Inspection on 14/12/06 for Southernwood Promoting Independence Centre

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

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The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

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Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Southernwood Promoting Independence Centre Southernwood Trafford Allerdene Estate Low Fell Gateshead NE9 6LH Lead Inspector Miss Andrea Goodall Unannounced Inspection 10:00 14 December, 2006, 15 & 17th January, th th 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 Southernwood Promoting Independence Centre DS0000066639.V324153.R02.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. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southernwood Promoting Independence Centre Address Southernwood Trafford Allerdene Estate Low Fell Gateshead NE9 6LH 0191 4333000 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) Gateshead Council John Stephen Hewitt Care Home 23 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (23), Physical disability (5), Physical disability over 65 years of age (6) Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Southernwood Promoting Independence Centre is a modern, purpose-built service designed to provide short-term care and accommodation for older people, some of whom may have a physical disabilities. The building is on the site of the former Southernwood residential home for older people, in a housing estate. The new building was completed in June 2006, when it began operating as an intermediate care service. The service is operated and managed by Gateshead Social Services Department, with input from health services, including Occupational Therapists and Physiotherapists. Southernwood aims to provide 3 distinct services, that is: intermediate care for people who are receiving rehabilitative therapy; short-term ‘assessment’ care for those people being assessed for further services; and short breaks (respite care) for people who will return to their own homes. The building provides 23 good-sized single rooms, all with en-suite shower and toilets facilities. There are also 2 communal bathrooms, which are fitted with appropriate adaptations to support people with a physical disability. There is a communal lounge and small dining room on the ground floor, a separate smokers’ lounge and small kitchenettes on both floors. There is good car parking at the side of the building, with 2 disabled parking bays at the entrance. There is level access into building through electronic doors into the reception area. Southernwood is a short walking distance from local shops, and a short bus or car ride from shops on both the Team Valley and Low Fell. There is access to local transport directly outside the building. There is no fee for the first 6 weeks of the rehabilitative service. The weekly fees for assessment and short breaks are £73.25 – 566.44. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report represents the first inspection of Southernwood Promoting Independence Centre. The inspection was unannounced and took place over 3 visits. As this was the first inspection, the centre was measured against all the national minimum standards for older people. During the first visit the inspector talked to the Manager about the development of this new centre, and to service users, staff and visitors about their views and experience of the service. During the other visits the inspector looked at care records, staff records, training, and health and safety in the building. The inspector also joined service users at a lunchtime meal for their views about dining arrangements, promotion of independence, and activities. A sample of bedrooms, bathrooms, lounges and dining rooms was examined. Comments cards about the service were received from 8 relatives or visitors. Their views are included in this report. There have been no complaints or adult protection investigations into the service since it opened in June 2006. What the service does well: Southernwood provides good written information about its services and can make this available in other suitable ways or languages for service users if they need it. Each service user has a written agreement so they know the terms and conditions of their stay. All service users have their needs assessed before coming to stay here, so the centre can make sure their needs can be met during their stay. Most prospective service user and their relative have the chance to visit the centre so that they can see what it is like before they come to stay here. Many service users said that they were “very pleased to have the chance to look around” because they had not known what to expect. Service users who come for the rehabilitation service are helped to relearn how to do as much as possible for themselves so that they can return home. During their stay all service user have very good access to health care services. There are arrangements with a local health centre if service users need to temporarily register with a GP during their stay. