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Inspection on 06/10/08 for Smyth House Residential Home

Also see our care home review for Smyth House Residential Home for more information

This inspection was carried out on 6th October 2008.

CSCI found this care home to be providing an Good service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents are well cared for by the staff who have been there some time, so that the residents know them well. Staff also know the residents well, how they like to be cared for and how they prefer to spend their time. All the residents told us that they always received the care and support they needed, and that the staff listened and acted on what they said. "All the staff are very helpful." "There is always someone you can talk to." A relative said: "I always find the staff happy and cheerful, and communicating well with all residents." The home is well served by the local GP practice, which ensures rapid attention for residents. A health professional told us: "Exceptionally high standards (are) provided for residents. Care and consideration for all. Friendly in every way. Can`t better them."

What has improved since the last inspection?

The home has been extended to provide six additional rooms with associated facilities, including a shaft lift. All the requirements listed in the last inspection report have been actioned. These have improved the safety of residents, and given them sufficient information about the home and their contractual rights.

What the care home could do better:

The owners acknowledge that a replacement laundry is needed. This has been included in the plans for another extension which is due to start shortly. The planned change of pharmacy supplier will improve the quality of this service, reducing the time spent by staff in returning incorrect deliveries, and reducing the risk of errors for residents.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Smyth House Residential Home 106 High Street Leiston Suffolk IP16 4BZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Goodship     Date: 0 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Smyth House Residential Home 106 High Street Leiston Suffolk IP16 4BZ 01728831373 Telephone number: Fax number: Email address: Provider web address: petmalmayh@aol.com Name of registered provider(s): Type of registration: Number of places registered: Mr Peter Michael Mayhew care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Smyth House is a private residential care Home providing care and accommodation since 1995. The Home is registered under the Provisions of the Care Standards Act 2000 to accommodate 9 older persons. A major variation was approved in August 2007 to increase the accommodation by six places.Located on the main road in the town of Leiston, Smyth House is close to all the amenities, with a regular bus service. The Home is semi-detached with a restaurant one side and a private road on the other side. Level access to the Home is via the side or rear entrance as there is one step to the front entrance. The Home is on three levels and access to the upper floors is by a shaft lift and stair lifts. The accommodation comprises thirteen single rooms and one shared room. Eight rooms have en-suite facilities and one room on the ground floor benefits with an en-suite shower and toilet. The garden is laid to lawn with a vegetable patch, greenhouse and a summer house. The range of fees at the date of the inspection was £355.00 to £414.00 per week. 0 Over 65 15 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. It took place on a weekday and lasted five and a half hours. It focussed on the outcomes for the residents, assessed against the standards listed under each outcome group. The previous inspection took place on 7th July 2006. The manager was not present but the staff and the two owners were present during the day. We toured the home, spoke to three residents in detail as well as chatting to others. We interviewed two members of staff, and examined two care plans, two staff files, training and maintenance records. Before the visit, we sent out a questionnaire to residents, relatives and staff. We Care Homes for Older People Page 5 of 25 received eight completed surveys from residents, four from staff and one from a relative. We also received two from health professionals who visited the home. The home was also required to complete an Annual Quality Assurance Assessment form for us. Information and comments from all these sources have been used in the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that they will only be admitted to the home if it can meet their needs, and they will have sufficient information to assess for themselves if the home will be suitable for them. Evidence: The Statement of Purpose and the Service Users Guide, which gave prospective residents information about the home, had been updated in 2007 prior to the registration of the extension to the home, so that the documents told people about the number of places in the home, how the home was run, the qualifications of the staff and the daily routine of the home. Six of the eight residents who replied to our survey said that they had received enough information before they moved in so that they could decide if it was the right place for them. The AQAA told us that visits to the home were encouraged. At previous inspections, Care Homes for Older People Page 9 of 25 Evidence: residents and relatives have confirmed that they were able to visit the home before deciding to come in. Some residents used to live very close to the home and had reunited with old neighbours. One person told us: I was not able to visit myself as I was in hospital. The home does not offer intermediate care, so Standard 6 is not applicable. Pre-admission assessment forms were filed in the care plans, identifying relevant aspects of the care needs of each admission.This ensured that the home was able to meet the needs of prospective residents, and the assessment formed the basis of the care plan. