CARE HOMES FOR OLDER PEOPLE
Southwater Residential Home 3-4 Conway Crescent Paignton Devon TQ4 5LG Lead Inspector
Sharon Goldsworthy Unannounced 20 January 2006
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Southwater Residential Home Address 3-4 Conway Crescent, Paignton, Devon, TQ4 5LG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 524140 Mr Thomas Lamont Mrs Mary Lamont Mr Thomas Lamont Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate two named service users with the category DE(E) Date of last inspection 17th March 2005 Brief Description of the Service: Southwater is a large property comprising of three terraced houses combined. A conservatory creating the impression of a large single property fronts all three houses. The home provides care for up to 18 service users who come into the category of old age. It is situated in a residential area near to local shops and facilities. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection of this inspection year. This inspection was unannounced and took place on a Friday for seven and a half hours. An additional visit took place in June 2005, to investigate a complaint – which was partly upheld. Time was spent at this inspection visit with the Proprietors, staff on duty and residents. A tour of the premises was conducted, a sample of documents were viewed and care practice was observed. What the service does well: What has improved since the last inspection?
The Proprietors have made considerable progress in meeting previously set Requirements and Recommendations. All staff have attended training in relation to the Protection of Vulnerable Adults from Abuse. The home’s activity programme has been extended and now provides a different group activity six days a week, offering a good variety and choice for all residents. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 6 With the exception of one identified on the day of this visit, all radiators have now been covered, which now eliminates the risk of residents scalding themselves on hot radiators. A number of magnetic door holders have been fitted to bedroom and communal doors to ensure that residents can keep doors open to aid mobility. All staff have obtained CRB checks, which ensures the residents are protected from the risk of being exposed to harm or abuse. Some work has been carried out to improve the administration systems in the home and this is continuing. All staff are now receiving regular supervision sessions from a member of the management team. What they could do better:
Some further work needs to be carried out on the residents care plans and medication records, which the Proprietors have stated their intention to do. Residents need to be more involved in the writing and reviewing of their care plans. The staff training programme needs to be further extended to ensure all staff attend the required statutory training and to improve on their skills in relation to the care of older people. The Proprietor who is also the registered manager needs to enrol on an NVQ programme to level four, to meet with the National Minimum Standards in relation to management training. One bedroom on the second floor needs to be decorated and will need to have a radiator cover fitted to ensure the safety and comfort of the existing resident. The quality assurance system already started needs to be completed and continued as planned to ensure that the results of surveys are analysed and published in a document available for residents and other stakeholders. Residents need to be encouraged to maintain skills in order to remain as independent as possible within this supportive environment. Residents need to be offered more choice in relation to meals offered. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 7 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. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 None of these standards were considered in depth at this inspection. The home does not provide rehabilitative or intermediate care. EVIDENCE: Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The residents’ health and personal care needs are being met. EVIDENCE: Care plans and daily care records are in place, complete and up to date. These records are held in the resident’s bedrooms and records demonstrate that staff constantly review and up date these documents when required. However, there is a need to further extend and put more detail into these records to ensure that staff have very clear instructions as the level of need for individuals. Three residents whose records were looked at stated that they have not been involved in the writing of these care plans, although were aware of their existence and roughly what is written in them. The Proprietors stated that they have purchased a new care record system and plan to implement these in the next few weeks. Daily records indicate that resident’s health care needs are fully met. Residents reported that they regularly have access to chiropody, dental and optical care and that they regularly see GP’s and district nurses when required. Residents stated that staff treat them with respect, addressing them as they wish, allowing them “time in their rooms alone if they wish” and are “not too
Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 11 intrusive or personal”. Residents spoke very highly of the care they receive from staff and felt they were all approachable and friendly. The owners have recently audited their medication system. A controlled drugs register has now been purchased and was found to be in use. Some minor advice was offered by the Inspector to ensure that these records comply fully with the Royal Pharmaceutical Society Guidelines for Care homes. Risk assessments required at the time of the last inspection in relation to medication administration have been completed – but these need to be completed in a little more detail to ensure that all staff are aware of the residents abilities, understanding and specific needs in relation to taking their medication. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Residents are enabled to maintain contact with friends and family and feel that they are enabled to maintain control over their lives in terms of choice and lifestyle. Meals are nutritious, balanced and of good quality. EVIDENCE: The home has now allocated a carer to the provision of an activity programme within the home. This person is on duty every afternoon to provide a group activity and to organise events and outings. Recent activities include; quizzes, bingo, board games, reminiscence, discussions, music and singing. There are regular entertainers and an external group work provider who visit the home approximately once monthly. Records are kept of these activities, with appropriate evaluations. One resident is involved in the running of a Sunday service held in the home and confirmed that local clergy visit the home regularly to see individuals also. Most residents spoken with confirmed that they attend at least one or two activities each week. Those that do not confirmed that they were happy spending time on their own or with one or two close friends who they have in the home or who visit regularly. Residents spoken with confirmed that they are supported in maintaining contact with relatives and friends. The home has an open visiting policy. A small number of residents are able to independently leave the home to visit
Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 13 family and friends, attend appointments or just to go out for a walk. Some residents confirmed that the Proprietors will very often take them to appointments or go out to do shopping for example on their behalf. The Inspector joined the residents for the main meal of the day. Residents were very complimentary about the food. The main meal on the day was hot, nutritious and well balanced. All residents spoken with stated that they do not know what is for the main meal each day, unless they happen to have seen the Proprietor earlier in the day, who always makes a point of telling them what is for lunch. Most said that they like all the meals provided, but felt comfortable to ask for an alternative meal if they didn’t want what was offered. All residents however, are consulted in the afternoons as to what they would like for tea, with a full open choice being offered. A discussion was held with the Proprietors about the provision of meals. They felt that they could easily implement a system to ensure that all residents are consulted and offered choices about all meals. It was felt that a number of residents would be able to independently serve themselves with drinks, vegetables and sauces and where they are not able to a system could be implemented whereby staff could spend some time with residents supporting them in making more choices and participating more independently in meal times. Again the Proprietors felt that they would be able to easily introduce a choice of drinks to the table as well as vegetable dishes and sauces. This would greatly improve the level of service offered to residents. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Residents can be confident that their complaints are listened to, taken seriously and acted upon. The homes systems, policies and staff training ensure that residents are protected from abuse. EVIDENCE: The home has a Complaints procedure. This includes details of how complaints will be managed and advises the complainant of timescales in which complaints will be addressed. The procedure advises the complainant of the CSCI’s existence, but does not include the address or telephone number of the local office. This information is however, printed at the bottom of the complaints record. At the last inspection these records were viewed and were seen to be appropriately used and completed in sufficient detail. A complaint was made to the CSCI in June 2005, after which a visit to the home was conducted. The complaint was in relation to the way in which the Proprietors deal with complaints. This was partly upheld. The Proprietors feel they have learned from this experience, and no further complaints have been made to the CSCI. All staff have recently attended training in relation to the Protection of Vulnerable Adults from Abuse. The home has a policy and procedure in relation to the protection of vulnerable adults from abuse. The procedure clearly indicates significant parties who should be informed of any allegation of abuse, now including the CSCI. The home also has a Whistleblowing procedure for staff. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 Residents live in a safe, clean and well-maintained environment. EVIDENCE: The home is now generally safe and well maintained. The Proprietors have now fitted radiator covers throughout the home, with the exception of one bedroom, where the resident has been reluctant to allow this. This radiator is said to never be turned on however. The Proprietors do intend to decorate this bedroom in the very near future and will fit a radiator cover in this room at that time. Magnetic door holders have been fitted throughout the home to all fire doors that were felt to be in need of being held open to aid residents’ mobility. These door holders are now able to function in this way, although do not compromise the safety of the fire doors from closing in the event of the fire alarm sounding. The Proprietors have continued to decorate and refurbish this home and have redecorated bedrooms as they have become available.
Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 16 The home was found to be clean, free from odour and tidy throughout. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff are not fully trained in all aspects of caring. EVIDENCE: The Proprietors have a focus and genuine determination to ensure that all staff receive the appropriate level of training required. Since the last inspection, all staff have attended training in relation to the Protection of Vulnerable Adults from Abuse. They are aware that training needs to be arranged for all staff in First Aid, Food Hygiene, Medication, Health and Safety and Manual Handling. Two members of staff have completed NVQ’s to level 2 and one at level 3. One member of staff is reported to have almost completed an NVQ to level 2. It is hoped that some further funding can be secured in order to offer this level of training to a number of other staff. The Registered Manager still needs to enrol on an NVQ at level 4. It is intended that this will be done in the next few months. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 The home is run in the best interests of the residents. Residents are safeguarded by the financial procedures in the home. Staff are now appropriately supervised. EVIDENCE: The home has set up and is continuing with a quality assurance system in terms of issuing surveys/questionnaires to all residents and their relatives. Some have been issued and completed by visiting professionals. The Proprietors have now collated a number of these surveys and is now in a position to analyse the data received. They are aware of the need to report on their findings and put this into a format that is appropriate for the residents and all other stakeholders to access. The Proprietors confirm that no service users monies are held in the home any longer. Where service users are unable to manage monies themselves, their relatives or the local authority responsible for placing individuals are asked to manage monies on their behalf.
Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 19 All staff are now receiving regular supervisions with a member of the management team. Records of these meetings were seen to be clearly recorded with action plans and signed by both supervisor and supervisee. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x 3 3 x x Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. Standard OP15 OP19 OP19 OP30 OP33 Regulation 12(3) 13(4) 23(2) 18(1) 24 Requirement Residents must be informed of the main meal each day and actively offered an alternative Covers must be fitted to the one remaining radiator identified The decoration must be undertaken to the room identified All staff must receive statutory training as required (previous timescale agreed 30/8/05) Continue with the development of the quality assurance system in place Timescale for action 20/01/06 20/02/06 20/03/06 30/05/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP7 OP9 OP9 OP15 Good Practice Recommendations Care plans should be reviewed to include more detail. Residents should be more involved in the writing and reviewing of their care plans. Medication risk assessments need to include more detail Controlled drugs records must include a running balance of medications held. Residents should be supported in maintaining skills of
D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 22 Southwater Residential Home 6. 7. OP30 OP28 independence and choice, particularly around meal times The Manager should be enrolled on an NVQ Level 4 and Registered Mananger Award programme 50 of care staff should obtain an NVQ to Level 2. Southwater Residential Home D54-D07 S18427 Southwater V260060 200106 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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