Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Southlands Court, Bridgerule Southlands Court, Bridgerule Bridgerule Holsworthy Devon EX22 7EW The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh
Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Southlands Court, Bridgerule Southlands Court, Bridgerule Bridgerule Holsworthy Devon EX22 7EW 01288381631 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Victor Lawrence Goaman,Mrs Celia Jane Goaman care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The Registered Manager to attain NVQ Level 4 in Care and Management by September 2005 Date of last inspection Brief description of the care home Southlands Court is a care home providing accommodation and personal care for up to 25 male and female older people, some of whom may have dementia. The home is situated on the outskirts of Bridgerule, North Devon. The building is a converted farmhouse on 2 floors. The majority of the private and communal living accommodation is sited on the ground floor. A stair lift gives access to the 1st floor. All bedrooms are single and have en-suite facilities. The grounds, including a large pond in a centre courtyard area, are well maintained. The home backs on to farmland and has glorious open views of the surrounding countryside. The owners of the home live a Care Homes for Older People Page 4 of 27 0 0 0 Over 65 25 25 25 Brief description of the care home short distance from the home and visit the home frequently. Copies of previous inspections are available in the home and are kept on display in the entrance foyer of the home. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was completed during a weekday in November and lasted for approximately six hours. Time was spent talking to people who live at the home to find out about their experiences. We also spoke to care staff and observed care and support being delivered throughout the day. We spent time looking at some of the key documents including plans of care assessments of new people moving into the home, staff recruitment files and training records, records relating to individuals finances and records on administered medications. Prior to the inspection we sent surveys to a sample of people who live at the home as Care Homes for Older People
Page 6 of 27 well as staff and visiting health care professionals. Their views and comments including those from face to face interviews are included in this report and have helped us to make judgments about the quality of outcomes for people who live at the home. The home were asked to complete an Annual Quality Assurance Assessment prior to this inspection taking place. This should have given us complete details about how the registered provider and manager ensure that the environment is well maintained and how often equipment and facilities are tested. It also gives us information about the policies and procedures the home have in place and what training staff have to ensure that they can do their job safely and effectively. We have had to request some additional information as the AQAA was not fully completed and many answers to questions only contained a few brief words.The AQAA is a legal requirement and we would expect that this information be completed fully. What the care home does well: What has improved since the last inspection? What they could do better: The registered provider and manager needs to ensure that staff have regular training in fire safety to ensure that they are aware of what to do in the case of a fire. This training should be recorded and be at least annually and more often for staff who cover nights. Plans of care should be developed and reviewed with the individual or their representative where possible. Plan must also be reviewed at least monthly to ensure that needs are being assessed and plans updated on a regular basis. This will ensure that staff are aware of what they should do to meet needs. Plans of care could be Care Homes for Older People Page 8 of 27 further improved by including more detail about the individuals personal and preferred routines, so that care and support can be planned and delivered in a more person centered way. Plans should also include more detail about the individuals social needs so that activities can be planned that meet these needs where possible. Individuals who are privately funded should have a pre admission assessment that covers all aspects as detailed in standard 3, to ensure that the home can meet all needs. This should also cover social, cultural and religious needs. Induction training for new staff should meet the specifications of Skills for Care. This ensures that all relevant topics are covered and new workers are assisted to gain a good understanding of their role. The registered manager will need to ensure that the information needed to ensure that the AQAA was completed is forwarded onto CSCI. The registered manager has been advised to look at the CSCI website for advice and guidance on completing the AQAA. Staff should have regular one to one supervision sessions to help them to discuss their role and training needs. The registered manager needs to ensure this is recorded. The registered manager needs to ensure that staff are checked on regular basis in respect of their competencies to safely administer and record medications. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessment information for privately funded people should be more detailed so that individual can be assured that the home can meet all assessed needs. Evidence: Pre assessment information was looked at for three people who live at the home. The registered manager stated that where possible she would visit the individual at their home or hospital and discuss their needs with the person and carers as appropriate. Although assessments contained basic information about the individual needs, there was very little recorded about their social history or needs, and this should be looked at so social needs can be planned for. The pre admission assessments for those people who are self funded should be more comprehensive and cover all aspects as detailed in standard three. It would be useful to discuss and record any diverse needs such as cultural or religious beliefs and these are not currently documented as part of the