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their health and personal needs will be identified and monitored to ensure that they are being met. The homes medication policy and practice assures residents that they are protected. Evidence: The two care plans we examined in detail showed us that residents needs were reviewed regularly to ensure that changes were picked up, recorded and any change to the care plan made and brought to the attention of staff. We noted that there was a day shift message book and a night shift message book, to make sure that handovers were up-to-date.The staff who replied to our survey said that the way information was passed between staff worked well usually. One member of staff told us that for someone working only one shift a week, they had to go through a weeks worth of records to see if there had been any changes. The care plans covered all aspects of daily living. Some recorded health aspects more fully for those with medical conditions. The home had a weighing chair which enabled Care Homes for Older People Page 11 of 25 Evidence: any resident to be weighed even if they were unable to weight bear. We noted that one residents weight had gone down since their admission. They had been seen twice by the dietitian in the last four months who had decided that no extra diet supplements were needed. Care plans also held risk assessments to identify how the independence of a resident should be balanced against their safety. There were assessments about wheelchair safety, dehydration,moving around the home, and smoking. We saw one resident smoking outside by the lounge. They had a remote caller which they sound the call system when they were ready to return indoors. The care plans identified visits to, or by, health professionals. One resident had been reassessed by their GP for their night medication. Changing the dosage had reduced their tendency to walk about during the night. One GP arrived while we were visiting to see a resident with a condition which the doctor was trying to control. The district nurse had visited them earlier that morning to check their blood and had asked the doctor to call. This showed that health needs were monitored, and medical advice sought as soon as possible. One of the health professionals who replied to our survey told us: exceptionally high standards are provided for residents at this home, both personal and professional. We reviewed the medication procedures by examining records of administration, by observation of a drug round and by checking the contents of the drug trolley. The records were complete and up-to-date, with photos of each resident on their record sheet for positive identification. We checked the amount of drugs remaining for a resident and this tallied with the amount already given to them. All except one bottle of medication had been dated on opening.One bottle of tablets which needed to be kept refrigerated was stored in the kitchen fridge in a covered box. Staff explained to us that, because of mistakes made by the pharmacy supplier recently, they were vigilant when each months supply was delivered and everything was double checked for the safety of residents. The owner told us that the home were intending to move the pharmacy contract to another supplier. We saw staff respecting the privacy and dignity of residents when for example health professionals came in to treat them, in their own rooms. Staff also knocked on the doors of residents rooms before entering. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for in a homely way, with choices over how they spend their time, and maintaining contact with friends and the community. Evidence: Four of the residents who replied to our survey said there were always or usually activities they could take part in, one said there were sometimes and three did not comment. A relative told us that they had never seen any activities when they visited. In the lounge were several people knitting and chatting to each other. One person told us I am very happy here. Two people were out in the garden at one point, one of them sitting in the summerhouse. This person told us that they liked to be away from the chatter in the lounge. The staff told us that many residents went out during the week, often to the nearby shops. Risk assessments were in place for those who went out on their own. Others were taken out by relatives. Two came in during our visit to take their relative to the dentist. Eight residents were due to go to the local cinema for a musical show. Several had been on the Leiston Old Folks outing the previous week. There was a visiting library service to the home. Two staff told us that it would be nice if they had more time to spend socially with Care Homes for Older People Page 13 of 25 Evidence: residents, and not all residents went out on outings. One person thought that residents should have some form of exercise and entertainment. None of the residents we spoke to felt that they lacked the opportunity for activity if they wished to use it. A relative told us that: I always find the staff happy and cheerful and communicating well with all residents. We were told: Smyth House is a home from home, one big family. We saw examples of the choices that residents could make, over meals, whether to spend time in their room, and when to have a bath. All the residents told us that they liked the meals and there was always a choice. Most residents took their meals in the dining room. Eleven were doing so when we visited. The care plans listed residents preferences and any special diets because of a medical condition, such as coeliac disease. This person needed a cooked breakfast each day. We noted that some diners were drinking cranberry juice. Others had water. The owner told us that other flavours were not provided but residents could purchase them. This was clearly stated in the service users guide. Staff were aware that fruit juices could be contra-indicated for some medical conditions. Fruit was included every day as part of the menu. Fruit squashes,as well as toiletries and sweets, were available from the non-profit making trolley. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the homes complaints procedure will enable their concerns to be dealt with. They can expect to be protected by the homes policy on vulnerable adults. Evidence: No complaints had been received by the home since the previous inspection. The complaints policy was displayed in the front entrance hall and was included in the information documents. All residents also had a copy in their room. All the residents who replied to our survey said that they knew who to speak to if they were not happy, and they all knew how make a complaint. An anonymous letter of concerns had been received by the Commission in June 2008 listing a number of matters. The concerns covered the quality of care plans, aspects of the catering service, staffing and training. We investigated these concerns as part of our inspection. We found that there was either no evidence for the concerns, or the home was aware of a problem and was taking action to improve it. The AQAA told us, and the training records confirmed, that all staff had received training in the protection of vulnerable adults. Of the two staff we interviewed, one was clear about the procedure to follow if they suspected any abuse had taken place. the other person was not clear about the procedure although they had received the Care Homes for Older People Page 15 of 25 Evidence: training. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a safe, hygienic and comfortable environment. Evidence: In 2007, the home was registered for six additional bedrooms in an extension at the rear of the property. A lift had been installed to access the first floor and a new stair lift installed from the first to the second floor. The dining room had been extended and there was sufficient room to accommodate fifteen residents. Eight rooms had ensuite facilities, and one ground floor room had an ensuite shower. The bedrooms which we saw had all been personalised with photos, ornaments and other personal items. All bedroom doors had devices to automatically close them in the event of the fire alarm sounding, which allowed the door to be kept open or ajar if residents wished. The cleanliness of the home and hygiene standards were being maintained. All the residents who replied to our survey told us that the home was always fresh and clean. The home used the system of red soluble bags for soiled washing to prevent cross infection. The laundry was in a separate building at the rear. The washing was done by the night staff during the week. The manager told us that the owner had put up a security light at the rear of the home for the safety of the staff when going to the Care Homes for Older People Page 17 of 25 Evidence: laundry. Although both night staff undertook the washing, one person stayed close to the door to the home in case the call bell rang. One resident told us: The night girls are very good. Just ring the bell and they come at once. The owner told us that it was planned to incorporate a new laundry, staff room and three additional bedrooms into another extension. A new washing machine was about to be purchased. The Fire Officer had visited the home in June 2008. The only requirement was to put a closer on the kitchen door. We saw that this had been done. The local authority environmental health and health and safety officers had visited the home in 2008. The kitchen was found to be in very good order and the home was assessed as low risk for safety, health and management. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by competent staff whose training is kept up to date, to ensure that residents are safe. Evidence: The increase in resident numbers had led to the staffing during the day being increased by one person to three carers.On the day we visited, the manager was on leave so one of the owners was covering for them. The cook was off sick, so the senior carer was acting cook from 10:30 to 14:30. We did not observe any problems that could not be dealt with by the staff on duty. There were two staff on duty at night. A resident told us: All the staff are very helpful in all ways. Another told us: There is always someone you can talk to and they help. All the residents who replied to our survey told us that there were always or usually staff available when they needed them. The AQAA told us that no agency staff were used. Any gaps caused by holidays or sickness were covered by existing staff. Only one person had left the staff since July 2007. This low turnover rate showed that the home had a stable workforce, who were well known to the residents. Residents told us that this helped them to feel comfortable with the staff. Care Homes for Older People Page 19 of 25 Evidence: We checked two staff files. All the required recruitment, identification and protection records were in place. Induction records showed that the home followed the national Common Induction Standards for carers. We examined the record of training undertaken by staff, both in house and externally. We noted the high percentage of staff who either had, or were studying for, an NVQ at Level 2 or above. To improve its in house training, the manager was studying to be an NVQ assessor, and three staff had completed the course to be qualified moving and handling trainers. We spoke to two carers who confirmed the training they had received, and the supervision they received. One of them told us that they would like to do a course about dementia to help them deal with those residents who were displaying some symptoms of this condition. Another told us that there were times when one more carer would be a help as two residents now needed two staff for personal care , and for transferring. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the home is run in their best interests, ensuring that it is a homely and safe place to live. Evidence: The manager was experienced in the care of older persons and had worked at the home for many years. They were allocated twelve hours for their managerial work, and were rostered for care work at other times.The manager and staff continued to make sure that the home remained a friendly place to live with a family ethos. We saw evidence of this from the interaction between staff and residents. There was continuous talking and listening to them. Residents confirmed this in their surveys. We were told that because of the size of the home and the closeness of the staff and residents, no separate residents meetings were held. However the home asked residents to complete an annual questionnaire. We saw the replies to the one issued in August 2008. There were no negative comments about the aspects of the home and their care that were itemised. Care Homes for Older People Page 21 of 25 Evidence: The staff records that we saw showed that the staff supervision schedule was up-todate in most cases. This helped to maintain the training and care practice of staff to ensure the quality of care for residents. We examined the records for fire alarm tests, hot water checks, and the maintenece of equipment. All were up-to-date and promoted the health and safety of residents. We noted that the fire risk assessment was due to be reviewed. A health professional told us in a survey that the home had particularly good staff and an exceptionally caring and conscientious manager. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 Staffs knowledge of safeguarding procedures should be refreshed at regular intervals. Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!