CARE HOMES FOR OLDER PEOPLE
Smallcombe House Oakwood Gardens Bathwick Hill Bath BA2 6EJ Lead Inspector
John Clarke Unannounced 29 September 2005 09:30
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_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Smallcombe House Address Oakwood Gardens 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 Only 32 Category(ies) of OP Old age, 32 registration, with number of places Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 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 20-Apr-2005 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_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and looked at the core standards not examined on the previous inspection. The manager Mrs Caddy was present during this inspection. Records looked at included care plans, staffing rotas, residents financial records kept by the home and health & safety such as equipment servicing and fire equipment. A number of residents and staff were spoken with. Staff were observed undertaking various tasks with residents throughout the inspection. The pilot arrangements about the management structure were discussed with Mrs Caddy. What the service does well: What has improved since the last inspection?
The home has met the requirements set from the previous inspection. Training has been provided to staff about caring for individuals who have mental health impairment or degree of dementia. Staff commented this had been “helpful” and gave them more confidence in working with residents. Residents’ questionnaires had been sent to get their views about the care provided at the home. There were a number of positive comments and these are mentioned elsewhere in this report. An induction programme has been introduced, which provides a structured introduction to Smallcombe House, how the home is managed and policies and procedures of the home. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 6 The new arrangements for the management of the home, which include Care Managers on duty, are being piloted. In discussion with the manager and staff it was felt these provide better supervision of staff and greater consistency of care. 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. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 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_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 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) Standard 3 was inspected at the previous inspection (20/04/05) and was met. Standard 6 is not applicable. EVIDENCE: Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 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) Standards 7,8,9, and 10 were inspected on the previous inspection and all were met. EVIDENCE: Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 10 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 Good effort is made to meet the recreational needs of residents. Opportunities are provided to make sure that social and religious expectations of residents are met. Residents are able and encouraged to manage their own affairs and maintain their independence as far as possible. EVIDENCE: Residents confirmed that the home provides suitable activities and that there “is enough going on”. The aim is for staff to undertake an activity such as quizzes daily. An exercise class is held weekly and outings are arranged. On the day of this inspection a member of staff was observed playing an organ for residents as well as a quiz. Daily prayers are held and the home now has its own chaplain who provides pastoral care for residents. One resident spoke of attending the local church. Friends and family are encouraged to visit the home. One relative spoken to on this inspection said that they were always made to feel welcome and kept informed about their relative. Wherever possible residents are encouraged to manage their financial affairs but the home will provide assistance if this is needed. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 11 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) 18 The home is making good effort to protect residents from abuse. Standard 16 was examined on the previous inspection and was met. EVIDENCE: There is ongoing training provided through BANES, which some staff have attended and others are due to attend. Whilst the home has a Vunerable Adults policy this needs revising to reflect the care home setting and linking to the local authority multi-agency procedure. No complaints have been made since the previous inspection. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 12 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) 26 The home has effective procedures in place to manage the risk of infections and their control, providing a clean and hygienic environment to safeguard residents. EVIDENCE: Clear instructions are available and displayed to staff when dealing with laundry and any clinical waste. Sluicing facilities are available in the home. At the time of this inspection the home was clean and free from offensive odours. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 13 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, 30 The arrangements for staffing of the home make sure that the needs of residents are met and there is a good mix of skilled, trained and competent staff. EVIDENCE: Staffing rotas showed 4 staff on duty am (2 x 7am-4pm, 2 x 8am-5pm) 2 on duty pm (1-9pm), with 2 waking night staff 9pm-8am. The new management structure being piloted also allows for a Care Manager on duty,they will be NVQ qualified. Additional staff have also been on duty if the needs of residents - ie because of illness - require this support. Training records showed a good level of training, though with some gaps particularly night staff - that had not completed First Aid training. The majority of staff have recently completed Dementia Awareness and Mental Health training. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 14 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, 38 The home practice and arrangements make sure that the financial interests, health & safety of residents is protected. EVIDENCE: Documents showed regular checks and servicing of equipment: Parker bath 15/07/05, Malibu bath 15/07/05, lift 16/09/05. Gas service took place 10/05/05. Fire drills and tests of fire systems ie alarms, lighting are as required. Fire system service 04/05. Staff complete health & safety training. Water system tested for legionnaires and temperature check. Staff were observed using a hoist to lift a resident; this was done in a safe and sensitive way and clearly staff were confident in this practice. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 15 Financial records were correctly completed, with two signatures to evidence money given or paid out on behalf of residents with receipts as required. The home deals with the pension of two residents and this money is deposited into a building society and not held in the homes accounts. Residents are encouraged where able to manage their own affairs or relatives act on their behalf. It is generally not the practice for the home to deal with resident’s pensions and other monies. Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 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. 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 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 x x 2 x x x x 3 x x 3 Smallcombe House D56_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 Page 17 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 18 Regulation 12 (1a) 13 (6) Requirement To have a Adult Protection procedure linked specifically to the care home and with reference to BANES Multi-Agency Vulnerable Adults policy. (Previous timescale of 31/08/05 not met) Ensure that there is a member of staff who is First Aid trained on duty at all times. First Aid to be part of mandatory training for all staff. Timescale for action By 31/01/06 2. 30 18 (1a,cI) 13 (4) By 31/01/06 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_D05_S8146_Smallcombe_V243825_300905Stage2.doc Version 1.40 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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