case the GP or on-call services are contacted for advice and if necessary a prescription obtained. For a person who self-administers their insulin and maintains independence with this there was a comprehensive risk assessment in place. The person records when they have self-administered the insulin. We noted an additional medication chart intended to record when staff provide the person with a new vial of insulin but the signed records suggested the insulin had been administered by staff. We discussed this with the manager in order to encourage these records to be clarified. We visited the persons room to see how safely the insulin was being stored. The home provides a lockable drawer in which to store the insulin. At the time of the inspection the insulin pen and vial were not stored in the lockable drawer but the vial was empty and awaiting replacement. Overall, the home is supporting this person well to maintain their independence safely. At the time of inspection we were informed there was one person currently having difficulty swallowing one of their oral medicines. When we examined care notes this was fully documented and clear guidance on breaking the tablet had been provided for staff to refer to. During the inspection we observed part of the lunchtime medicine round conducted in the dining area. We noted that the order followed by the senior carer for medicine administration was correct. However, we found that whilst wearing latex gloves the senior carer removed medicines from the cassette containers by hand and placed them in peoples hand to take. The latex gloves were not replaced after each persons medicines were given and were used for general handling of the containers and medicine trolley. We raised this practice as being unsafe hygienically and we discussed with the manager the use of small plastic vessels to enable medicines to be transferred hygienically from the containers to give to people to take them. The deputy manager said the home already had a number of such vessels available to use. At the time of inspection we were informed there was one person currently having difficulty swallowing one of their oral medicines. When we examined care notes this was fully documented and clear guidance on breaking the tablet had been provided for staff to refer to. The latex gloves were not replaced after each persons medicines were given and were used for general handling of the containers and medicine trolley. We raised this practice as being unsafe hygienically and we discussed with the manager the use of small plastic vessels to enable medicines to be transferred hygienically from the Care Homes for Older People Page 13 of 25 Evidence: containers to give to people to take them. Residents have access to health care professionals and they are called to attend the residents when necessary. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure that they have their daily needs identified and met. They can be sure that they will receive a healthy and varied diet. Evidence: The home offers a variety of activities to suit all the residents who live in the home. Each resident has a list of the weekly activities in their room. this lists the daily activities with the times set out clearly. The residents can choose what activities they want to be part of. On the day of the inspection we found the sitting rooms set out in a manner that allows the residents to communicate easily with each other and the staff. There was a variety of magazines to suit all tastes. There were board games and residents had the opportunity to knit and to do other crafts. We saw staff gently guide residents through a very gently exercise routine. We saw staff attend to frightened residents in a gentle calming manner. The music that was playing in the lounge gave a calm and relaxing atmosphere. We saw a good structure to the home where individual needs were assessed and provided for. The residents we spoke to told us that they were very happy in the home and that there was always something to do. We were told that the staff and manager listen to the residents and make changes where they can. An example of this is one residents Care Homes for Older People Page 15 of 25 Evidence: has been chosen to be a representative of all the residents. Every day that person speaks to each resident and gives them an opportunity to say if there is anything they are unhappy with. They showed us the notes they make daily. An example of how the staff and manager listened to them is, the residents felt that lunch was served too early and they would prefer it later. This was done and the lunch was put back to meet with their wishes. We observed a resident assist staff set the tables for lunch. This was done as a team making the resident feel appreciated. We spoke to residents visitors who told us that the day of the inspection was a typical day in the home. They told us that they are welcomed into the home at all reasonable times and are offered refreshments. We noted that the residents were well presented in well laundered and ironed clothes. It was clear that for some of the residents that their appearance was very important to them and that their choice of clothes represented them as individuals. An example of this was one resident who was very formally dressed. Thus ensuring that their individuality and dignity was respected. One person told us that they love to go for a walk and confirmed that staff take them for a walk every day. We were told that the food is very good. We tasted it and found it to be of pleasing appearance and very tasty. Meal time was calm and relaxing. Staff clearly know the residents and their needs at lunch times. Residents were assisted to eat in a manner that preserved their dignity. There was free access to snacks in each of the two lounges. We saw fresh fruit, chocolate, biscuits and a variety of savoury snacks. We were told by residents and visitors that they were always available. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure that any complaint they may have will be taken seriously and investigated. They can be sure that they will be protected from abuse while living in the home. Evidence: The home has a complaints procedure that they follow. There were no complaints since the last inspection. As stated earlier in the report a resident asks all the residents on a daily basis if they have any issues and they are dealt with before they can become an issue. We saw letters complimenting the home on the care they offer to the residents. Staff we spoke with were fully aware of the issues pertaining to the safeguarding of adults. All had up to date training and they were able to tell the inspectors what constitutes abuse and what action they are required to take if such event occurred. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure that it meets their needs. They can be sure that it is well maintained, clean and fresh Evidence: On the day of the inspection the home was clean fresh and well maintained. All the residents rooms were clean and fresh. The residents have decorated and furnished their rooms to reflect their personal taste and their personalities. At present two more bedrooms and a sitting room are being added to the home once completed the home will apply to this Commission to change their registration to increase the number of residents they can admit. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can be sure that the staffing group are trained to meet their needs and there will be sufficient staff on duty to meet their needs. They can be sure that staff are recruited appropriately. This means that the safety will be promoted. Evidence: We found that the home was well staffed on the day of the inspection. This allows staff to meet the needs and wishes of the residents. The home has two sitting rooms one has a higher ratio of staff that the other. Residents who need more care are cared for in the larger lounge. The outcomes for the residents - by this we mean what its like for the person living there - are good. Staff clearly contribute to this by knowing how to meet the needs of the residents and delivering care in a manner that maintains their dignity and promotes independence. We observed the staff to be well trained in the delivery of care and the promotion of independence. When we checked the training records we found further evidence of this. Staff have received all mandatory training required and in addition to this a high proportion have received in depth dementia training. Staff who returned surveys indicated that they were very happy working in the home and that they found the manager of the home easy to talk to. They told us that the Care Homes for Older People Page 19 of 25 Evidence: training they receive allows they to care for the residents in a person centred manner. Recruitment was carried out appropriately, we inspected the three most recently recruited staff. The records contained a work history, two references, identity checks and a Criminal Records Bureau Check. The references were applied for by the Agency who recruited them from abroad these had not being verified by the Manager, however this was done within 48 hours of the inspection being completed. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home can be sure that it will be managed and run in their best interest. Evidence: The home is well managed and is run in the best interests of the residents. As already stated the residents are cared for in a person centred manner. Staff were well trained and they told us that they are skilled in caring for residents. We observed this throughout the inspection. The Manager and Deputy Manager have recently completed a training course in the care of people who have dementia. This has enabled them to make changes to the home particularly around the use occupations of the residents, which we found to be excellent. Staff and residents told us that they find the management of the home easy to talk to and approachable. The quality assessment of the home is done annual and on a daily basis all the Care Homes for Older People Page 21 of 25 Evidence: residents are given the opportunity by a fellow resident to comment on the home and to request any changes they want to see. There are regular residents meetings. The residents looked well cared for and assured us that they were. Health and safety are taken very seriously and procedures are in place to ensure the continued health and safety of the residents. All the staff were welcoming and took time to explain what they were doing and why. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be given to 31/01/2009 people living at the home by members of staff who observe safe hygiene practises when administering medicines. You need to do this to ensure the optimum safety of the residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 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. 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