CARE HOMES FOR OLDER PEOPLE
Stockdove House 12 Stockdove Way Cleveleys Lancashire FY5 2AP Lead Inspector
Ruth Edgington Unannounced 12 May 2005 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. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Stockdove House Address 12 Stockdove Way Cleveleys Lancashire FY5 2AP 01253 855967 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) Mr David Joseph Lalgee Care Home 13 Category(ies) of OP 13 registration, with number of places Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 1/11/04 Brief Description of the Service: Stockdove House is an adapted property that has retained a great deal of the atmosphere of a large family house and is sitiuated in a residential area close to local shops and amenities. The home is registered to accommodate a maximum of 13 persons over the age of 65years. Accommodation comprises of a lounge and dining room on the ground floor. There are three double bedrooms, one of which has ensuite facilities and seven single bedrooms, two having ensuite facilites. The double bedrooms are occupied as singles unless a specific request is made by persons wishing to share. There are sufficient toilet and bathing facilities to meet the needs of the residents. A passenger lift enables residents easily access the first floor. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 10am, taking over 4 hours. The Inspector spoke to four residents, one member of staff and the home owners. During the inspection the Inspector looked at a number of records including those of selected residents and staff. The Inspector also looked around the home and was able to observe the daily activities of the residents. The Pharmacy Inspector was present for part of the inspection and concentrated solely on the medication procedures. What the service does well: What has improved since the last inspection?
The Inspector examined a selection of resident’s files and found that they contained a comprehensive pre-admission assessment and confirmation in writing that the home could meet these assessed needs. This ensured that all interested persons were aware of the care that was to be provided.
Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 6 On a previous inspection concerns were raised because a resident wished their bed to be next to an unguarded radiator. The Inspector found that a radiator cover had now been fitted removing the risk of any accidental injury. The home had achieved the Investors in People Award in December 2004, which concentrates on the abilities of the staff to undertake their role affectively therefore ensuring that residents are provided with the care required. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 The assessment procedures were clear to ensure the care needs of the residents are met. However there has been no progress made to improve the written information provided to prospective residents before admission to enable them to make an informed choice about the home. EVIDENCE: The Inspector examined the records of two residents that had been admitted since the previous inspection and found that there was a full assessment of their needs recorded and that the home had confirmed in writing prior to admission that they could meet these assessed needs. The residents informed the Inspector that their family and friends had been mainly involved in the choice of home and that they were very happy with the choice made. At the previous inspection the homeowner was advised of additional information that should be included in the written information given to prospective residents prior to admission. They confirmed that no changes had
Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 9 been made to this information and therefore the previous relevant requirements and recommendations remain. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 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 Promotion of health is taken seriously. Residents’ welfare is closely monitored and health needs met. The systems for the administration of medication could potentially place residents at risk. EVIDENCE: Individual records were kept for each resident with a plan of care setting out in detail the action needed to be taken by care staff to ensure all aspects of health, personal and social care needs of the resident were met. Significant events had been recorded and daily entries made setting out the care given. Examination of the care plans showed clearly that they were reviewed on a monthly basis, however there was no written evidence to confirm that the relative or their relative had been involved, where possible, in the formation of the care plan or the review. The residents spoken to were not sure what information was recorded about their care, but one resident said ‘that they must keep records because they know what they are doing’. The residents confirmed that they were involved in
Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 11 all decisions that affected them and the Inspector was able to observe the management sharing information with relatives and friends visiting at that time. During the inspection comments made by a district nurse confirmed the information seen by the Inspector when looking at care plans. The Pharmacist Inspector looked at the medication procedures in depth and found that there were shortfalls in the procedures, which could potentially put residents at risk. The requirements and recommendations made will be included in a separate inspection report. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 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) 13 & 15 Contact between residents and their families is encouraged to help them maintain relationships. Meals are varied and a nutritional diet is provided to residents. EVIDENCE: Residents spoken to said that they keep in touch with their families and friends, who are welcome at any time. The Inspector noted that on one resident’s care plan it stated that the daughter wished to be as involved as possible in the care. Another resident said that they were in daily contact with their daughter either by the telephone that they had in their room or by the daughter visiting. During the inspection the Inspector observed visitors to the home and the positive relationships between them and the management. The Inspector examined the menus and record of meals provided, which were varied and well balanced. This was further confirmed by observations made by the Inspector when lunch was served. Special diets were provided which at the time of the inspection included diabetic diets. Examination of care plan showed that the likes, dislikes and dietary needs were recorded. The residents confirmed that they enjoyed their meals.