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 6 In discussion service users described how their privacy is respected during their stay. All bedroom doors are lockable by service users, and some said that they choose to lock their door during the night. Service users said they were “very pleased” to have their own private shower/toilet facilities. Service users were also impressed that they had their own telephones in their rooms. This means that service users can make and receive calls in the privacy of their own rooms whenever they wished during their stay. Staff are very respectful and courteous to the people who stay here. Service users were very positive in their comments about the attitude of staff. Their comments included, “All the staff are patient, caring, and friendly”; “They go out of their way to support us”; and “They are very personable. They have a lovely attitude.” Many service users also commented that the centre offered them an opportunity to build up their strength. One service user said, “It’s been a lovely place to get back on my feet.” There are well-stocked kitchenettes on each floor where service users can make themselves drinks and snacks if they are able. Service users described the quality of meals as ”very good”. It is good practice that service users are offered the choice of main meals when they are seated at the time of the meal. In this way service users can make an informed choice about which dish they would prefer. It is good practice that service users have good access to advocacy services provided by Age Concern during their stay if they needed to talk with someone for support. Southernwood is a bright, modern building that is furnished and decorated to a good standard. It offers warm, comfortable and cheerful accommodation. It is very clean, pleasant and hygienic. Overall service users were very satisfied with the good quality of accommodation. One person said, “It’s a comfortable place to be whilst waiting to get better.” All support staff have a qualification in care so they are trained to support people in the right way. The Social Services Department only employs staff after it has carried out police checks and references, so only suitable people work here. The registered manager has is also suitably qualified and experienced to be in charge of this service. A representative of the Social Services Department carries out monthly visits to the service to check it is running in the right way. In this way the service is well managed. Service users said, “The manager is very competent, and has an excellent staff team.” There was clearly a friendly atmosphere in the centre, and good relations between staff, the manager and the service users. What has improved since the last inspection? Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 7 Not applicable. This is the first inspection of this new service. What they could do better: The service is supposed to provide short stays of up to about 6 weeks for people who are being assessed for other care services. However some people have been staying here for several months. In this way, the assessment service could become ‘bottle-necked’, so reducing the chance for other people to use the service here. Some care plans do not have enough details about how staff should help someone with their specific goals, such as exactly how to support them to make their own drinks and snacks. Some people need help with their mobility such as getting around, and using the bath, but there were not always assessments in place to show staff have to help them. Some people who can manage their own medication at home were not assessed to see if they can manage it at Southernwood, so staff managed it instead. This does not help them retain their independence during their stay. It also meant that the service users had to give up their lockable drawer for this, so they did not have anywhere to keep personal things. It would be better if night staff had training in giving medication just in case someone needed support with this through the night. Some service users and their visitors feel that there are not enough leisure activities during their stay, and not enough staff to help them with activities. At mealtimes the meals were served plated up by staff, so service users could not help themselves. This does not support their choices or independence. There is written information for service users about how to make a complaint, but some people have visual impairments and would need this on cassette or on CD as soon as they came to stay, and the equipment to play it. Some of the showers have been flooding bedrooms. This means that some showers cannot be used by service users on their own, so staff have to hold the showerhead. This does not support people’s independence, dignity and privacy. Staff training records are not up to date, and some training is now out of date. There were some health & safety issues at Southernwood that could put service users at risk. An Immediate Requirement Notice was given to Southernwood to put these matters right urgently. These matters included : staff do not have recent training in health and safety matters such as first aid, and moving & assisting; fire doors to 2 kitchenettes were propped open with a chair; hot water to baths had never been tested to make sure it was not Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 8 dangerously hot; and bathrooms were full of furniture and wheelchairs which some service users might have tripped over. 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. The summary of this inspection report can be made available in other formats on request. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 9 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 Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6. Quality in this outcome area is good, adequate This judgement has been made using available evidence including a visit to this service. Southernwood provides good written information about its services and can make this available in other suitable formats for prospective service users. Each service user has a written agreement so they know the terms about staying here. All service users have their needs assessed before coming to stay here, so the centre can make sure their needs can be met. Most prospective service user and their relative have the chance to visit the centre so that they can see what it is like before they come to stay here. Service users who are referred solely for intermediate care are helped to maximise their independence and return home. EVIDENCE: Southernwood has a written Statement of Purpose that provides clear information about the different services that it aims to provide. The Statement Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 11 of Purpose also includes information about the staff that work here, the