CARE HOMES FOR OLDER PEOPLE
Sherwell St Ives Road Carbis Bay St Ives Cornwall TR26 2SF Lead Inspector
Paul Freeman Announced 25 April 2005 10.00 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. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Sherwell Address St Ives Road Carbis Bay St Ives Cornwall TR26 2SF 01736 796142 01736 796142 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) Mr Ronald James Cottam N/A Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 22 November 2004 Brief Description of the Service: Sherwell is situated on the main Road to St Ives and has panoramic sea views to the front of the property. The present registered person who is in day to day control of the care home has been in charge since 1984. The Home accommodates nine older people and Sherwell aims to provide ‘a small family unit’ that is based upon promoting independence and service user lead care. Since April 2001 an extensive refurbishment programme has occurred and phase 1 is now completed. The registered person is now considering extending the property and refurbishing some of the facilities. A small car park is located at the front of the property and the garden area is currently being improved. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day. The Inspectors spoke to the owner, all of the residents and staff and toured the premises. Records, documents and policies and procedures were also examined. Outstanding requirements and recommendations from previous inspections have been renotified in this report. What the service does well:
Prospective residents are provided with the opportunity to visit the care home as part of their decision making process. Each prospective resident is also provided with written information about the care home. Residents are positive about the manner in which staff treat them and this has a pleasing effect on their day to day lives. Any concern about a resident’s health is dealt with promptly and arrangements are in place to make sure all a resident’s health needs are met. Positive arrangements are in place for the safe-keeping and administration of medicines. Wholesome and nutritional meals are provided that reflect residents preference and choice. There are no restrictions to residents raising concerns with the care home or the Commission and any issues are dealt with and appropriate records are kept. Residents said they were very satisfied with the standard of hygiene and cleanliness and the care home is furnished to a good standard. Experienced staff are on duty each day and night and the staff have successfully completed a wide range of training. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
The information collected and recorded in resident’s assessments needs to be improved. This will further develop the service provided. Care Plan arrangements also require improvement and each resident must have a care plan. This will assist the staff in meeting the residents’ needs in the manner of their choice and preference. Reliable arrangements need to be established to regularly review the care plans to make sure the service provided is up to date and comprehensive. The care home does not have robust arrangements to manage avoidable risks and to ensure all reasonable steps are taken to protect the residents and staff. The kitchen at the care home requires refurbishment. The arrangements for adult protection must be recorded in a policy and procedure and this needs to reflect the Department of Health’s Guidance ‘No Secrets’. This will tell the staff what steps to take if any concerns arise. The home need to keep an up to date staff duty roster that tells residents who is due to be on duty and makes sure the minimum number of staff are on duty at all times.
Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 7 Staff need to be better informed about their roles and responsibilities about working in a safe manner. This will make sure that a high standard of safety is provided at the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 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 standard(s) 1, 3, 5 and 6. The care home has written comprehensive information about the facilities and services provided. Prospective residents are given a copy of the information to help them to make an informed decision about the care home. Prospective residents are also able to visit the care home as part of the decision making process. Each prospective resident has an assessment of their needs but the current arrangements need to be improved. This will make sure all needs are taken account of and support is provided in the manner preferred by the resident. EVIDENCE: The care home has in place an informative statement of purpose and service users guide that details the facilities and services provided. New service users are assessed by the care home to make sure their needs can be met and where appropriate the views of social workers and health professionals are obtained. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 10 Prospective residents and their relatives or representatives also have the opportunity to visit the care home to help decide if this is a suitable place for them to live. The home has a flexible approach about the visiting arrangements. The care home does not provide a dedicated rehabilitation service but is keen to help residents to keep their independence. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 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 standard(s) 7, 8, 9 and 10. The care provided is satisfactory and residents are treated in a respectful and dignified manner. The documentation supporting the caring activity is inadequate. Care plans need to be more detailed, regularly reviewed and reliable arrangements to manage risks need to be established. This will further improve the service and the safety of residents. Residents health needs are well catered for and positive arrangements are in place for the administration of medicines. EVIDENCE: Not all residents have a care plan. The care plans in place provide insufficient detail to appropriately meet the needs of the residents. Reviews need to be undertaken each month when each aspect of the person’s needs is considered. The quality of the records does not accurately reflect the quality of the care provided. The arrangements in place to minimise risk to residents also need to be improved. On each occasion a situation arises that could compromise a resident’s safety a risk assessment needs to be undertaken. Any action required to minimise the assessed risks will then need to be part of the individuals care plan. Residents said they were satisfied with the care support and assistance provided by the staff.
Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 12 The records confirm the care home have a positive approach to meeting the health needs of residents. Residents said the Doctor was promptly called when any concerns arise. Residents are also supported to access specialist medical services like the opticians, chiropodist and dentist. The care home has reliable arrangements in place for the storage and administration of medication. Residents said they were treated in a dignified and respectful manner by staff at the home. Observations were made of staff addressing resident by their preferred title, knocking on doors before entering and conversing with residents in a positive manner. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 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 standard(s) 13 and 15 The visiting arrangements are flexible and visitors are well received by the staff. This helps residents to keep regular links with their family and friends. There are no restrictions to residents accessing the community and local facilities when it is safe to so. Wholesome meals are provided each day that reflects the choices and preferences of residents. Refreshments are also provided throughout the day or when required by the resident. The care home is planning to improve the kitchen facilities in the next year. EVIDENCE: Residents said there are no visiting restrictions and the staff positively welcome any visitors. Residents decide where they meet with visitors and the staff will support them if they decide they do not wish to receive a visitor. There are opportunities for residents to participate in a number of activities outside the care home, which include a local lunch club, and organised activities at a nearby care home. Residents are very satisfied with the food provided and commented on the quality of the meals. The cook ensures the meals are nutritional and meets with the preference and choice of the residents. Mr Cottam the owner of the care home is planning to refurbish the kitchen and dining room in the year ahead.
Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Arrangements for protecting residents need to be recorded in a policy and procedure document the staff is familiar with. This will make sure that any concerns are dealt with in a positive way. Any complaints or concerns are dealt with satisfactorily. EVIDENCE: A policy and procedure about complaints has been given to all the residents who are able to raise any issues of concern with Mr Cottam or the staff. Each formal complaint is recorded, investigated and the complainant receives a letter that details the findings and any action that will be taken. There are no restrictions to the Commission being contacted about concerns. One complaint had been received by the care home and this had been dealt with satisfactorily. The documents regarding the arrangements for the protection of residents were not available for inspection. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.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) 0 The standards were not assessed in detail. The environment is well maintained and clean at all times. A number of the bedrooms have been personalised by the occupants and a good standard of furniture and fittings are provided. It was observed that work had commenced on the garden to create a safe attractive area for residents. EVIDENCE: The environment was tidy, clean and well maintained. Residents said they were satisfied with the facilities provided and standard of hygiene maintained. Work has commenced on the garden to provide a safe and attractive area for residents to access. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 30 The number of staff on duty each day and night is satisfactory to meets the needs of the residents. Staff at the home are trained but the training opportunities could be organised better. EVIDENCE: Staffing levels each day appear to meet the minimum standard. One staff member is on duty during waking hours and Mr Cottam acts as a second carer. A cook is employed each weekday and a staff member stays at the care home each night to deal with any needs residents may have. A duty roster was not available for inspection. The staff at the care home all have a lot of experience of providing care. All staff at the care home also have opportunities to attend training courses but their training could be better organised. Some of the staff are also NVQ 2 trained. Residents said they were very satisfied with the staff and felt confident in the care they provide. The arrangements for introducing new staff were not examined on this occasion. No new staff had started at the care home in recent weeks. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 35, 36, 37 and 38. The arrangements to supervise and meet with staff need to be improved. Records are kept of events that occur to service users each day but they need to be developed. The guidance for staff and residents about safe working and certain record keeping practices are not satisfactory. EVIDENCE: The care home do not assist any residents to manage their monies and it is the policy that where assistance is required this is provided by an independent third party. Staff said they have access to reliable advice and guidance from Mr Cottam on a day to day basis. There are no arrangements to formally supervise staff on a regular basis. Staff meetings occur when required but there is no regular pattern and a record is not kept of the meeting.
Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 18 The staff at the home keeps a daily record of events that occur to residents. There are no barriers to residents looking at the records. The records continue to improve but need to be developed further. The home have policies and procedures to promote safe working practices but all these need to be updated to make sure the current legal requirements are met and the staff are fully aware of their roles and responsibilities. Positive arrangements are in place to maintain the equipment and services provided at the care home and the arrangements about fire protection have recently been improved. The current arrangements for wedging doors open and recording accidents that occur are not satisfactory. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 3 x 2 x 3 N/A 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 x 13 3 14 x 15 2
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x x x 3 2 2 1 Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 20 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 3 Regulation 14 Requirement Service users assessment must be in sufficent detail to identify needs, the means of meeting need and to determine the care home are able to meet the assessed needs of the service user. Records must be maintained that demonstrate how the care home meets the needs of service users. (Previous timescale of 30.3.05 not met) Detailed Service User Plans must be introduced for all service users. (Previous timescale of 28.2.05 not met) Care plans must be reviewed each month and a suitable record must be made. (Previous timescale of 30.3.05 not met) Risk assessments must be undertaken and recorded when any situation arises that could compromise a service user’s health, safety or well being. (Previous timescale of 28.2.05 not met) A policy and procedure regarding Timescale for action 30.6.05 2. 4 12, 14 30.8.05 3. 7 14, 15 30.8.05 4. 7 15 30.9.05 5. 7 12, 13 30.6.05 6.
Sherwell 11 12 30.10.05
Page 21 D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 7. 15 23 8. 18 12, 17 and schedule 4 9. 21 23 10. 27 17 and schedule 4 11. 29 18, 19 and schedule 2 19 and schedule 2 18 12. 29 13. 30 14. 33 24 15.
Sherwell 36 18 terminal care and death must be established and a system for recording service users’ preferences must be set up. The kitchen wall and kitchen door that adjoin the dining room must comply with the fire regulations. Policies, procedures and guidelines regarding protection must established and reflect the department of Healths guidance No Secrets. (Previous timescale of 30.1.05 not met) If occupancy exceeds eight service users the bathroom on the first floor must be available for use. An accurate and up to date duty roster must be maintained that details who is due to work and who actually worked each day and night. (Previous timescale of 30.12.04 not met) The recruitment and selection arrangements must be developed to be more robust and meet the requirements stated in schedule 2. New staff members must not commence care duties until the registered person has received a satisfactory POVA check Induction training documentation and individual staff training and development records must be introduced. Formal quality assurance processes that are verifiable must be introduced. The conclusion of the review must be recorded and made available to interested parties. Formal supervision of staff with appropriate records of each 30.12.05 30.5.05 30.9.05 30.5.05 30.7.05 30.8.05 30.9.05 30.9.05 30.9.05
Page 22 D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 16. 37 17 17. 38 13, 23 18. 38 12, 13 and 17 19. 38 12, 13 and 23 session must be introduced. (Previous timescale of 30.3.05 not met) Improved arrangements for service users daily recording must be established. The records must state the events that have occurred that day, any action that staff undertook and the outcome of these action where necessary. Service users’ daily records must be user friendly and accessible to service users. The registered person must make arrangements to ensure that nominated fire doors are not wedged open at any time. (Previous timescale of 30.1.05 not met) The accident book must be completed in a manner that details the circumstances of the accident, the action taken and the outcome of the action. All Health and Safety policies and procedures must be reviewed, updated and adjusted accordingly. Where appropriate professional advice must be sought. (Previous timescale of 30.3.05 not met) 30.7.05 30.5.05 30.5.05 30.7.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 31 Good Practice Recommendations The registered person or a registered manager should have obtained or commenced the registered manger award in care and management by 31 december 2005. Sherwell D52-D04 S9163 Sherwell V212974 250405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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