CARE HOMES FOR OLDER PEOPLE
Smallcombe House Oakwood Gardens Bathwick Hill Bath BA2 6EJ Lead Inspector
Jon Clarke Unannounced 20 April 2005 9:30
th 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. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Smallcombe House Address Smallcombe House Bathwick Hill Bath BA2 6EJ 01225 465694 01225 465769 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) Salvation Army Mrs Ena Margaret Caddy Care Home 32 Category(ies) of OP Old age, 32 registration, with number of places Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate up to 32 persons aged 65 years and over requiring personal care only. Date of last inspection 1-Nov-2004 Brief Description of the Service: Smallcombe House is a purpose built care home for older people aged 65 years and over. It is owned and managed by the Salvation Army. However it should be noted that whilst the ethos of the home is based on Salvation Army beliefs (in particular no alcohol and daily prayers are held ) residents do not need to be of the Salvation Army faith. The home has 32 single en-suite rooms arranged over two floors with lift access. There is one main lounge with a smaller lounge area and a dining room. The home is set in extensive grounds and all the residents rooms overlook the grounds. A decking area accessed from the front of the home provides a pleasant seating area along with patio areas at the rear of the home. The home is located about a mile from the city centre on a steep hill but on a main bus route giving access to the shops and facilities of Bath. The mission statement of Smallcombe House states: To provide long term residential care in a secure, safe, homely and loving environment for elderly people who can no longer manage in their own home. Our staff aim to give a high standard of quality care, ensuring physical, emotional and spiritual support for each resident, while at the same time encouraging the residents to live as independently as possible. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.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 and was an unannounced inspection. The inspector was assisted by Ms Sandra Cockle (Administrator) and Ms Nicky Guy (Senior Care). The manager was not present during this inspection. A number of residents (12), staff (4) were spoken to individually as well as in a group. Documents including care plans, daily records of care provided, training records, medication administering records, minutes of staff and resident meeting, policies and procedures were looked at. Discussions were held with Ms Guy and Ms Cockle about the care practices and in particular the needs of residents and how these were being met. There was also opportunity to observe staff directly and indirectly during the day. What the service does well: What has improved since the last inspection?
Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 6 Since the last inspection a new manager has been appointed this has provided some stability to the home following a period of uncertainty however there is still gaps in the organisational structure with no deputy manager or staff members who have higher level of responsibility around the day to day care of residents. Senior staff have been provided with supervision training and there is now supervision of staff on a regular basis as well as the “ mentoring “ of new staff. What they could do better: 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. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 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 Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 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) 3 The quality of assessments obtained by the home and undertaken by the home on admission were of a good standard providing a full and comprehensive picture of individual’s health and social care needs. This helps the home to meet identified needs and provide good quality care. EVIDENCE: A resident who had recently been admitted to the home spoke of how staff had discussed with her what she ‘ needed help with ‘, another was able to recall talking ‘ to my carer ‘ about what she liked to do and her interests. Individual records of a number of residents had Pre-Admission Assessments and assessments, which had been provided by the local authority. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 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) 7,8,9,10,11 There is a clear and detailed care planning system in place to make sure that staff have the information they need to satisfactory meet resident’s needs. Adequate arrangements are in place to provide health services to residents with good multi-disciplinary working and involvement of health professionals. The arrangements in the home to meet the resident’s medication needs are good and provide safe working practice. The working practices in the home ensure that residents are treated with respect and there are positive and appropriate relationships between residents and staff. EVIDENCE: Care plans were detailed with monthly reviews. Risk assessments are completed as well as mobility and handling. Independence score is given which provide good evidence and illustration of care needs. These should be reviewed to evidence changing needs of individuals. Resident’s involvement was evident
Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 10 though there was some inconsistency. A resident commented that they had “ sat down and we (member of staff) had talked about what help I needed “The arrangements, working practice and systems in the home adequately provide health and personal care and make a safe environment for residents. Residents confirmed and records also showed that residents have access to a range of health service on a regular basis ie chiropody, district nursing. In discussion with staff they were aware of the importance of involving other health care professionals in meeting the needs of residents. In one instance a resident’s health had deteriorated considerably and her needs were being closely monitored with the support of her GP and 3 times a week visits by a district nurse. This individual’s care plan recorded their changing health needs. Medication administering records were up to date and generally accurate in the recording of drugs given to residents. Residents are able to self-administer if able though at present no residents are doing so. Storage is satisfactory including secure storage for controlled drugs and a staff member was able to state the practice in giving controlled drugs to individuals. In talking with residents about how they were treated by staff there were a number who commented on the attitude of staff: “ they fit in with you quite well “, “ very caring “, “ treat me with respect and can’t fault them “. When discussing with staff they had a real understanding of the importance of establishing close and sensitive relationships with the residents and this was observed over the day of this inspection. Their approach was supportive and recognised the importance of the dignity of older people.This was particular evident when staff were observed assisting residents to the toilet ands providing assistance during the mealtime. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 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) 15 The meals provided in Smallcombe House are good offering choice and variety. EVIDENCE: Residents commented positively about the food provided: “ you can’t fault it “, “ couldn’t be better”, “ difficult to better “. Residents are given daily choice of menu and residents confirmed this and menus illustrated the choice available. During the inspection lunchtime was observed and the inspector sat with residents who commented on the quality of food provided “ always looks nice”. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 12 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) 16,18 The complaints procedure is satisfactory with residents feeling that they are able to express their views and dissatisfaction, they are listened too and action is taken. EVIDENCE: In discussion with residents they made positive comments about their ability to raise complaints or concerns. They were all aware of the complaints procedure and “complaints and suggestions box”. One resident stated that they would if worried about anything “ have a word with my carer “ another “ go to the office “, “ wouldn’t hesitate in going to the manager “. They all felt that they would be listened to and “something would be done “. The complaints policy sets out in a clear manner how to make a complaint informing complainants of the time they can expect to get a response. It also says that individuals can register their complaint directly with the CSCI. When suggestions have been made particularly about the food provided at the home changes have been made as evidenced by meeting minutes and menus. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 13 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 The environment is well maintained with a good standard of decoration. It is well equipped and provides a safe and homely atmosphere. EVIDENCE: All of the communal areas and a number of resident’s rooms were seen during the inspection. They were all well furnished with appropriate seating of a domestic nature. New seating has been purchased for the main lounge area and residents were involved in choosing colours of materials. There is a Safety Action Group, which discusses areas of concern about the safety of the building and the environment of the home. There is a resident representative on this group. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 14 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) 29,30 Whilst arrangements for the recruitment and training of staff are generally good and protect residents, there is a significant lack of training about dementia failing to equip staff with the necessary level of skill to meet the needs of residents with dementia type conditions. There is a lack of formal induction this was identified in previous inspection and no action has been taken. EVIDENCE: Records and discussion with staff showed training in number of areas: Health & Safety, Food Hygiene, and Infection Control. Senior staff have undertaken Appraisal and Supervision training. Recruitment records demonstrated procedures had been following with regard to completing of application forms, references and criminal record checks. There is no evidence of Dementia Awareness training or formal induction for new staff. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 15 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 There is a lack of opportunity for residents to express their views; the home fails to provide different ways of consulting with residents to show that the home is run in the best interests of residents and for residents to make comments about the quality of care they receive. EVIDENCE: No resident’s questionnaires have been completed for 2004 or up to the date of this inspection. The last resident’s meeting was in October 2004.One resident when asked about resident meetings stated that she would attend and would like her family to be invited. Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 16 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 2 x x x x x Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 17 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 OP 18 Regulation 12 (1A) 18 (1A) 24 Requirement Ensure all staff undertake Dementia Awareness training. Previous timescales of 30/11/04 & 30/04/05 not met. Ensure residents are given opportunity through regular meetings and questionaires to express their views about the quality of care and make suggestions for improvements. Introduce formal induction specific to Smallcombe House. Previous timescale of 2/11/04 not met. Adult Protection procedure to be specific to care home and linked to BANES Vulnerable Adults policy. Timescale for action By 31/08/05 From 20/04/05 2. 0P 33 3. OP 30 18 (1c,i) By 30/06/05 By 31/08/05 4. OP 18 12 (1a) 13 (6) 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 Smallcombe House D56_S8146_SmallcombeHouse_V221792_200405Stage2.doc Version 1.20 Page 18 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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