accommodation and the different level of fees. The Statement of Purpose is clear about the categories of care that the centre can meet. There are references in the Statement of Purpose to the service being predominantly for people over 65 years old, “with some scope for persons under 65 years” (although it also states that “service users should usually be over 55 years old”, so could be a little confusing.) The manager stated that the Statement of Purpose is being reviewed by Plain English officers and will continue to be reviewed as the service develops. Southernwood also provides a written Service Users Guide for the people who might use this service. This explains in plain English what the service is like, what the building is like and what people can do during their stay. The Service Users Guide is part of an information pack that is kept in each bedroom for easy reference by the people who are staying here. The manager confirmed that, on request, this information can be made available in other languages and formats. However at this time, the information is not immediately available in other formats to meet prospective service users’ needs. For example, the centre is registered to provide care for people who have learning or sensory disabilities, but there is no information in pictorial format or on cassette tape or CD ready for them. Service user have a signed agreement about the purpose of their stay proposed length of stay, and fee levels. There are three distinct services provided at the centre: rehabilitation; an assessment period, perhaps to arrange other services; and a short-break holiday stay. Only people whose needs have first been assessed by a health or social care professional are referred to the centre. No–one is admitted without the centre receiving a written assessment, including emergency placements. The registered manager can then make a decision about whether the centre can meet their specific needs. For referrals to the 5 rehabilitation places, the manager also takes advice from the occupational therapists and physiotherapists to ensure that the prospective service user has the potential to achieve rehabilitation. In discussion the manager was very clear about his gatekeeping role, and about the number and categories of care that the centre is registered to provide. This helps to ensure that only people whose needs can be met are admitted to the centre. Room planning also ensures that people with a physical disability are only accommodated in rooms that are suitable for them. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 12 Although the centre provides short-term care and some people are admitted from hospital, most service users have the opportunity to visit the centre before coming to stay here. This is very helpful as it gives them a chance to see what the centre is like so that they can make a fully informed decision about whether the service will be suitable for them. In discussions many service users said that they were “very pleased to have the chance to look around” before they came in because they had not known what to expect. One service user having a short-break said that she was even show the bedroom that she would be staying in, and was “delighted” with the accommodation. There is no separation of accommodation for the 3 different short- term services. Rehabilitation is usually up to a 6-week stay. There is no charge for the first 6 weeks, after which a financial assessment is carried out. Assessment and short breaks would usually range from 1 night to 6 weeks, depending on individual needs. There is a set charge for the first 6 weeks, but would then be subject to an individual financial assessment, so could range from £74.66 to £566:44. At the time of this inspection there were 18 places occupied at Southernwood: 3 for rehabilitation; 7 for ‘assessment’; 5 for planned short-breaks; and 3 emergency placements. Of the 7 service users admitted for ‘assessment’, 5 people had been staying here for 3-7 months, one of whom had been here since the centre home opened in June 2006. These service users are awaiting care packages to be put in place before they can be discharged. In this way, the assessment service is currently not always short-term and there is the potential for this element of the service to become ‘bottle-necked’. This reduces the availability of an intermediate service for other potential service users. Already within the service a difference in culture between ‘longer-stay’ and short-stay service users had become apparent, and this impacts on the service’s stated aims and objectives as set out in its Statement of Purpose. Staff expressed concerns that some service users had been enabled to reach their optimum level of independence during their stay, but due to lack of care packages in place had to remain at the centre. Their skills had then reduced again during an extended stay. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are set out in an individual plan of care. Service users health care needs are met, but some service users moving & assisting needs are not assessed. Some service users’ ability to manage their own medication is not assessed or promoted. Service users feel that they are treated with respect and their privacy is upheld. EVIDENCE: For each service user a care plan sets out their needs and goals during their stay, whichever service they are receiving. Of the sample examined, all service users had signed their care plans to show their involvement in setting their goals. Goals matched the pre-admission assessed needs of service users. