CARE HOMES FOR OLDER PEOPLE
Southernhay Retirement Home Second Drive Landscore Road Teignmouth Devon TQ14 9JS Lead Inspector
Stella Lindsay Key Inspection (unannounced) 28th June 2006 10:45 X10015.doc Version 1.40 Page 1 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 Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 2 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 DS0000038524.V301092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Southernhay Retirement Home Address Second Drive Landscore Road Teignmouth Devon TQ14 9JS 01626 773578 01626 772834 Telephone number Fax number Email address Provider Web 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 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 DS0000038524.V301092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th August 2005 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, three double, and all but two have an en suite WC. There is a stair lift to the first floor. There is a pleasant enclosed garden to the rear, and a small patio and car parking area at the front. Fees are currently £363 per week. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a Wednesday and Thursday in June 2006. It included a tour of the premises, examination of care records and staff files, and discussion or observation with twelve residents, three staff on duty and the Registered Manager. It involved tracking the care of four residents and gathering views from relatives and health professionals involved. The Manager supplied information about the running of the home, and staff views were gathered using randomly distributed surveys. All core standards were inspected. What the service does well: What has improved since the last inspection?
Work had continued to make the garden even safer and more attractive, for the enjoyment of residents. All hallways and the dining room had been redecorated and were looking bright and attractive. A new bath with a hoist, and a toilet, had been installed in the ground floor bathroom, and staff reported that this was a great benefit to themselves and the residents. An extra room beside the laundry had been made available, which is to be developed as a drying room, which will complete the separation of soiled and clean clothes. The appointment of the chef has been popular. He has been providing a variety of nutritious and attractive meals. As administrator had joined the staff team, to help the Manager keep up to date with office work and to introduce improved systems. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 6 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 DS0000038524.V301092.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 the following standard(s): 1,3 Quality in this outcome area is good, with up to date information provided and assessment carried out prior to any admission. EVIDENCE: The Manager has presented the information required for the home’s Statement of Purpose in clear simple language so that people who are interested in the home are given a good idea of what it has to offer. The Manager is planning to supplement her Service Users’ Guide with photographs of the home, to be given to prospective residents to reassure them during the anxious time of moving in. The files of three recently admitted residents were examined. Nursing referrals or Social work care plan summaries had been received, and the Manager had visited them to ensure that the home was suitable for meeting their needs, and sent a very nice letter to them to confirm this. Intermediate care is not offered at Southernhay. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 Quality in this outcome area was adequate, with previous good practice in care planning having lapsed this year, though good health care was seen to be maintained. EVIDENCE: Southernhay has had a good track record of reviewing care plans, but this had lapsed since the New Year. The recently admitted clients had no care plan, and those of longer staying residents had not been up-dated. Daily recording had continued, to assure communication between staff for the safety of residents, but there had been no overall consideration of the peoples’ care, and no consultation with residents or relatives had been recorded. The Manager has written personal profiles of residents, to inform staff of their family history, careers, interests, religious beliefs, and all important aspects of their lives, which is good practice, and essential for people with dementia who cannot tell their own story. However, this had not been done for the residents admitted this year. Physical and mental health care remains good, with evidence of good working relationships with local GPs and District Nurses as well as the Mental Health Team.
Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 10 The medication system was seen to be sound, and administered with care. The procedure was on display for staff to consult. Seven care staff had received training in the safe handling of medicines, including a Night Care worker. No resident was assessed as being capable of self-administer their medication. No medicines were being administered covertly. There was a suitable safe system for administering Controlled Drugs, if needed. There was a lockable fridge, though no insulin was in use at this time. A new medicine trolley had been provided, to assist the staff in accurate and safe administration of medicines. The inspector saw staff treating people as individuals, and treating them with affection and respect. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area was found to be good, with staff giving individual attention to residents as time allowed. Meals were much enjoyed. EVIDENCE: Staff help residents to get up and dressed when they are ready, and if they do not want to be helped to wash even with gentle coaxing, the staff will try again later. The mornings are taken up with personal care and house keeping tasks. The staff organise an activity for residents on many afternoons, often with musical quizzes or dancing, but there were few records of any activities during the previous month. The garden has been made more accessible and was looking most attractive. Certain residents were known to enjoy going out into it, and others went regularly when relatives visited, but others would need encouragement as well as help to go out and this was not seen to happen, though the weather was beautiful. No trips out had been arranged this year. Not all residents wish to go out at all, and group outings would not be suitable for Southernhay’s residents, but staff considered that outings to the nearby seaside in a taxi would be appreciated by some, if time allowed. The Manager stated that she is considering buying an accessible vehicle. Visiting musicians and entertainers have been engaged. Staff and management have taken residents to medical appointments.
Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 12 The appointment of the chef has been popular. He has been providing a variety of nutritious and attractive meals. Records have been kept of alternative meals that have been provided, whether for reasons of choice or special diet. On the day of this inspection tender pork and stir-fried vegetables and pasta were served, followed by a traditional sponge pudding. Most residents sit to tables in the dining area that overlooks the garden. Those who need staff to feed them stay in the lounge, and some residents choose to eat there, alongside the staff. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 the following standard(s): 16,18 Quality in this outcome area is good, as residents feel secure and able to tell staff if they are worried, and the Manager is trusted to ‘put things right’. 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. The home had received no formal complaints, and had no record of minor concerns. It was advised that it is good practice to record concerns that arise, in order to see if there are recurring problems, and to show what action (if any) has been taken. There is a good policy for Adult Protection, including whistle blowing, and the Home owner is aware that it should include the local arrangements for reporting any allegation 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’. She had booked staff training in the Protection of Vulnerable Adults for all her staff for the week following this inspection. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 the following standard(s): 19,26 Quality in this outcome area is good, with on-going refurbishment and prompt maintenance. 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 garden has been developed as a safe enclosed and attractive space for residents, with sturdy garden furniture, a parasol, and colourful flowerbeds. Some bedrooms have patio doors onto a balcony. Alarms are fitted to external doors, and also available on bedroom doors, to alert night staff of a person on the move. All hallways and the dining room had been redecorated and were looking bright and attractive. A new bath with a hoist, and a toilet, had been installed in the ground floor bathroom, and staff reported that this was a great benefit to themselves and the residents. All pipe work and radiators accessible to residents have been guarded, and baths are fitted with temperature regulation valves.
Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 15 The laundry walls have an excellent smooth finish, to make them cleanable. Staff have received training in Control of Infection. An extra room had been made available beside the laundry, and it was recommended that it be used as a drying/ironing room so that clean and dirty laundry could be separated entirely. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Good staff are employed, but not well qualified and not always in sufficient numbers to meet residents’ needs. EVIDENCE: A written rota is kept, which shows that although the home is well staffed on some days, more often there are not the four care staff in the mornings and three in the afternoons which are found at present to be sufficient to meet residents’ needs in a prompt and individual manner. The Manager works alongside her staff, but should not be included on the care rota, as her management duties demand her time and attention. On the day of the inspection lunch had to held back by over half an hour, as residents’ personal care needs had not been met. At this time, fourteen residents were in the lounge without staff attention. It has already been recorded in standard 12 that residents’ individual needs for attention or to be encouraged to go out for some fresh air have not been met recently. Management and staff are very caring and try at all times to please the residents, but do not always have the time. No staff had achieved NVQ. Some have been engaged in working toward this, but progress had not been made this year. The Manager stated that their tutor had not been able to visit. Southernhay has a procedure for appointing staff, and the Manager is careful to employ people with the right attitude for caring for people with dementia. Written references had not been obtained for recently appointed staff, which is necessary to protect residents from potential harm.
Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 17 The Manager had completed her induction programme with the new staff. They had not yet started the foundation course. Five staff had completed a course in Safe Handling of medicines. Some staff were in need of an up-date to their Moving and Handling training. Some staff could demonstrate an understanding of different types of dementia and good care practice. Some staff had received basic training in care of people with dementia. All care staff should be trained to understand the particular requirements of providing care in a home for people with dementia. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area was adequate, with the experienced and caring Manager not completing all management tasks. EVIDENCE: The Home owner is competent and experienced. She has achieved NVQ 4 in care and management, the Assessors’ Award, and has one further unit to complete the Registered Managers’ Award. With her partner, she has drawn up plans for the development of the service and improvement of facilities. Staff meetings are held, the last one being in March, when various procedures that effect the care of residents were discussed. There should have been one on the day of this inspection but it had been postponed due to staff absences. Staff have appreciated that the Manager is an approachable person, but has not been able this year to be as available to staff as previously. She has taken
Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 19 on an administrative assistant, two days per week, which should help her to complete her work more satisfactorily. There are records from previous years of staff appraisals and supervision records, but none seen for this year. The Manager has been gathering feedback from relatives. Blank survey forms are available in the entrance hall. Analysis and an action plan resulting from this consultation is needed. The Manager stated that she plans to adapt the Betal audit system for use at Southernhay. Residents’ money was seen to be handled with care, and records kept of all transactions. It was recommended that any cash records be kept in columns showing cash in and out, and a running balance, for clarity. Accidents had been recorded and reported. It was advised that falls be recorded in such cases as a person is found on the floor, in case of injury that is not apparent at the time. Not all such falls had been recorded as accidents, though they were included by staff in the daily records. All staff had received fire training, and the fire precaution system had been checked, serviced, and repaired as necessary on 21/06/06. The inspector recommended that the exit through the conservatory be considered in terms of emergency access. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 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. 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15 Requirement The residents care plan must be reviewed by care staff in the home at least once a month. Previous time 10/10/05. There must be evidence that residents or their relatives have been involved in care planning. Staffing must be maintained at the agreed level. The Home must make progress towards achieving NVQ trained staff. Two written references must be obtained when recruiting staff. The Registered Manager must provide induction training which meets the specification of Skills for Care. Previous time scale 31/07/05. All staff must be up to date with Moving and Handling training. All staff must receive training in meeting the needs of people with dementia. A quality monitoring system must be developed. Care staff must receive individual supervision sessions at least six times per year.
DS0000038524.V301092.R01.S.doc Timescale for action 30/08/06 2. 3. 4. 5. 6. OP7 OP27 OP28 OP29 OP30 15 18 18 19 18 30/10/06 30/08/06 31/10/06 30/08/06 30/08/06 7. 8. 9. 10. OP30 OP30 OP33 OP36 13(5) 18 24 18(2) 31/10/06 31/12/06 31/12/06 31/12/06 Southernhay Retirement Home Version 5.2 Page 22 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 OP16 OP38 OP38 Good Practice Recommendations A record should be kept of minor concerns, and any action taken in response. All falls should be recorded as accidents in case of nonapparent injury. The exit through the conservatory should be considered in terms of emergency access, in consultation with the fire safety officer. Southernhay Retirement Home DS0000038524.V301092.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office 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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