CARE HOMES FOR OLDER PEOPLE
Southernhay Retirement Home Second Drive Landscore Road Teignmouth TQ14 9JS Lead Inspector
Stella Lindsay Unannounced 25 August 2005 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. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Southernhay Retirement Home Address Second Drive, Landscore Road, Teignmouth, Devon, TQ14 9JS 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) 01626 773578 01626 870469 scary-mary49@yahoo.co.uk Mrs Mary Crook Mrs Mary Crook Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20) of places Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13/04/05 Brief Description of the Service: Southernhay is a detached house in a quiet residential area, a little more than half a mile from Teignmouth town centre. It caters for people aged sixty-five and over, and the service is designed for people with a dementia. The home has two lounge areas, and a small conservatory adjoining the dining room. There are twelve single rooms, and three double, and all but two have an en suite WC. There is a pleasant enclosed garden to the rear, and a small patio and car parking area at the front. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Thursday in August 2005, between 10.15am and 4.45pm. It involved a tour of the premises, and examination of care records, and discussion with the Home owner, five staff, 15 residents, and two visitors to the home. It will be necessary to review both inspection reports for 2005-06 to obtain a full understanding of the extent to which the home meets the 38 standards of The National Minimum Standards. What the service does well: What has improved since the last inspection?
The refurbishment of the kitchen has been completed. This is now an excellent working area, with good working surfaces and flooring, all sealed, to assure good hygiene for the safety and health of the residents. Redecoration has continued, with two bedrooms and the upstairs corridor being completed. Employment of an enthusiastic domestic has improved the thoroughness of the cleaning. All care staff had participated in Foundation training, meeting the Skills for Care specification, and staff were recording their up-dates in fire safety awareness. Several staff had received training in the mental health problems of older people.
Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 6 The garden was looking better than ever, with colourful borders, and a new raised bed. 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. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.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 Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.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) 1,3,5 Prospective residents and their families are given full information about the service at Southernhay, by visiting or telephone, although the written information needs to be brought up to date. The Home owner assesses peoples’ needs carefully before offering accommodation. EVIDENCE: Southernhay has a Statement of Purpose which is clearly written and gives all the information recommended by the National Minimum Standards, but is due to be re-written as some of the information is out of date. The Homeowner and staff are approachable and pleased to discuss their service with prospective residents and their families or representatives, and visitors are made welcome at all times. The Home owner has gathered information before offering accommodation to a new resident, and sent a letter confirming that Southernhay is appropriate for meeting the person’s needs. Prospective residents are welcome to visit, but professional judgement sometimes allows that a visit would be unhelpful, due to the mental state of the individual. This decision should be recorded, with reasons given. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.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) 7,8,10 The personal care of residents at Southernhay is very good, and health needs are well met with evidence of good multi disciplinary working taking place regularly. EVIDENCE: Clear care plans have been drawn up for each resident, but signatures of residents or their relatives were not seen, and the monthly summaries had not been written, as had happened until June of this year. Daily records of care have been maintained. Oral care needs had just been reviewed and clarified for staff on a chart. This should be displayed in a more private position than by the kitchen door. Specialist equipment for the prevention of pressure sores was seen in bedrooms. The Continence advisor is in regular contact with the Home, and had visited during the week before this inspection. There were records of recent help and advice from the Community Mental Health team. Regular blood tests are arranged as necessary, and the Home owner has taken residents to medical appointments. Chiropodist, dentist, and opticians have attended residents in the home. Regular exercise within the home is encouraged. Suitable locks have been fitted to residents’ bedroom doors, to provide for
Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 10 privacy without the danger of a person becoming locked in. Two of the three double bedrooms are currently in single occupation. Staff were seen to treat residents wit respect at all times. A private bedroom was being used as a hairdressing salon, which is an infringement of the privacy of the occupants. The Home owner stated that a dedicated room for hairdressing and chiropody is included in the plans for the Home. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Staff continue to be successful in their efforts to make residents feel cared for in a way which suits them. The residents’ interest in daily life is maintained by activities and good food. EVIDENCE: Bathing, hairdressing and cleaning took place during the morning. Staff provide a variety of activities during the afternoons, and keep a record of who joins in. An exercise game was enjoyed during the inspection. Other activities have included board games and quizzes. Visiting musicians and entertainers have been engaged. Staff and management take residents to appointments, but not for social trips out. Some residents become anxious when away from the home. Some relatives are able to take their family member for a trip out. Residents can entertain their guests in their own room, the conservatory, or out in the garden. The Home owner has recorded in the Service Users’ Guide that relatives and friends are welcome to visit. All residents spoken with said they enjoy their meals. A choice was not offered, though staff know the residents’ preferences and do not serve food they do not like or should not eat. One resident confirmed that staff ask what she wants. Four residents need help with feeding. On the day of the inspection, cottage pie was served, followed by rice pudding, so that the food did not need to be blended. The menus available show that nutritious and
Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 12 varied meals are served. Fresh fruit is served prepared so that residents can eat it, including in ‘smoothies’, blended with ice cream. A record of food eaten by residents should be kept, as a nutritional record for individuals, and to help pinpoint the cause if there are any problems with health or digestion. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 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) 16,18 Residents are protected because they feel secure and able to tell staff if they are worried, and feel that if they have any concern they will be heard and the Home owner will deal with any problems. Protection would be improved by knowledge of what to do if there were an allegation of abuse. EVIDENCE: The Complaints procedure is published in Southernhay’s Service user Guide, and displayed on the wall by the front door. No complaints had been received by the CSCI. There is a good policy for Adult Protection, including whistle blowing, but it did not include the local arrangements for reporting allegations to the Social Services Adult Protection team. Staff and residents have said that they would be able to approach the Home owner if they were worried about anything, and would be confident that she would be able to ‘put it right’. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,24,25,26 The home is kept bright, clean and comfortable, with a safe and pleasant garden. EVIDENCE: The Home owners have continued with their work to improve facilities in the home. The Home owner’s partner carries out all repairs, maintenance and improvements. The work on the kitchen is complete, and it is now a very good working area, with excellent surfaces, all sealed, and the room is well ventilated. Two further bedrooms have been refurbished. Good carpets are laid throughout the house. Some edges needed to be secured to avoid any risk of tripping. Being an old house, there are some uneven floors. It was recommended that a slight ramp on the upper corridor be highlighted, to avoid the risk of tripping. The two lounges and the dining room are all adjoining, which can be reassuring for the residents, as they can see and hear each other and the staff. The brightest room is the conservatory, which is a very cheerful space, but needs shading, as it has been too hot during the summer. It looks on to the garden, which is safe and attractive, with a lawn, raised flower beds, and level paths.
Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 15 Most bedrooms are attractive, and some have fine views. Residents confirmed that they had everything they wanted in their room. One described it as ‘a charming place’. Another had their own paintings displayed. Many family photographs were on view. All had suitable locks fitted, for security and privacy. Most had lockable storage space. Raised electricity sockets had been fitted, for the convenience of the residents. Rooms have wall lights as well as central lights. New bulbs were being fitted during the inspection. All pipe work and radiators accessible to residents are guarded. Thermostatic valves have been fitted to the hot water being delivered to baths, to avoid risk of scalding. A professional assessment has been done with respect to the risk from Legionella, and on-going checks maintained. The home is cleaned systematically by the recently appointed cleaner, and all staff and management are commended for their success in maintaining a sweet-smelling home. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 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) 27,30 Southernhay employs sufficient staff with the attitude and skills to provide very good care for the residents. EVIDENCE: There are four care staff on duty in the mornings, and three in the afternoons, though on the day of the inspection the Home owner was included in this, due to staff absence. There were also a domestic and a cook at work, and the residents’ needs were clearly being met. At night there are two waking night staff. Seven care staff attended a Foundation training event with the Home owner, who now has a Foundation training based on Skills for Care standards to work through with any new staff. Care staff had all been working together on a distance learning course on Safe Handling of Medicines’, which will help all be aware of the proper administration of medication, as well as enhance their observations of the effects on the residents of their medication. Five further staff had attended a training session on Mental Health and Older People, which covered awareness of depression and dementia. The Home owner also gathers information regarding issues and conditions through nursing journals, to share with staff. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 17 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) 31,33,38 The residents benefit from a relaxed atmosphere in the Home, combined with close attention to their individual needs. The Home owner leads by example with kindness and consistent good care. Communication is good and staff feel supported in their work. Safe systems of work are generally in use, but the fire precaution system had been undermined. EVIDENCE: The Home owner is competent and experienced. She has achieved NVQ 4 in care and management, the Assessors’ Award, and has two further units to complete the Registered Managers’ Award. Staff, residents and visitors confirmed that she is caring and approachable. She has drawn up plans for the development of the service and improvement of facilities. Informal feedback is seen to be very good. Systematic feedback from residents and their representatives is needed for quality control, and a summary and report produced, to ensure that any suggestions are considered.
Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 18 The standard on safe working practices was not inspected in full. The home owner has previously complied promptly with requirements relating to health and safety. Fire training and up-dates have been delivered and recorded. The fire routine is posted by each entrance and fire alarm activator, to be brought to the attention of visiting relatives. The Home owner had previously stated that the laundry door (which is a fire door) would be kept shut when not in use, but it was found to be pegged open, which is potentially dangerous. Moving and Handling training has been maintained, including use of the hoist. The Home owner stated that there is a spare hoist that could be kept upstairs, in case anyone should suffer a fall on the first floor. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 x x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 2 x x x x 2 Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 20 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. 2. 3. Standard OP1 OP7 OP18 Regulation 4 15 13 Requirement The Homes statement of purpose must be up-dated to maintain accuracy. The residents care plan must be reviewed by care staff in the home at least once a month. The Adult Protection policy must include the local reporting arrangements. Previous timescale 30/11/04. Those carpet edges which have no edging must be secured, to avoid risk of tripping. All fire doors must be kept shut, unless approved hold-open devices are fitted, following consultation with the Homes Fire Safety officer. Timescale for action 10/10/05 10/10/05 10/10/05 4. 5. OP19 OP38 23 23 10/10/05 with immediate effect 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 OP5 Good Practice Recommendations If it is decided that a propective resident should not visit the home before moving in, this should be recorded, with reasons.
D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 21 Southernhay Retirement Home 2. 3. 4. 5. OP7 OP10 OP15 OP33 There should be evidence that residents or their relatives have been involved in care planning. Residents private accomodation should not be used as a communal hairdressing salon. A record of food eaten by residents should be kept. The Home owner should gather feedback from residents and their representatives, and produce a summary and action plan. Southernhay Retirement Home D54-D07 S38524 Southernay V242055 250805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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