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 14 Overall care plans were well set out and up to date. Some goals were not sufficiently detailed. For example, for one person receiving a rehabilitative service a goal was “staff to prompt with basic kitchen skills”. However evaluation records only gave occasional references to the service user making a cup of tea. This does not demonstrate a purposeful rehabilitative programme, nor demonstrate the progress by the service user in their goal. The completion of the care plans was mixed. Some were very detailed and fully completed, and described the ability of service users and where they needed support. However others did not describe how staff should support a service user with each particular care task. For example some care plan actions simply stated “promote independence” with no detail of how this might be achieved. Care plans also contain a life history assessment for care staff to complete with service users. Some of the questions are irrelevant and could be construed as patronising, whilst others are an important acknowledgement of the equality and diversity of service users. At this time moving & assisting assessments are not carried out for every service user who is admitted. It was clear from care files that moving & assisting assessments had not been carried out for some people with significant physical support needs. During their stay service user have very good access to health care services. There are arrangements with a local health centre if service users need to temporarily register with a GP during their stay. There are visits to the centre by a GP from the local practice at least twice a week, and whenever needed by community matrons and district nurses. If a service user’s nutritional health is identified as an issue on admission, the centre will make arrangement for contact with a dietician. The 5 rehabilitation places provide specialist therapy service to those people who have been assessed as having the potential to regain sufficient independence to return home. Those receiving this service have the planned input of occupational therapists and physiotherapists where necessary to help them with a programme of mobility exercises and/or independent living activities to support them to go home. Of the 12 people who have completed a rehabilitative stay at Southernwood, 7 returned home (about 60 ). At this time only the people using the 5 rehabilitation places would be assessed to see if they can manage their own medication, or how they can be supported to achieve this. The centre does not routinely assess the capability of service users of the assessment and short break services to manage their own medication. In many cases the centre takes responsibility for managing their medication. However this does not promote service users’ independence in this area. For example some short-break service users manage their own medication at their own home but did not during their stay at Southernwood, Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 15 though they had not been assessed, and this does not support them to retain that skill for their return home. Medication is kept in a locked facility in respective service users’ bedrooms. However where the centre takes responsibility for their medication, the staff hold the key, not the service user. This means that those service users do not have a lockable facility in which to store private and personal possessions during their stay. The manager stated that there is a proposal for additional lockable cupboards to be provided in each room so that service user will have a lockable facility to use during their stay. Records relating to incoming and disposal of medication were in good order. Records of the administration of medication were in place, though these did not always include the full date, and had occasional gaps where the code for non-administration was not used. The storage of medication was secure. Staff who are designated as responsible for the administration of medication are suitably trained. At this time night staff are not designated as responsible for the administration of medication. This means that if a service user required or requested support to take medication through the night, the on-call assistant manager would have to visit the home and this could take up to one hour. The manager confirmed that some night staff have had training in this area and the remainder will be nominated for future courses. In discussion service users described how their privacy is respected during their stay. All bedroom doors are lockable by service users, and some said that they choose to lock their door during the night. Service users said they were “very pleased” to have their own private shower/toilet facilities. Service users were also impressed that they had their own telephones in their rooms. This means that service users can make and receive calls in the privacy of their own rooms whenever they wished during their stay. Staff interaction with service users was courteous and respectful. Service users were very positive in their comments about the attitude of staff. Their comments included, “All the staff are patient, caring, and friendly”; “They go out of their way to support us”; and “They are very personable. They have a lovely attitude.” Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to continue their own lifestyles during their stay, although there are limited recreational activities. Service users can maintain good contact with their relatives. Service users can exercise some choices during their stay. Service users stated that meals are of a good quality. EVIDENCE: Apart from those who have some input into their rehabilitation, service users tend to spend the day as they choose within the building. There is a TV lounge where most people socialise during the day. There is good freedom of movement for service users around the building, and many people spend some time in the privacy of their own rooms. There is no specific time set aside and no staff arrangements for service users to be supported with leisure activities. If staff do begin to arrange a leisure activity this has to be abandoned if a service user requires support with other care needs. Also some staff may not feel confident or competent to organise Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 17 social