CARE HOMES FOR OLDER PEOPLE
Southwater Residential Home Southwater Residential Home 3-4 Conway Crescent Paignton Devon TQ4 5LG Lead Inspector
Sharon Goldsworthy Unannounced Inspection 8th March 2006 09:20 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 Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 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. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Southwater Residential Home Address Southwater Residential Home 3-4 Conway Crescent Paignton Devon TQ4 5LG 01803 524140 NONE 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) 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 DS0000018427.V260063.R01.S.doc Version 5.1 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 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 DS0000018427.V260063.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and is the second visit to take place in this inspection year. This visit took place over four hours. A tour of the premises was conducted, a number of residents were spoken with individually and as a group and a sample of documents were observed. The Proprietors were present for the most part of this visit. It must be noted that the home had their last inspection on 20th January 2006, and as such have not had sufficient time to address some of the requirements or recommendations made at that visit. What the service does well: What has improved since the last inspection?
The Proprietors have continued to make progress in meeting previously set Requirements and Recommendations. All staff have attended training in relation to the Protection of Vulnerable Adults from Abuse recently. 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 DS0000018427.V260063.R01.S.doc Version 5.1 Page 6 With the exception of one, all radiators have now been covered, which now eliminates the risk of residents scalding themselves on hot radiators. Some work has been carried out to improve the administration systems in the home and this is continuing. What they could do better:
Assessments need to be completed for all prospective residents by someone in the home qualified to do so, that indicates if the home feels able to meet the individuals needs within the home, prior to their admission. 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. Residents need to be encouraged to maintain skills in order to remain as independent as possible within this supportive environment. 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 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. 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. The staff recruitment process needs to ensure that two references and a current CRB applied for by the home needs to be obtained for all staff. All hot water outlets used by residents need to be fitted with thermostatic control valves that regulate the hot water temperatures to a maximum of 43 degrees centigrade to prevent the risk of residents from scalding. Liquid soaps and paper towels need to be provided adjacent to all hand washing facilities to comply with safe hygiene and prevention of cross infection. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 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 DS0000018427.V260063.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 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 the following standard(s): 3 Prospective residents do not currently have their needs fully assessed before entering this home. EVIDENCE: The home does not at all times carry out formal assessments on prospective residents prior to their admission to the home. The owner/manager states that she does on occasions visit prospective residents in hospitals or meets them on an initial visit and look around the home, but does not complete a formal needs assessment. A new format was identified at the time of this inspection, and this was felt to be a suitable document that can be used for this purpose. The manager stated her intention to implement this immediately and intended to review the level of visits and assessments undertaken to the prospective clients homes, hospital settings and arrange for short stays and days spent in the home, where a full assessment of needs could be undertaken. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 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. At the last inspection in January 2006, 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 manager was able to show the inspector a newly purchased care record system and plans to implement these in the next few weeks. Daily records indicate that resident’s health care needs are fully met. The owners have recently audited their medication system. A controlled drugs register has now been purchased and was found to be in use. Risk assessments required at the time of the last inspection in relation to medication administration have been completed – but these need to be
Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 11 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. A new risk assessment document was identified on the day of this inspection, that is felt to be appropriate for this purpose. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 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 the following standard(s): 14 Residents feel that they are enabled to maintain control over their lives in terms of choice and lifestyle. EVIDENCE: A discussion was held with the proprietors at the last inspection about the need to encourage residents to maintain and improve on skills of independence. 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. 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 DS0000018427.V260063.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered on the day of this visit. EVIDENCE: Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 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 DS0000018427.V260063.R01.S.doc Version 5.1 Page 15 The home was found to be clean, free from odour and tidy throughout. . The proprietors were advised to obtain and provide paper towels and liquid soaps adjacent to all wash hand basins to fully comply with infection control and hygiene practices. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Service users needs are met by the numbers and skill mix and trained staff. However, the home’s recruitment practices do not fully protect the residents. EVIDENCE: Staff rotas and observation of staffing levels indicate that four care staff on duty each morning, three in the afternoons and three sleeping in at nights (two of which are the owners themselves who live on the premises). There are additional kitchen and ancillary staff to these numbers. The staffing levels currently, appear to be sufficient to meet the needs of the current resident group. 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. Two staff personnel files were observed on the day of this inspection. For one member of staff no references had been obtained. For another a CRB was
Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 17 present – but this was from a previous employer. The manager is aware of the need to obtain two written references and a current CRB and POVA check for all staff including existing staff and stated her intention to address this. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 38 The home is run in the best interests of the residents. The environment is generally safe. 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. With the exception of one, all radiators have now been covered, which now eliminates the risk of residents scalding themselves on hot radiators. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 19 A sample of hot water outlets were tested and one in particular was found to be exceeding the maximum 43 degrees centigrade. Following discussion with the proprietors, it became evident that not all hot water outlets are fitted with thermostatic control devices. The manager advised that advice had been sought on this issue from a heating engineer who had not mentioned such devices. The manager was advised that all hot water outlets used by residents need to be fitted with thermostatic control valves that regulate the hot water temperatures to a maximum of 43 degrees centigrade to prevent the risk of residents from scalding. 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. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. 6. Standard OP3 OP19 OP19 OP30 OP33 OP29 Regulation 14(1) 13(4) 23(2) 18(1) 24(1)(2)( 3) 19(1)(4)( 5) 13(4) Requirement Assessments need to be carried out for all prospective residents by a person qualified to do so. 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 Two references and a current CRB and POVA first check must be obtained for all newly appointed staff All hot water outlets need to be fitted with thermostatic control valves Timescale for action 30/03/06 20/02/06 20/03/06 30/05/06 31/03/06 30/04/06 7 OP38 30/05/06 Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP7 OP7 OP9 OP15 OP30 OP28 OP26 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 Residents should be supported in maintaining skills of independence and choice, particularly around meal times The Manager should be enrolled on an NVQ Level 4 and Registered Manager Award programme 50 of care staff should obtain an NVQ to Level 2. Paper towels and liquid soap should be provided adjacent to all wash hand facilities. Southwater Residential Home DS0000018427.V260063.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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