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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 The home’s complaints procedure requires minor amendments to ensure that residents and relatives are confident that any complaint would be taken seriously and acted upon. EVIDENCE: The complaints procedure is included in the written information made available to prospective residents, however the Inspector noted that the information on how to contact the Commission for Social Care was not included. Residents spoken to said that if they had any concerns they could speak to ‘David or Carole’ (the providers) or any of the staff. They were however unaware of who to contact outside of the home and had no idea of the role of the Commission. The home has a procedure in place for the dealing with allegations of abuse. The provider had a good understanding of the procedure to be followed in the event of any allegations or suspicion of abuse being raised. The Commission has not received any complaint about the home since the last inspection. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 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, 25 & 26 The standard of the environment within the home provides service users with an attractive and homely place to live. EVIDENCE: On a tour of the home the Inspector was able to see the personal touches that individual residents have made to their bedrooms. The home was found to be warm, clean and free from any offensive odours. One resident jokingly commented ‘they are cleaning mad, the duster and hoover are always out’. The Inspector was unable to evidence that the radiators are maintained at a low surface temperature, as at the time of the inspection it was a nice day and therefore the radiators were not on. This situation will continue to be monitored on future inspections. However the Inspector did notice that a radiator cover had been fitted in one bedroom where a possible risk had previously been identified. The temperature of the hot water provided to residents was found to be acceptable.
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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) 27, 29 & 30 Recruitment procedures have not been consistently followed, resulting in residents receiving care from staff who have not been properly vetted. The staffing arrangements operating in the home could potentially leave the residents at risk. EVIDENCE: The Inspector found that the staffing levels within the home were the minimum that is acceptable to meet the basic needs of the residents at this time. There were four members of staff employed, two of whom were family members and very competent. The home owner was undertaking the majority of night duties and both he and his wife were working extremely long hours. The Inspector examined the staff files and found that one member of staff had commenced employment without the required checks being carried out through the Criminal Records Bureau. This was discussed with the homeowner and is being dealt with separately to this report. Evidence was seen through the examination of staff records that relevant training is ongoing. The homeowner confirmed that two new staff members had been interviewed and were waiting for the necessary clearances before commencing work. The Inspector reminded him that CRB checks carried out by another employer are not acceptable.
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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) 31 & 33. Recent changes in the management structure and staffing levels has resulted in the provider having less time to manage effectively. This could potentially put residents welfare at risk. EVIDENCE: The Inspector was informed that the person who had been employed to take over the day- to- day managing of the home had left. The limited number of staff employed also affected the time available to carry out management tasks. The homeowner was fully aware of this and was actively trying to resolve the situation in order that he could use his time more affectively. At the time of the inspection the homeowner was in the process of going through records and relevant documentation to ensure that all the required information was available. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 18 The homeowner is aware that although he is a registered nurse if he is to be the person in day-to-day control he will be required to complete level 4 NVQ in management. The Inspector received very positive comments from resident about the care that they were receiving from the management and the staff employed. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 19 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 2 x 1 x x x x x Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 20 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. Standard 1 Regulation 5 Requirement The registered provider must ensure that the information given to prospective service users in the Service User Guide contains a copy of the most recent report. (Timescale of 01/11/04 not met) The registered provider must include in the homes compliants procedure, the name, address and telephone number of the Commission. The registered provider must ensure that at all times suitably qualified, competent and experienced persons are working inthe home in such numbers as are appropriate for the health and welfare of the residents. The registered provider must ensure that new staff are only appointed following completion of a Criminal Records Bureau check and check of the Protection of Vulnerable Adults register. (Timescale of 01/11/04 not met) Timescale for action 4/07/05 2. 3. 16 22 4/07/05 4. 27 18 12/05/05 5. 29 19 12/05/05 Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 21 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. Refer to Standard 1 7 31 & 33 Good Practice Recommendations The service user Guide should contain a summary of the service users views. All care plans should be agreed with the service user and signed by them or representative. The registered provider should obtain a level 4 NVQ in management. Stockdove House F57 F09 S9711 Stockdove House V218749 v3 250405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor Unit 1, Tustin Court Portway Preston, PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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