activities. There is a weekly group exercise session held at the centre, and occasional pat-a-pet and benefits advice services that visit the centre. Some service users and relatives felt that there was not enough social stimulation for service users during their stay here. However many service users also commented that the centre offered them an opportunity to build up their strength. One service user said, “It’s been a lovely place to get back on my feet.” Some service users are very motivated to keep up their skills during their stay. One rehabilitation service user said, “Staff are very supportive, but I try to do as much as I can for myself”. One short-break service user said, “I keep active by making my own tea, washing up, and washing my tights - just as I do at home.” Support for a service user to go out would be part of a rehabilitation plan, for example a planned visit home with an occupational therapist. If service users wish to go out, or continue to attend their own community events, this would have to be arranged by themselves or their relatives. Staff stated that occasionally they may support someone to the local shops but that this would be dependent upon staff levels and the needs of other service users. There were a number of visitors during the inspection. All had many positive comments to make about the centre and the service that their relatives were receiving. One visiting relative commented, “Staff are very pleasant and helpful at all times. Nothing has been too much trouble.” Comment card received from 8 relatives were also generally positive about the service. The Service Users Guide informs service users that there are male and female staff and encourages them to state if they would prefer not to have personal care support from either gender of staff. This demonstrates that service users can exercise choice over their personal care, and acknowledges their rights under the service’s equality and diversity protocols. Several service users described how they make choices throughout their day during their stay. These included making menu choices at mealtimes, choosing to spend time on the privacy of their bedrooms, and choosing how they spend their time. There are well-stocked kitchenettes on each floor where service users can make themselves drinks and snacks if they are able. Some people receiving a rehabilitation service also use these, with support, to regain confidence in their kitchen skills before returning home. Service users described the quality of meals as ”very good”. It is good practice that service users are offered the choice of main meals when they are seated at the time of the meal. In this way service users can make an informed choice Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 18 about which dish they would prefer. The menu is traditional, and service users commented that it suited their preferences. There are dining facilities in a small lounge, within the larger TV lounge and in a small kitchenette on the first floor. Main meals are prepared in the main kitchen by catering staff and transported by hotlock trolley to the small kitchenettes. Service users are asked which of the 2 main dishes they would prefer. This is then plated and served by support staff. In this way service users do not have the opportunity to serve any part of their meal themselves, which does not promote their independence. One service user said, “The meals are good, but sometimes they put too much on my plate.” Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are confident that their complaints would be listened to. Service users have good support to access advocacy services during their stay. The service has robust procedures and staff training to safeguard service users from abuse. EVIDENCE: There is clear written information about how to make a complaint in the Service Users Guide, which are in each bedrooms, as well as leaflets that are displayed in corridors. However at this time, the complaints procedures is not immediately available in other formats to meet prospective service users’ needs. For example, the centre is registered to provide care for people who have learning or sensory disabilities, but there is no information about complaints in pictorial format or on cassette tape or CD ready for them. In discussions service users and their visitors said that they would feel comfortable about approaching senior staff if they had any concerns, and were confident that these would be dealt with. All care staff have had training in customer care so that they would know how to recognise and acknowledge any dissatisfaction people might have with the service. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 20 There have been no formal complaints about the service since it opened last year. There have been some informal comments from service users, mainly about missing laundry, and these have been recorded and dealt with individually. Any service users staying at the centre during election times would have to make their own voting arrangements. It is good practice that service users have good access to advocacy services provided by Age Concern during their stay if they need such support. There are also proposals for an Age Concern representative to make weekly visits to Southernwood for service users so they will have independent access to an advocate to discuss any issues they had. As with all adult services in the Gateshead area, Southernwood uses the local authority POVA (Protection of Vulnerable Adults) policy. This includes robust procedures for reporting and investigating suspected abuse. All staff at the centre have had updated training in the POVA procedures within the past year. Discussions with the manager and senior team indicated that they are very clear about their roles and responsibilities under the procedures. There have been no POVA alerts at Southernwood since it opened. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users stay in a comfortable and well-equipped accommodation. Service users have good access to specialist equipment to support them during their stay. The centre is clean, pleasant and hygienic. EVIDENCE: Southernwood is a new building that has been specifically designed to provide short-term accommodation for older people with a range of needs, including physical disabilities. It is a bright, modern building that is furnished and decorated to a good standard. It offers warm, comfortable and cheerful accommodation for up to 23 older people. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 22 As new premises, the building is still under the warranty of the builders for one year. The manager submits a “snagging” list of any teething items each month. These have mainly been plumbing issues. The building provides one larger lounge/diner, a small dining room, and a small smokers’ lounge. The overall lounge space meets the minimum standards for the number of people who may stay here. However several residents and their relatives suggested that another lounge would have provided an alternative sitting space for service users who wanted to socialise without disturbing those who watch TV. Service users commented on the lack of lounge space for visiting families. It was clear at dining times that there was just sufficient room for the 18 people staying here to dine. There is a very large patio area to the side and the front of the building. There is some outdoor seating for service users to use during better weather. The 23 single bedrooms all have en-suite showers/toilets. However due to an unfortunate piece of design, some showers cannot currently be used independently by service users as there is a risk of flooding the bathroom. This means that staff have to hold the shower head for service users, which contradicts the centre’s aims of independence, privacy and dignity for service users. One bedroom has been out of action for a while as the bathroom floods every time the shower is used. There are 2 communal bathrooms that are fitted with adapted baths. However both these rooms are full of other equipment, including hoists, wheelchairs and bedding. This has to be cleared out into the corridor if a service user chooses to have a bath. The therapists’ office was similarly cluttered with the centre’s equipment including several walking frames. There is clearly insufficient storage space for such equipment within the building. The needs of people with dementia, visual impairments and physical disabilities have been taken into account when designing the sizes, equipment, décor and colour schemes within the centre. There is good signage and distinct colour contrasting around the building to support service users to find their way around. One bedroom has been equipped with pressure mattresses and pressure pads to unobtrusively monitor the safety of a service user who needs additional support during the night. Bedrooms are very well equipped with wardrobes, drawers, writing table, digital TV and large-button telephone. All bedroom doors are fitted with dorguards so that they can be held back to support a service user’s easy access, without compromising fire safety within the building. All bedroom doors are lockable from the inside by a service user. Service users are asked if they want a key to their bedroom, rather than automatically given one. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 23 Overall service users were very satisfied with the good quality of accommodation. One person said, “It’s a comfortable place to be whilst waiting to get better.” Service users described the building as “very, very clean” and “spotless”. There is a laundry service provided by support staff and domestic staff (or service users can choose for relatives to manage this). The laundry is wellequipped and in a service area away from service users’ accommodation. In discussions several service user commented that they often receive some clothes back from the laundry that do not belong to them. Although service users are requested to mark their laundry it may not always be practicable or possible for them to do so. As a result the centre proposes to provide individual laundry sacks. All parts of the building that were examined were clean and hygienic. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by skilled staff. The centre’s robust recruitment practices make sure that only suitable staff are employed to support the people who stay here. Staff have had suitable training in care, but training records do not demonstrate their training needs. EVIDENCE: All of the current staff team were already employed in similar services operated by the Provider (Gateshead Social Services Department) before being redeployed to this service. In this way all staff were familiar with their job descriptions, responsibilities and the code of conduct prior to the centre opening. During the day and evening (e.g. 7.30am – 9.30pm) staffing levels are 1 assistant manager, 1 senior and 3 support staff. This level of staffing was sufficient to support service users with their personal care needs. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 25 Night-time staffing is 2 support staff on duty at the centre, with 1 assistant manager on call for this and 3 other care facilities in the area. At this time staff stated that 2 night staff is sufficient for the number of service users. However night time staff are not currently trained in all aspects of care that may be required by service users during the night, e.g. medication, and first aid. Service user and relatives had many positive comments to make about the supportive attitude of staff. One relative wrote, “Care provided is excellent due to the efforts of staff on duty at any time.” However, 3 relatives commented that there are not sufficient staff on duty to manage the social care needs of service users. One relative said, “A staff member should monitor the lounge area and perhaps offer some activities to service users. Also