CARE HOMES FOR OLDER PEOPLE
Solway House 5 Station Road Benton Newcastle upon Tyne NE12 8AN
Lead Inspector Anne Brown Unannounced 12th April 2005, 10.00 am 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. Solway House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Solway House Residential Care Home Address 5 Station Road Benton Newcastle upon Tyne NE12 8AN 0191 2660138 0191 2660138 N/A Mr Davinder Vij 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) Mrs Mary Ann Gray CRH 28 Category(ies) of DE - Dementia (5) registration, with number OP - Old age (23) of places Solway House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Until a suitable bathroom and toilet is provided on the first floor adjacent to bedrooms 23, 24, 25/26, 27, 28, 29 and 30/31 only service users who are fully mobile and able to negotiate stairs may be admitted to these rooms. 2. Bedrooms 1, 2, 3, 4, 5, 6, 7, 8 and 9 in the south wing of the premises must only be occupied by service users who do not require staff assistance for moving and handling or are confined to bed. Date of last inspection 3 and 20/9/04 Brief Description of the Service: Solway House offers residential care to male and female residents who are over the age of 65 who are suffering from problems relating to general old age and/or dementia. The accommodation is provided on two floors and a passenger lift has been installed. There are two main lounges, dining room and sun lounge overlooking the gardens. The home is situated in Benton close to the metro network and local shops are nearby. The home is surrounded by gardens. Solway House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours and was carried out to check on the progress made towards meeting the requirements and recommendations from previous inspections and to assess the service against the National Minimum Standards. One additional visit has been made since the last announced inspection. Letters sent to the registered person following this visit can be obtained from the from the CSCI office on request. A complaint received by the CSCI has been investigated. A partial tour of the premises was carried out and staff files, care plans, fire log book, accident and complaints records were inspected. Four staff members, nine residents and two visitors were spoken to. What the service does well: What has improved since the last inspection?
Work has commenced to provide a bathroom and toilet facility on the first floor and the proprietor stated the builder would be visiting next week to ensure the work is complete. The staff team are working hard to provide new activities for the residents to enjoy. Work has been done to improve the format of the care plans and this needs to continue to so all staff are aware of the needs of the residents.
Solway House Version 1.10 Page 6 The management are committed to providing appropriate training for the staff team and courses have been booked for the future. This will ensure that the staff are competent to deal with any specialist needs. 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. Solway House Version 1.10 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 Solway House Version 1.10 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) 1, 2 and 3 Prospective residents are given verbal information about the home and how their needs can be met. The draft statement of purpose and service user guide has been produced but not issued. Statements of terms and conditions is currently being issued. Assessments are carried out by the care manager and the manager of the home. EVIDENCE: A statement of purpose and service user guide has been produced in draft form so information is given to prospective residents verbally. These documents have not been finalised and issued to existing and potential residents. At present they are not reviewed to make sure they are effective and do not form part of the staff training programme to ensure they are aware of their contents and the aims and objectives of the home. Statements of terms and conditions have been produced and the manager is in the process of issuing these documents to the residents. Solway House Version 1.10 Page 9 Full assessments are carried out by care managers and the manager visits prospective residents in their own home or hospital to ascertain if their needs can be met in the home. The sample of care plans examined during the inspection did not contain full assessments carried out by the home to ensure the assessed needs of the residents are fully met by the staff in the home. Solway House Version 1.10 Page 10 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 and 10 The health and personal care needs of the residents are being monitored. However limited progress has been made to ensure this information is recorded which could potentially place the residents at risk. The residents are treated with respect and their privacy is upheld. EVIDENCE: At the last inspection the care plans had been reorganised into relevant sections including health care, diet, individual profiles etc. The manager and staff have completed some work to bring the information up to date. Upon examination of a sample of care plans these were found to be out of date and some information was incomplete. The information in the plans and risk assessments is limited and does not meet the needs of the residents. There was no evidence that the care plans are drawn up and reviewed with the involvement of the service user and/or their representatives. Training is not provided on dietary needs and nutrition. Suitable weighing scales are not provided. Full records of the residents’ weights are not kept and used as a monitoring tool.
