CARE HOMES FOR OLDER PEOPLE
Silverleigh Cedars Silver Street Axminster Devon EX13 5AF Lead Inspector
Vivien Stephens Unannounced 3 August 2005
rd 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. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Silverleigh Cedars Address Silver Street, Axminster, Devon EX13 5AF 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) 01297 32611 01297 32559 Silverleigh Limited Christine Susan Brooke Care Home 54 Category(ies) of DE(E) - Dementia over 65 (54) registration, with number MD(E) - Mental Disorder over 65 (54) of places PD(E) - Physical Disability over 65 (54) OP - Old Age (54) Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 25/01/2005 Brief Description of the Service: Silverleigh Cedars is a detached, converted and extended property set in its own grounds in the centre of the town of Axminster. The home is laid out in two distinct parts - one side is known as Silverleigh and the other side is known as Cedars. Accommodation and personal care is provided for up to 54 older people who may also have a physical disability, mental disorder or dementia type illness. There are five lounges and two dining rooms plus other smaller sitting areas around the home. There are 36 single bedrooms, 5 double rooms and 4 apartments each consisting of an entrance hall, living room, kitchenette, bedroom and bathroom. 30 of the bedrooms have an en suite W.C. There are bedrooms on the ground, first and second floors. Passenger lifts provide access to all levels. There is also a stair lift. Outside, there are pleasant and interesting gardens with plenty of seating, and a private parking area. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the afternoon of the 3rd August 2005. During the inspection 7 residents were interviewed, care plans were sampled, and discussions were held with 3 staff and the Manager, Sue Brooks. The inspector joined one of the activities during the afternoon. The main focus of the inspection was on the Quality Assurance processes. What the service does well:
The home takes very great care to ensure they can meet residents’ needs. Careful assessment before admission, and excellent care planning systems ensure that staff have the information and skills to meet all individual needs. The staff were able to demonstrate a confident, open and positive attitude to their work. They had a thorough understanding of the personalities, needs, likes and dislikes of each resident. They were attentive, patient and friendly towards both residents and their visitors. Good care has been taken to ensure the health needs of each resident have been met. Specialist advice and treatment have been sought and equipment provided wherever necessary. There is an exceptionally high level of activities provided. A team of activities staff including a physiotherapist are employed. Between them they provide a wide range of activities both on a group or individual, one-to-one basis. Regular outings are provided using the home’s minibus or staff will take residents out in a wheelchair or walk with them if preferred. Musical entertainments, exercise sessions, arts and crafts, games, outings and parties are just some of the activities provided. The menus are on display around the home. These are varied and balanced. Individual dietary needs are set out in the care plans, and one resident had his own menu on display in his room setting out his individual choices. The premises have been well maintained throughout. There is a team of maintenance staff who ensure repairs are carried out promptly, and all areas are well decorated. The gardens are secluded and attractive, and furnishings are homely and stylish throughout. Risk assessments have been carried out on all areas, and action has been taken to eliminate or minimise risks wherever possible. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 6 The home places great emphasis on quality assurance and continuous improvement. One of the senior care staff has been given responsibility for monitoring the quality of the care and facilities provided. An excellent system has been drawn up covering all of the National Minimum Standards and consultations have been set up will all relevant persons, with the main focus on seeking the views of the residents. Many positive outcomes have already come about as a result of this process. All of the residents interviewed were positive about the care, facilities and services. Comments included “Everything is one hundred percent here!” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 Residents’ needs are met by the home. EVIDENCE: Care plans sampled during the inspection showed that prospective new residents are assessed carefully before admission in order to ensure that the home can meet their needs. The staff and manager talked about the philosophy of the home, and what they do if they find that, after admission, the new resident’s needs are greater than they had realised. They described how the home makes every effort to ensure that staff are trained and supported to meet any unexpected problems. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 Excellent care planning systems are in place to ensure all aspects of residents’ needs are met fully, including health care needs. EVIDENCE: The care plans have been drawn up in two distinct parts – one part covers the health and personal care needs and the other part covers the daily life and social needs. The care staff has responsibility for the health and personal care plans, and they demonstrated how they follow these on a daily basis and keep accurate records to show how the plans have been met. The Activities Organisers have responsibility for the social activities care plans, and again there are detailed records kept on a daily basis. Each staff team has methods in place to check that all of the care tasks and daily routines have been carried out. Mid-morning a ‘house check’ is carried out by senior staff to ensure that nothing has been missed. Residents and staff talked about how residents’ health needs are met by the home. Health care professionals have been involved appropriately, with treatment and advice sought where needed. The home has a range of equipment in place including nursing beds where needed, various hoists,
Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 10 pressure mattresses and moving and handling equipment. Care plans include dietary assessments, weight checks, and assessments to prevent the risk of pressure sores. The home employs a Physiotherapist and some of the residents talked about how they have been helped to regain mobility by regular exercises and the use of aids and equipment. Attention has been paid to prevention of falls including the use of hip protectors, health screening, and physiotherapy where required. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The home provides an exceptionally high level of assistance with individual and group activities to meet all interests. Relatives and friends are always made welcome. The home has a range of methods to ensure relatives and friends are involved in all aspects of the services and care provided. A high emphasis is placed on helping residents to exercise choice over all aspects of their lives. Residents receive a balanced and well-cooked range of meals to suit their individual likes and dislikes and dietary needs. EVIDENCE: The home employs an Activities Organiser and a team of Activities Assistants. Between them they provide a very wide range of activities to suit all interests and abilities. On the day of this inspection a group of residents went out in the minibus, and another group were sat in one of the lounges enjoying a musical afternoon. One of the residents was playing the piano, and everyone else had a songbook and were able to sing along to favourite songs. Three activities staff were assisting the residents with the songbooks.
Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 12 Elsewhere in the home some residents had chosen to remain in their rooms, and some were sat either in small groups in other lounges, or in quiet areas of the home and garden. A member of the activities team was sat with two residents playing card games. One resident was sat listening to the radio in a quiet lounge. Another resident said that he enjoys outings to the local church to listen to musical concerts. Residents also talked about the computer training sessions held in the home. Staff were seen encouraging and enabling residents to participate in their chosen activity. Later in the afternoon a Communion Service was held, given by the local Vicar. Residents talked about the ways in which they are assisted with exercises and mobility. Regular exercise sessions are held, and staff will assist residents who want to go out for a walk, or to walk around the home. The home encourages families to visit and keep in touch. There are no visiting hours – the philosophy of the home is one of ‘open house’. Families and friends are given a copy of the home’s Welcome Brochure when they first visit. Staff always welcome visitors with offers of tea, coffee or cold drinks. During the summer the home will be holding a garden party to which all relatives and friends are invited. They are also trying to organise a regular Relatives’ Support Group. Relatives are always welcome to attend Residents’ Meetings if they wish. Residents talked about how they are able to make choices over all aspects of their lives. Examples were given of individual menus, choices about getting up/going to bed, and going out. Copies of menus were displayed around the home. These showed that menus are varied and balanced. One resident had his own printed and laminated menu in his room showing his choice of supper menu. Those residents with special dietary needs have been fully catered for. Residents were full of praise for the standard of meals provided. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not covered during this inspection. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The home has been decorated, furnished and maintained to a very high standard throughout. All areas were clean, bright, spacious and homely in style. Every effort has been taken to ensure the environment is safe. EVIDENCE: The home is situated conveniently in the centre of Axminster. A team of maintenance staff are employed and during the inspection all areas were found to be in very good order. There are 44 single bedrooms and 5 double rooms, 5 lounges and 2 dining rooms. Many of the bedrooms have en suite facilities. Bathrooms are light, airy, modern and well equipped. All areas have level access or gentle slopes. There is a shaft lift and a stair lift. The home has a range of equipment including handrails and grab rails to assist with mobility. All areas of the home have been decorated and furnished to a high standard.
Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 15 Residents talked about the high standards of cleanliness, and how much they appreciated this. Risk assessments have been carried out on the environment. Where risks have been identified measures have been taken to minimise or eliminate the risks. Radiators have been covered, thermostatic valves have been installed on hot taps on all baths, and upper floor windows have been restricted to prevent accidental falls from the window. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 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 The home employs a high level of staff. Staff were confident, competent, open and friendly. Residents expressed very high praise for the caring manner and attention provided by the staff team. EVIDENCE: In the morning there are usually 19 care staff, 6 activities staff, 1 housekeeper, 7 domestics, 2 cooks, 4 maintenance, 3 administrators and 1 manager. A physiotherapist is employed for 3 hours per day. In the afternoons there are usually 12 care staff, 6 activities staff, 1 housekeeper, 2 domestics, 1 cook, 4 maintenance, 3 administrators and 1 manager. In the evenings there are usually 11 care staff and 3 domestic staff. At night there are normally 4 waking care staff and 2 sleeping-in staff on the premises. Residents expressed complete satisfaction in the level of staff provided. The staff were confident and positive about their work. They talked about the level of support and supervision they receive and the various ways they have to express their views, including staff meetings, individual supervision, and daily handover sessions. They said there are very good working conditions and they all work well as a team. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 17 All staff have been given a Staff Handbook setting out their roles and responsibilities, and giving essential information about the home. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home has an excellent Quality Assurance System in place that ensures residents receive the highest standard of care and facilities. EVIDENCE: One of the senior care team has been given the responsibility for monitoring the quality of the service provided. She has been allocated three hours each week to focus on this task. A comprehensive system has been drawn up covering all aspects of the services and facilities. The system covers each of the National Minimum Standards, and involves a range of consultation methods with everyone living, working or involved in the home. Staff and residents talked about some of the positive outcomes as a result of the quality assurance system. Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 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. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 4 x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4
COMPLAINTS AND PROTECTION 4 4 4 4 3 3 4 3 STAFFING Standard No Score 27 4 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 4 x x x x x Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 20 no 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Silverleigh Cedars D54-D06 22030 SilverleighCedars 234341 030805 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road EXETER, EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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