to mediate between those with dementia or not.” There are currently no staff vacancies. There have been only 2 new appointments since the centre opened. It is clear from the Provider’s recruitment and selection processes that all necessary checks and clearances are taken up on potential new staff prior to their employment. Most records are held centrally at the staffing section of the Social Services Department. The manager has some information for his own reference about each staff member within the centre. All support staff have achieved NVQ level 2 or above (a social care qualification) to support them in their care of the people who stay here. The aim of the centre is to promote independence and the manager proposes to pursue any training in intermediate care that would further equip staff in this role. In discussions staff were enthusiastic and motivated about training opportunities. There are individual training records for each member of staff. However it was clear that these are not fully up to date. No training analyses has been carried out to ensure that all staff have the required training or to identify any gaps. As a result some statutory training needs had not been met, for example first aid. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 and 37. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is managed by a person who is fit to be in charge. Service users benefit from the positive ethos of the service, and are enabled to give their views about the service in confidence. Staff are supervised and the provider operates a well run service. The health and safety of service users is not protected by outdated training for staff, poor fire practices and lack of hot water safety tests. EVIDENCE: The registered manager has attained suitable care and management qualifications to take responsibility for the day-to-day management of the Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 27 service at Southernwood. He has many years experience in care setting for older people, and is competent to be in charge of this service. He is supported by 3 assistant managers, who supervise staff in the care of the service users and who deputise in his absence. He is supported and supervised by a representative on behalf of the Provider who carries out monthly visits to the service to report on its operations. There are clear lines of accountability within the organisation. In this way the service is well managed. It was clear from discussions with service users, visitors and staff that the management style within the home is open, accessible, and positive. Service users commented on the approachability of all staff including the management team who make themselves available to service users and visitors. One service user said, “The manager is very competent, and has an excellent staff team.” There was clearly a friendly atmosphere in the centre, and good relations between staff, the manager and the service users. The Provider’s quality assurance processes include a number of performance tests of the service including “mystery visitors” to experience the customer services delivery at the centre. There are monthly meetings for service users staying at the time to express their views, and it was clear from minutes that service users who attend do participate in these meetings. There are also service users’ satisfaction questionnaires to seek their views as to the service they have received during their stay. The questionnaires are given to service users just prior to their discharge so that their experience of the service is still fresh, and their responses are sent to the Provider for collation. It is good practice that as part of its quality assurance processes, the Provider involves Age Concern to test customer care services and customer satisfaction at Southernwood by talking with service users about their experiences. This offers Southernwood an independent collection and collation of service users views about the service it provides. Satisfactory insurance and public liability cover is in place to protect the service, its staff, the people who stay here, and visitors. The centre does not take responsibility for service users monies during their stay. However items can be securely stored during service users’ stay if they request. Each member of staff has the opportunity for individual supervision sessions with their line manager from time to time. The files of 6 staff examined indicated that staff have had, on average, 2 supervision sessions since the centre opened, and these are recorded. The centre aims for each staff to have at least 6 supervisions sessions a year. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 28 Records are securely stored and managed within confidentiality guidelines. Service users have information in the centre’s Statement of Purpose about their rights to access their own records and how to do so. Some service users have signed their own care plans to demonstrate their involvement in these. There were a number of health and safety shortfalls to the service at the time of this visit and an Immediate Requirement Notice was given to the centre to address the following matters as a matter urgency. All staff are nominated for statutory training in health and safety matters. However at the time of this visit some training was out of date and the centre staff commented on their difficulties in acquiring places on training courses that are arranged by the Provider. For example, most night staff did not have up to date training in First Aid, although they had been nominated several times. This meant that for many nights there were no first aiders on duty to attend to service users who had an injury or accident through the night. Although all staff received fire safety training before the centre opened, there was no record of any regular in-house instruction since then. Again, for night staff this meant they had not had 3 monthly training to demonstrate their knowledge of