Solway House Version 1.10 Page 11 The residents’ who made comments stated that their privacy and dignity was respected and the staff were sensitive to their needs. The staff on duty were observed to be respecting privacy and dignity at the time of the inspection. Solway House Version 1.10 Page 12 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 and 13 A wide range of activities are provided in the home and friends and family are encouraged to visit and participate in any events taking place. EVIDENCE: A member of staff takes responsibility for arranging the activities in the home. These include bingo, crafts, jigsaws, knitting, board games, trivial pursuit, sing a longs etc. Each month a theme is chosen to decorate the dining room and the residents enjoy participating in this. Two visitors were present during the inspection and commented that the atmosphere is friendly and conversations take place all the time between the staff and the residents. Some residents said the staff made efforts to provide entertainment. Some residents said they would like to go out more but did not like to ask the staff to take them as they were always very busy. Activities taking place in the home are displayed in the dining room and are recorded in the activities book. The names of those residents participating in activities is not recorded. Solway House Version 1.10 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) 16 and 18 Complaints are addressed appropriately and residents are confident about making a complaint. The service users are protected from abuse. EVIDENCE: A complaints procedure has been produced and is on display and issued to the residents. A complaints log is maintained by the manager. A complaint investigated by the CSCI was not recorded in this book along with the outcomes. The residents stated that they would know how to complain if this was necessary. An adult protection policy and procedure has been produced to ensure a proper response to any suspicion or allegation of abuse. The staff on duty were able to describe types of abuse and said they would report any poor practice to the manager. No formal training in the protection of vulnerable adults has taken place to ensure they are fully aware of who to contact and procedures they should undertake. No training has been provided on challenging behaviour and restraint. Solway House Version 1.10 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, 21, 22, 25 and 26 Limited improvements have been made to the facilities in the home. The outstanding matters do not provide the residents with the facilities they require. Some areas in the home are showing signs of wear and tear. Health and safety risk assessments are limited. Most areas of the home were clean and hygienic. EVIDENCE: Since the last inspection work has commenced to provide a bathroom and toilet on the first floor. A washbasin, toilet and domestic style bath has been provided. However the bath does not meet the needs of the residents as overhead tracking and hoist have not been provided. This was discussed with the proprietor who has agreed to provide the appropriate hoist or reconsider other options. In the meantime the bathroom cannot be used.
Solway House Version 1.10 Page 15 Parts of the home were showing signs of wear and tear. A maintenance and renewal programme has not been produced. The proprietor has not submitted an application and plans to alter the bedrooms in the south wing which are extremely small and narrow. This means it is not possible for carers to assist residents who may require help getting in and out of bed. An application and plans to alter these rooms has not been received by the Commission which was a requirement from the last three inspections. A condition of registration has been made to ensure the rooms are occupied by residents who are mobile. The hand washbasin in bedroom 10 is not accessible to the resident due to their disability. Lockable facilities are not provided in all bedrooms so residents cannot keep their own valuables safely. The panel on the boiler in the laundry was missing and had not been replaced. New doors have been provided to some upstairs bedrooms but they had not been painted. The radiator cover in room 29 had not been painted. Grouting around the washbasin was discoloured. Lampshades are not provided in all bedrooms. Dirty clothing was observed on the downstairs bathroom floor which could pose a health and safety risk. The bin used for disposing of incontinence pads for one resident was not appropriate. The staff team have not undergone formal infection control training. Small tables have been provided in the lounges for the convenience of the residents. Solway House Version 1.10 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 and 29 The staff are committed to providing a good standard of care but they have not received appropriate training in some specialist areas. The management and staffing structure in the home does not ensure that an appropriately trained member of staff is in charge of the home in the absence of the manager. Procedures for the recruitment of staff are in place but there are gaps in the information retained on the staff files. EVIDENCE: The residents who made comments said that the staff were very caring, cheerful and pleasant. A relative who was visiting the home said the staff engaged the residents in conversation and the atmosphere was relaxed and friendly. Two residents stated they would like to go out more to local places of interest. They said they did not like to ask the staff to escort them because they are very busy. One gentleman said he would like the home to employ a male carer as he did not like female staff attending to his personal needs. The manager confirmed a male carer would be employed if a suitable candidate applied for employment. Training has not been provided on dietary and nutritional needs, POVA, challenging behaviour, restraint and infection control.