Care Homes for Older People Page 11 of 27 Evidence: assessment. The registered manager said that for individuals who were funding from the local authority the care management assessment and care plan were obtained. Care Homes for Older People Page 12 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual personal and health care needs are well met, but improvements in planning for care are needed to ensure consistent care and support is provided. Evidence: People who live at Southland Court who were spoken to and those who returned surveys said that they did have their personal and health care needs well met. People who live at the home said that staff made sure they had their personal needs met each day and that they had good access to medical help such as community nurses, GPs, chiropodist, dentist and opticians. People who returned surveys said I like it here, I am perfectly satisfied, I have no reason to make a complaint. All ten surveys returned from people who live at the home had ticked always to the question do you receive the care and support you need. Seven out of ten ticked always to the question do you receive the medical support you need and the rest ticked usually. Care Homes for Older People Page 13 of 27 Evidence: People who live at Southlands Court said This is the best place, I first went to another home but hated it, but now I am here it is much homelier and I have accepted that I need to be here. It is always lovely and clean. I really love this room (bedroom) I was here on respite and when I knew this was available I said I would take it, you can bring in your own things and it is always kept spotless. Staff were observed to provide care and support in a caring and respectful way, although one person who did not eat very much lunch had their plate removed and was not asked why they hadnt eaten much or offered something else. In discussing this as part of the feedback to the registered manager, she felt staff may have felt nervous in front of the inspector, and so may not have reacted as they would normally. Three plans of care were looked at and although they give some basic information about individuals needs, they need to be improved in order to demonstrate that good planning is in place for ensuring all needs are met. One persons plan identified that they had depression, and their assessment had said they had been suicidal, but in the actions for staff it simply said monitor. We would expect to see some clearer directions for staff as to what to look out for. None of the plans looked at gave any clear indication as to the individuals social, cultural or religious needs. One plan stated enjoys company another was blank for this section. Plans could be improved by including some social history and talking to the individual about their social needs so that this can be planned for. Plans could include more detail about the individuals preferred daily routines, and how staff can meet these so that care and support can be delivered in a person centered way. Plans seen had not been reviewed on monthly basis, nor had they been signed or agreed by the individual or their representative. The registered manager said that they do try to share the information with the person, and the plan is kept in their room, although perhaps not always in an accessible place for some people. The district nurse team were contacted and the team leader said that they had no concerns about the care at Southlands Court that it was one of the best homes in the area and provided excellent care. They confirmed that they were called in as appropriate and worked closely with the home and the GP to ensure health care needs were met. The medication records and storage was looked at as part of this inspection. We checked the controlled drugs, which was being appropriately managed. Any returned drugs are signed for by the pharmacist and staff have a policy to follow for administering medications. Staff should have their competencies checked regularly as
Care Homes for Older People Page 14 of 27 Evidence: part of supervision and appraisal as well as regular undated training in the safe handling and administration of medications. Care Homes for Older People Page 15 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are flexible and social needs are generally met. Evidence: Individuals spoken to said that they could choose what time they got up, went to bed and where they spent their day. One person said they do encourage us to go to the dinning room for our meals, but I prefer to spend most of my time in my room. One person said that they enjoyed the activities on offer and that these included weekly exercises, bingo and craft sessions. One person showed me a Christmas decoration a group had been working on and during this inspection a large number of people were taking part in chair exercises. The registered manager said that they have an activities coordinator that works around 6 hours per week and plans a range of different activities, although it was unclear how people were consulted about activities, except at a yearly meeting. Plans of care and pre admission assessments did not contain any detail about individuals social needs or past interests and hobbies. This information could be used to better plan activities. Care Homes for Older People Page 16 of 27 Evidence: As mentioned in the previous two outcome groups, the assessments and plans of care do not give very much detail about individuals social needs or cultural or religious needs, and this should be discussed with individuals so that activities can be planned around needs and wishes. Some people spoken to confirmed that they were able to have visitors wherever they wished and the visitors book in the main entrance hall confirmed this. During this inspection family members were seen visiting as was a hairdresser and chiropodist. Individuals are offered a reasonable range and choice of meals and most people spoken to and those who returned surveys said that they were satisfied with the food offered. One person was observed struggling to cut up their meat and said that it was too tough. Their main meal was taken away by staff without them asking if they wanted something else. No one was offered seconds of either the main meal or pudding, although portion sizes were fairly generous. Another person had had a stroke and could only use one hand. They made the comment that it was sometimes a struggle to get the last bits of food off their plate. A plate guard would have been helpful and the individual said they had seen them but had not been offered one. After lunch all the staff sat down to eat their meal and one person was heard to ask for some help and was told that the staff were having lunch. This was discussed with the registered manager who said that this was not always the practice, but that staff did need a break. It was suggested that staff should not all take breaks together as people may perceive that they cannot ask for assistance at this time, when they should be able to ask for help at any time. Care Homes for Older People Page 17 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views will be listened to and acted upon. Evidence: The home have a stated complaints procedure and need to ensure that individuals copies have CSCI up to date contact and address details included. The complaints log held at the home showed that they had not had a written complaint since March 2004. The registered manager said that they try to ensure that individuals are given the opportunity to air any concerns they have before they become a problem. The home ask people to complete surveys and hold an annual residents and families meeting where people are encouraged to say what they think about the service. The home states in their