fire procedures in the event of a fire during the night. Staff training records indicated that some staff have not had moving & assisting training for up to 6 years. There have been many changes to moving techniques since then that those staff are not trained in. All staff had instruction in Infection Control about a year ago but this was not provided a trained trainer, so this was not certificated course. All support staff may be engaged in assisting service users to prepare their own snacks and meals as part of their promoting independence role. However not all support staff have had training in food hygiene. Some practices also compromised the health and safety of service users and were also outlined in the Immediate Requirement Notice. For example both kitchenettes contain several ignition sources, including cookers. Both doors are fire doors to be kept closed, but both were propped open with chairs during this visit. It is acknowledged that this practice is to allow easy access by service users. However it also presents a fire safety hazard and tripping hazard. A health & safety audit is carried out by senior staff each month. However staff had omitted to test the hot water used by service users, so hot water temperature for baths, showers and washbasins had not been tested since the home opened. The thermometers in bathrooms for testing water were Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 29 unsuitable as these only tested up to 20°C, so could not determine whether the safe hot water temperature guideline of around 43°C was being met. In this way, the centre could not demonstrate that service users’ safety was protected when they used baths. Both bathrooms contained a lot of furniture, mattresses and mobility equipment. As well as looking unsightly this presents a tripping hazard for any service users who may enter these rooms. By the end of this inspection, the Provider had begun to address these health & safety issues. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 30 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 3 3 3 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 3 3 3 3 1 Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A 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 OP1 Regulation 4(1)a Requirement As it develops Southernwood will need to review its aims and objectives, as set out in the Statement of Purpose, in light of the average length of stay of the assessment service and the impact this will have the availability of the service for other potential service users. All care plans must be sufficiently detailed to show the specific actions to support service users towards their goals, and evaluations must reflect the progress towards those goals. Moving & assisting assessments must be carried out in respect of each service user, so that their independence or support needs in this area are clearly set out. Self-administration of medication assessments must be carried out with each service user so that their potential for independence is promoted within a risk assessment framework. The complaints procedure must be available at the centre in a DS0000066639.V324153.R02.S.doc Timescale for action 01/07/07 2. OP7 15(1) 01/06/07 3. OP8 13(4)b & 13(5) 01/04/07 4. OP9 12(2) & 12(4)a 01/04/07 5. OP16 22(6) 01/04/07 Southernwood Promoting Independence Centre Version 5.2 Page 32 6. OP21 12(4)a & 23(2)c 7. OP30 18(1)(c)i 8. OP38 13(4), 13(5), 18(1)(c)i 9. OP38 13(4) 10. OP38 13(4) suitable format for use by people with a visual impairment, e.g. on cassette or CD (with accompanying equipment so that it can be listened to.) Showers in en-suites must be fitted in such a way so that these can be used independently by service users who have been assessed as capable to do so, in order to uphold their dignity and privacy. Individual training records must be up to date and training needs analyses carried out to identify and rectify any gaps in staff training. The Provider must ensure that all staff are provided with up to date statutory training in health & safety matters, including first aid, moving & assisting, fire safety and food hygiene. The manager must ensure that all health & safety tests are carried out including monthly tests of the temperature of hot water to baths; and that bathrooms are kept free of potential tripping hazards. The service must ensure that fire doors are kept closed. 01/04/07 01/05/07 15/03/07 15/03/07 15/03/07 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 Refer to Standard OP1 OP7 Good Practice Recommendations Copies of the Service Users’ Guide should be available at the centre in other formats e.g. on cassette or CD, and in pictorial. Life history questionnaires should be revised to remove DS0000066639.V324153.R02.S.doc Version 5.2 Page 33 Southernwood Promoting Independence Centre 3 OP9 4 5 6 7 8 OP10 OP12 OP15 OP26 OP30 irrelevant or insensitive questions. Consideration should be given to designated, trained night staff being responsible for administration of medication so that residents who require assistance with medication through the night receive that support quickly. All service users should have access to a lockable facility in which they can store private possessions during their stay. Consideration should be given to how service users’ social and leisure care needs can be met during their stay. Consideration should be given to providing vegetables, side dishes and sauces in tureens for service users to have the opportunity to help themselves at mealtimes. Proposals to purchase individual laundry sacks should progress, so that individual service user’s laundry can be identified, and returned to the correct room. The centre should pursue training for staff in intermediate care to support them in their role of promoting the independence of service users. Southernwood Promoting Independence Centre DS0000066639.V324153.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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