Inspection on 10/01/07 for Silver Howe

This inspection was carried out on 10th January 2007.

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

Other inspections for this house

Silver Howe 24/09/08

Silver Howe 05/12/07

Silver Howe 21/03/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Silver Howe Dalton Drive Sedbergh Road Kendal Cumbria LA9 6AQ Lead Inspector Ray Mowat Unannounced Inspection 09:00 10 January 2007 th 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 Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Howe Address Dalton Drive Sedbergh Road Kendal Cumbria LA9 6AQ 01333 340421 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) Hometrust Care Limited Vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (30) of places Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 30 service users to include: up to 30 service users in the category OP (Old age, not falling within any other category) up to 3 service users in the category DE(E) (Dementia over 65 years of age) 21st March 2006 Date of last inspection Brief Description of the Service: Silver Howe is a large detached Victorian building, set in its own grounds in a quiet residential area, on the outskirts of Kendal, Cumbria. It is accessed by a private road at the end of a cul-de-sac. Public transport is within walking distance and the town centre is approximately a mile away. Silver Howe is registered to provide residential care to thirty older people, including up to three people with dementia. All the bedrooms are single, ten of which have en-suite facilities. The home is on three floors, which are accessed by a passenger lift or one of the two staircases. The top floor is used by staff and provides private living accommodation. There are two lounge areas on the ground floor, and one on the first floor with two dining areas, one for each floor. The home provides a good range of adapted bathing/shower and toilet facilities. There is parking to the front of the building with wheelchair access to the side door. The grounds and gardens are attractively landscaped and well maintained. To the rear of the home there is ramped access to both the garden and patio areas. The home provides information to residents and prospective residents in an informative brochure and service user guide, which are regularly updated. The current fees charged range from £374 to £434 depending on the size of the room and its facilities, with additional charges for personal sundry expenses such as hairdressing. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this visit I met with many of the residents either in one of the lounges or in their own rooms. I also joined a group of residents for lunch. I talked with staff as they went about their duties and met with three of them individually. I received comment cards from friends/relatives and other professionals in addition to resident’s surveys I sent out as part of this inspection. The previous manager completed a detailed questionnaire about the home sent out prior to this visit. What the service does well: What has improved since the last inspection? What they could do better: The resident’s records/personal information must be looked at regularly to make sure the information is up to date and accurate. The home should ask residents about how they want to use the lounge and support them to do this. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 6 The home should look at their policy that tells staff in how to deal with incidents involving abuse, to make sure it is up to date. Equipment in the bathrooms and toilets should be looked at to make sure it is in a good state of repair and easily cleaned. Feedback from residents about the quality of the service should be collected and a report written telling people what the home is going to do about any issues they raise. Resident’s records that identify risks and make sure they are kept safe should be looked at regularly to make sure they are up to date and accurate. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process ensures people are given suitable information to make an informed decision about moving into the home. This process also ensures the home is able to meet the individual needs of residents. EVIDENCE: The home’s service user guide and brochure provide suitable information to residents and their representatives about how the home is run and their rights and responsibilities. Terms and conditions of residence including the services provided and charges are fully explained in a written contract that is agreed and signed by the resident or their representative. I examined resident’s files, which contained signed copies of the contract. Residents funded by Adult Social Care also had a Social care contract in place explaining the terms of their stay. Prior to admission the home complete their own pre-admission assessment, which identifies individual needs and preferences and enables the home to make an informed decision about offering a place and being able to meet people’s needs. Further detailed assessments are completed once a resident is admitted to the home. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole care plans provide staff with suitable information to support residents and promote their independence. However the review and updating of care plans should be more thorough to ensure information is current and relevant. EVIDENCE: I case tracked three residents care plan files, which involves meeting the person and key staff that support them, in addition to examining their care plan and any other information held by the home. It was evident some of the care plans contained information that was no longer relevant or in need of review. It is recommended that all care plans are reviewed and updated on a regular basis, signed and dated and information that is no longer relevant is removed. The home is in the process of developing a pen picture/social history of each resident for their care plans. Those that were in place were informative and will help care staff to gain a better insight and understanding of residents and their individual needs and preferences, which is good practice. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 10 Supervisors and staff complete a daily log to monitor the care provided and any health interventions with relevant information transferred into individual care plans. There was evidence of a range of health professionals being involved with the home on a regular basis such as the Occupational Therapist, District Nurse and GPs. The home monitors nutrition, weight and pressure care with suitable assessments completed to maintain and promote good health. New weighing scales were on order to enable the home to weigh residents who are unable to stand on the existing scales. Manual Handling assessments were in place and provided suitable guidance to safeguard both residents and staff. Based on my observations of and discussions with staff they were knowledgeable about residents personal and healthcare needs and were observed being attentative, whilst promoting people’s independence. Residents I spoke to felt “well looked after”, with one resident describing the staff as “marvellous, they will do anything for you even though they are busy”. The home has sound systems in place to record and monitor all the medication coming into or leaving the home. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although on the whole people were being supported to pursue their interests and hobbies, how residents are involved in and given choice in how the home is run and how they live their daily lives could be improved. EVIDENCE: Since the last inspection the layout of the main lounge downstairs had been altered with all the chairs being placed around the outside walls in a square. Previously the chairs were back to back and in a less uniform layout, with some looking out onto the garden and some facing the television. None of the residents I talked to were aware of why the room layout had been altered or if their had been any consultation. Whilst I was in the lounge both the television and radio were on at the same time in close proximity to each other making it difficult to concentrate on either of them. It is recommended the home consult with residents about the layout and usage of the lounge area and equipment to ensure their needs and preferences are responded to. Residents were seen to move freely around the home with access to the upstairs via one of the two staircases or the passenger lift. There are four Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 12 communal lounges where residents can socialise or find a quiet corner to relax or read. Some of the residents I met said how much enjoyment they got from spending time in the gardens in the summer months. Based on discussions with residents they had enjoyed the Christmas and New Year festivities, which included a Christmas party and visiting entertainers who provided a show. During the day some residents were observed joining in a group activity whilst others pursued their own interests, which included reading, sewing, watching TV, crosswords. Some residents enjoyed going out for a walk on their own or with their relatives. There were frequent visitors to the home during the inspection. There is a notice board in the main lounge that is used to advertise forthcoming events and other relevant information about the local community and services available to people. I examined some quality assurance responses from residents that made comment about activities provided but currently no action had been taken in response to them. The home had recently recruited a new cook, which has had a positive effect on the quality and choice of food provided. He was consulting with residents and ensuring their preferences were recorded and responded to. I joined a group of residents for lunch, this was served in the downstairs and upstairs dining rooms. The meal was freshly prepared and home cooked with all the residents I spoke to confirming that the “quality and quantity of food was good”. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adult protection policies and procedures need to be more robust and updated in line with current legislation, to ensure residents are safeguarded. EVIDENCE: The home has a suitable complaints policy and procedure in place, which is supplied to all residents in the service user guide and is displayed in the home. There have been four complaints since the last inspection with two of the complaints partially substantiated. Not all the complaints records were available during the inspection as they were being held in the Trust’s central office. All the complaints had been responded to within the 28-day period. The home has purchased a training package relating to mistreatment and abuse of vulnerable adults for use with the care staff. The acting manager also has plans to attend further training to enable her to deliver in-house training. Staff spoken to were aware of their responsibilities in identifying and reporting abuse. The home has a copy of the latest local Adult Protection procedures, however it is recommended their own policy and procedure be reviewed to ensure it is up to date and in line with this new policy and current legislation relating to the Protection of Vulnerable Adults (POVA). Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Silver Howe provides a safe and comfortable living environment. It is clean, hygienic and well maintained. EVIDENCE: The home has developed a quality improvement and refurbishment programme for the coming year, which will ensure the home environment and grounds are maintained to a suitable standard. This included a proposal to increase the size of the home by three en suite rooms that will require a major variation to be submitted. All areas of the home I examined were well maintained, clean and hygienic. There are dedicated domestic staff who maintain this standard something that is very important to the residents I spoke with. The home also employs a handyman who takes a lead role in monitoring the maintenance and servicing of equipment and services. The bedrooms I inspected were personalised with residents having their own furniture and belongings around them. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 15 There was work being completed on the front entrance to improve access and the manager’s office was going to be relocated to create more work space. The home liaises with specialist health services to ensure appropriate aids and adaptations are in place for individuals to maintain and promote their independence. It is recommended the home examine all the toilet seat raisers as the legs of two of these that I examined were rusty and therefore cannot be properly cleaned. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are knowledgeable and well trained providing appropriate support to residents. They are clear about their role and responsibilities and provide a consistent service. EVIDENCE: Based on my discussions with residents, staff and examination of the staff rota there are sufficient staff on duty to meet the needs of the current residents. Call bells were answered efficiently and staff were seen to spend quality time with residents when they were providing care or support. Since the last inspection a training plan has been developed, which ensures staff training and development needs are assessed and responded to. A new induction and foundation training pack had been purchased for use with all new staff. The induction process includes several shifts where the new staff are supernumerary to the staff team enabling them to familiarise themselves with the residents and the routines of the home. There was evidence on individual training records that other mandatory training was also being provided within the required timescales. Staff records were on the whole complete and up to date with an individual personnel file in place for all staff. All staff are issued with an informative handbook, contract and job description, which clarifies their role and responsibilities. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 17 Although police checks and references from their country of origin were in place for some overseas staff, it is recommended criminal record bureau checks (CRB) are also completed. In the interim period a Protection of Vulnerable Adults check (POVA first) should be in place. I met with staff as they went about their duties in addition to speaking to three staff individually. They had a good awareness of their role and responsibilities and from my observations and discussions had developed positive relationships with the residents. As one resident described them “they are always polite and nothing is too much trouble for them”. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager has settled in well and works closely with the senior team to maintain a continuity of care for residents. She is developing her skills and knowledge in the management role. EVIDENCE: The Trust has appointed an acting manager, Tamara Hope to cover the vacancy left when the previous manager resigned. Ms Hope has transferred from one of the Trusts other homes. She has two years experience as a deputy manager and has obtained NVQ 2 & 3 qualifications and is working toward the NVQ level 4 and registered manager award. Ms Hope has limited management experience and is still developing her knowledge of relevant legislation. A senior manager is acting as a mentor providing support and guidance through regular management meetings. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 19 Ms Hope has held meetings with the residents and staff enabling them to raise issues and concerns and has made a positive impact since her appointment. The residents and staff confirmed that she provides good support and is approachable. I examined eight returns from a residents’ quality assurance survey, which on the whole were positive, however the results from these should now be collated and the outcomes feedback to all interested parties. Fees and invoices for personal sundries are invoiced on a regular basis. The home only holds a small amount of personal monies for a few residents. I spot-checked the monies held against the records and found these to be accurate, with a robust system in place to safeguard personal finances. Due to the change of manager the frequency of supervision has slipped, however there were plans in place that staff were aware of to correct this situation. I examined records relating to maintenance, servicing and health and safety within the home. On the whole these were up to date and accurate, however there is a need to review risk assessments to ensure they are up to date and reflect the current situation. Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 2 Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(6) Requirement All care plans must be reviewed and updated on a regular basis and information that is no longer relevant must be removed. Timescale for action 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations It is recommended the home consult with residents about the layout and usage of the lounge area and equipment, to ensure their needs and preferences are responded to. It is recommended the home’s adult protection policy and procedure be reviewed to ensure it is up to date and in line with the local policy and current legislation relating to the Protection of Vulnerable Adults (POVA). It is recommended the home examine all the toilet seat raisers as the legs of two of these that I examined were rusty and therefore cannot be properly cleaned. 2. OP18 3. OP19 Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 22 4. OP33 The quality assurance survey results should now be collated and the outcomes feedback to all interested parties. It is recommended all risk assessments be reviewed to ensure they are up to date and reflect the current situation. 5. OP38 Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Silver Howe DS0000066837.V308621.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!