Solway House Version 1.10 Page 17 There is no structure in place to ensure an appropriately trained member of staff is left in charge of the home in the absence of the manager. Some staff members are known as senior carers but no job descriptions are provided and no financial reward is given. Three staff files were examined and gaps in the information held were apparent. The manager confirmed that information regarding any gaps in employment were explored and but this information is not recorded. Photographs were not available on all files. Discussions that take place regarding the Criminal Records Bureau checks are not recorded. Solway House Version 1.10 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) 31, 33, 36 and 38 There is no structure in place to ensure there is always a qualified and competent person in charge of the home at all times. The health and safety of residents and the staff team are not safeguarded at all times. EVIDENCE: The manager has been employed in the home for a considerable number of years. The manager has informed the proprietor that she wishes to retire in the near future. The proprietor has made no plans to ensure a competent person is available to take over the home in her absence. Solway House Version 1.10 Page 19 There is no management structure to ensure an appropriate person is left in charge of the home in the absence of the manager. Due to the lack of structure some tasks cannot be delegated to enable the manager to concentrate on training issues, supervision and risk assessment. Due to the manager being involved in other tasks, supervision sessions with staff members have not taken place. A programme for supervision sessions is not in place. Staff meetings and residents meetings have been held but these are not structured and the minutes do not include an action plan. The proprietor does not a report on the home on a monthly basis in accordance with Regulation 26. A quality assurance system has not been implemented to monitor the standard of care and services offered to the residents. Health and safety risk assessments could not be produced at the time of the inspection so there was not evidence that these are carried out and updated. The following health and safety issues were observed during the inspection:The upstairs fire exit door does not open freely. Some bedroom doors were not fitted with closing devices to ensure they close fully onto their rebates. There was no lock on the cupboard in the laundry that contains harmful substances. Solway House Version 1.10 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 1 x 1 x 3 2 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x 3 x x 2 x 2 Solway House Version 1.10 Page 21 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 1 Regulation 4 and 5 Requirement A statement of purpose and service user guide must be made available and form part of the staff training programme. (Previous timescale of 31 May 2004 not met) Up to date assessments must be carried out for all residents and made available in the case files. Care plans must be updated and risk assessments expanded. Evidence must be produced to confirm residents and/or their representatives are fully involved in the care plans. Dietary and nutritional training must be provided for staff. Suitable weighing scales must be provided and weights monitored. (Previous timescale of 31st May 2004 not met) residents must be consulted ascertain their preferences with regard to outings. A record of activities attended by individual residents must be kept. All complaint investigations and the outcomes must be recorded in the complaints log. Staff must undergo formal training in the proection of
Version 1.10 Timescale for action 31/5/05 2. 3. 3 7 14(1) 15 31/5/05 30/6/05 4. 8 12(1)(a) 31/5/05 5. 12 16(2)(m) 31/5/05 6. 7. 16 18 22 6 and 7 30/4/05 30/6/05 Solway House Page 22 8. 19 19(2)(b) 9. 10. 21 23 23(2)(j) 16(2)c and 23(2)f 11. 12. 13. 14. 15. 26 26 29 31 33 16(2)(j) 16(2)(k) 18(1) 9(2)(b)(i) 18(1) and 26 16. 38 13(4) vulnerable adults, challenging behaviour and restraint. (Previous timescale of 13th April 2004 not met. A maintenance and renewal programme must be produced and redecoration must be carried out in all areas showing signs of wear and tear. Bedroom doors and radiator cover must be painted and the panel on boiler must be replaced. Work must continue to provide an upstairs bathroom with appropriate bathing facilities. Application and plans to alter bedrooms in south wing must be submitted to the CSCI. Hand washbasin in bedroom 10 must be made accessible to resident. Lockable facilities and lampshades must be provided in all bedrooms. Previous timescale of 30th June 2005 not met. Staff must undergo infection control training. Suitable bin must be provided to dispose of incontinence pads for one resident. All the necessary information must be made available on the staff files. Manager must complete NVQ Level 4 in care and management. Staffing structure must be reviewed to ensure there is a competent person in place in the absence of the manager. Proprietor must produce a monthly report in accordance with Reg. 26. Health and safety issues must be addressed and health and safety risk assessments to be produced. 31/5/05 31/5/05 30/6/05 30/6/05 20/4/05 30/4/05 31/12/05 30/6/05 30/4/05 Solway House Version 1.10 Page 23 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. 2. 3. Refer to Standard 2 33 36 Good Practice Recommendations Continue to issue a statement of terms and conditions to all residents. Meetings held in the home should be more structured and the minutes should include an action plan. A programme for supervision sessions should be produced to ensure all staff receive formal supervision at least six times per year. Solway House Version 1.10 Page 24 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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