AQAA that they have policies to protect vulnerable people and staff spoken to said they had done training in this area. Staff were aware what they should do if they suspect abuse. Care Homes for Older People Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people with a clean, warm and homely environment. Evidence: During this inspection all communal areas and some of the individual bedrooms were looked at. The home is nicely furnished and appears warm and homely. Individuals spoken to said that they were impressed with the environment, most said they liked having their own en suites, and that they could bring in their own items of furniture. Some bedrooms had been personalized. The registered manager when asked said that lockable storage would be provided in bedroom on request or if they had anyone who self medicated, but that it was not given as standard. None of the bedrooms have locks fitted so individuals may not always have their privacy respected. This is something the registered provider should consider. Overall the home presented as very clean and well maintained, however the AQAA did not give details about some aspects of maintenance as requested. This information gas been asked for but at the time of writing this report has not been made available. (see last section on management.) Care Homes for Older People Page 19 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are reasonably well trained to do their job effectively. Evidence: Staffing levels are sufficient for the number and needs of the current people they provide a service for, but this should be kept under review and increased should the needs increase. Staff available is normally, three care staff per shift, one of these being the manager or deputy. Some staff said that when this was the manager, in effect there was often only two carers available as the manager was busy in the office. Two care staff for over twenty people is not sufficient. The registered manager said that care staff were well supplemented with ancillary staff including a cleaner in the mornings, and at least two kitchen staff who prepared all meals. On the day of the inspection however the afternoon care staff were observed preparing the evening/tea time meal and when asked said that they normally did do this, which again would leave two staff available to do the care and support for a short period of time. Three staff were spoken to during the inspection and said they had regular updates in all training, except two had not had fire training during this year, but said they had covered this in previous years. One staff member said they had done training in mental capacity and some dementia training. All said they had opportunities to do NVQ training.
Care Homes for Older People Page 20 of 27 Evidence: Induction training does not currently follow the national guidance and standards and needs to be more detailed and include all aspects as recognized by the Skills of Care. The registered manager agreed she would look into this, but said that their induction did cover all the essential information they require a new staff member to know. Care Homes for Older People Page 21 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed in some aspects of training to ensure that the home is well run and in the best interests of the people who live there. Evidence: The registered manager has her NVQ4 in care and the registered managers award, which are the current recognised required qualifications. She says she has continued her training with ensuring her core skills training in all matters of health and safety are up to date. The AQAA sent to the commission by the manager was not completed to a standard we would expect of a home whose quality star rating is two stars. It lacked any real detail about how the home ensures quality care and support. Some sections were left blank including when the electrical circuits of the home were last tested and when the heating system was last serviced. None of the policies had dates to say when they had last been reviewed. The manager has been asked to supply this information but it has
Care Homes for Older People Page 22 of 27 Evidence: not been made available to date. We are therefore unable to say whether standard 38 in respect of ensuring the health and safety of the people who live at the home and staff, is fully met. The home uses annual surveys for people who live at the home and their family members, but now need to ensure the results of these surveys are made available to people including CSCI. Monies held on behalf of individuals is kept secure and records show there is a robust audit trail. Staff who returned surveys and those spoken to said that they do not have regular one to one supervisions at least 6 times per year. This should be offered to all staff to ensure they have an opportunity to discuss their role and any training needs. Staff induction needs to follow national guidance and be more comprehensive to ensure that new staff fully understand their role. Currently the home are using a brief tick list that covers only very essential information about the home. The training records showed that staff have not had fire training for any period of 2008. The registered manager said that she stopped the external training as she felt it was a waste of time paying for someone to come in and show a video. She said that she had discussed the fact that training now consisted of staff running through a fire drill with the fire officer when they visited in January 2008 and that they had agreed that this sufficient. We have since clarified with Devon Fire and rescue service that they would expect that all staff have this training on a regular basis, not just some staff who are available when the fire drill is being done. The registered manager needs to have a system in place to ensure that all staff have regular updates on fire safety and that this is recorded. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 38 13 The registered person must ensure all parts of the home are free from risks to health and safety including ensuring regular maintain and servicing of all parts of the home The information pertaining to these services should be forwarded to CSCI 31/01/2009 Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Pre admission assessment information should include all aspects as detailed in standard three and include any equality and diversity needs, to ensure that the home can meet all identified needs. Plans of care should be more detailed and include details that would ensure individual diverse needs as well as social needs could be planned for and met. Induction training should meet the specifications of the Skills for Care. The results of surveys should be collated and made available to people who live at the home and to CSCI
Page 25 of 27 2 7 3 4 30 33 Care Homes for Older People 5 36 Staff should be offered regular one to one supervision so that they can discuss their role and training needs. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
