CARE HOMES FOR OLDER PEOPLE
Stocks Hall 76a Nursery Avenue Nursery Lane Ormskirk Lancashire L39 2DZ Lead Inspector
Val Turley Unannounced Inspection 24th March 2006 10:30 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 Stocks Hall DS0000005909.V264690.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. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Stocks Hall Address 76a Nursery Avenue Nursery Lane Ormskirk Lancashire L39 2DZ 01695 579842 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) Stocks Hall Care Homes Limited Mrs Ann Elizabeth Williams Care Home 45 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (18) of places Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for a maximum of 45 service users to include: Up to 18 service users in the category OP - (Old age, not falling within any other category) needing personal care only. Up to 27 service users in the category DE (E) Dementia (service users who are over 65 years of age) needing personal care only. The registered person must at all times, employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the National Care Standards Commission regarding staffing levels in care homes. 19th October 2005 2. 3. Date of last inspection Brief Description of the Service: Stocks Hall care home provides 24-hour personal care and accommodation for the elderly and people who have care needs associated with dementia. Stocks Hall is owned by Stocks Hall Care Homes Limited and is one of four homes managed by the company. The home is situated in a quiet area of Ormskirk, close to the town centre, near to shops, pubs and post office. Ample car parking is available at the front entrance with garden areas and a larger garden at the rear of the home. The premises are a two storey “purpose-built” property. Bedroom accommodation is on both floors. All bedrooms are single and several of these rooms have an en-suite facility. Lounge and dining rooms are also located on both floors. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedroom and living rooms. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in March 2006 by one regulatory inspector. The inspection involved discussion with and observation of the staff working at the home, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection?
Additional information had been included in the care plans to help ensure that the personal and social care needs of the service user were met. Staff provided discrete and sensitive assistance to service users at meal times. Although there were no service users who needed a liquidised diet at the time of the inspection, the cook was aware of the approach that needed to be adopted when preparing liquidised food. The home had made some improvements in its quality assurance processes and had accident records had been stored in accordance with the Data Protection Act. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 6 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. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 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 the following standard(s): 6 The home provided suitable accommodation for those service users receiving intermediate care and support was provided by health professionals to help the service users maximise their independence with a view to returning home. EVIDENCE: The home had a small intermediate care unit. This provided dedicated space for those service users who were in receipt of this service. There was input from health professionals, including occupational therapists and physiotherapists who worked with the staff team to provide appropriate support to the service users. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 9 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 and 10 The staff were given good information as to the support needs of the service users enabling them to provide a good service and respect their privacy and dignity. Medication in the home was generally well managed although some additional safeguards could be built in to further reduce the possibility of any errors being made. EVIDENCE: Standard 7 was partly assessed at this inspection. Requirements made at the previous inspection had been acted upon. Additional information had been included within the care plans giving support staff more information as to how the personal and social care needs of the service user were to be met. Care plans had been reviewed monthly to ensure that the changing needs of the service users were being addressed. There was an inconsistent approach to risk assessments with different approaches/formats in use across the home. It was recommended that staff adopt a common approach to help ensure that the most effective methods were used to ensure that the safety and well-being of the service users was maintained. The home had a comprehensive policy in place with regard to the management of medication in the home and this included a procedure for enabling service
Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 10 users to self medicate following an appropriate risk assessment. Senior staff had received training in the administration of medication. The home had introduced a range of competency checks for staff administering medication to help ensure that procedures were followed correctly. A number of recommendations were made to help improve the systems already in place and to help ensure that the risk of any medication errors being made is reduced. It was recommended that any handwritten entries on the Medication Administration Record (MAR sheets) are countersigned by a second member of staff to ensure that the medication details have been recorded accurately. It was also recommended that guidelines for any medication that is administered on an as required basis (PRN), is written up for each service user and kept with the MAR sheets. In addition to this consideration should be given to the way in which a record is made when PRN medication is not administered, as the current method gives an unclear picture as to how often the medication is required. It was noted that the staff at the home used secondary dispensing in certain situations and the manager was advised that some advice should be sought in relation to this practice with a view to reducing the possibility of errors in administration being made. During the course of the inspection it was observed that the support staff spoke to the service users appropriately. There was a policy in place that outlined the need to respect the privacy and dignity of the service users. The home had a telephone in place where service users could make calls with some degree of privacy. All service users had a single bedroom, some with en-suite facilities. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 11 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): 13,14 and 15 The service users were able to make choices and decisions regarding their daily lives and social activities. EVIDENCE: Visitors were welcome at the home at any reasonable time and service users were able to receive visitors in either their own room or a communal area. There was a policy in place that recognised that service users could determine who they received as visitors. The home was involved with the local community. The local churches were involved on a regular basis and groups from the local school visited and service users visited the school. The service users were supported to visit the local shopping area. Wherever possible the service users were supported to exercise choice and control over their lives. There was evidence that they were encouraged to bring personal possessions into the home to personalise their rooms. Information regarding local advocacy services was made available and the manager stated that an advocate supported one of the service users. The families of the service users managed their financial affairs with the home holding a small sum of money for each of the service users for any day-to-day expenditure. Two recommendations had been made at the previous inspection in relation to standard 15. One was in relation to the presentation of liquidised food. Discussion with the cook took place. She stated that the home did not have any service users who required a liquidised diet at that time. She was aware of
Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 12 the need to present the food attractively and to keep flavours separate and that the intention was to use food moulds. The manager of the home confirmed that the home was in the process of trying to purchase these moulds. A recommendation that the staff providing assistance to service users at meal times should do so in a discrete and sensitive manner had been acted upon and staff were observed to sit with service users as support was being provided. Stocks Hall DS0000005909.V264690.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): 18 The home had some good policies and procedures in place in order to protect service users. Some work needed to be undertaken to ensure that they all reflected current best practice. EVIDENCE: The home had a number of policies in place that dealt with the protection of the service users living at the home. The policy that dealt with the reporting and responding to any suspicions of abuse were clear and outlined the action that staff must take. The whistleblowing policy also contained all of the expected detail and guidance for staff. The policy that dealt with the management of challenging behaviour and the use of restraint needed to be reviewed and updated. The registered manager was clear that a multidisciplinary approach must be adopted and strategies for dealing with challenging behaviour must be agreed, but this must be reflected in the policy. The homes policy on the use of bed rails must also be reviewed to make it clear that the use of such rails must be based on the outcome of an appropriate risk assessment to safeguard health and safety of the service users. Stocks Hall DS0000005909.V264690.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 and 26 The home was clean and hygienic and provided a safe environment for both the young adults and support staff. EVIDENCE: Standard 19 was partly assessed. A recommendation made at the previous inspection had been acted upon and outstanding work identified during a visit by an Environmental Health Officer had been attended to. The laundry at the home was inspected. It was situated appropriately so that laundry did not have to be carried through any food areas. It was appropriately equipped and had a supply of protective clothing available for staff to use. Sluicing facilities were provided on all floors within the home. The homes policies relating to infection control contained all of the necessary detail. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 15 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): 29 and 30 The home was aware of its responsibilities in terms of the recruitment and appointment of staff but must ensure that all necessary checks and documents are in place prior to appointment. Appropriate training and support was provided for staff to help ensure that the needs of the service users are being met. EVIDENCE: The files of two members of staff were examined. From these it was clear that the home was fully aware of the checks it had to undertake and the documentation required before a prospective member of staff was appointed. However the application form on one of the files had not been fully completed. In order to protect service user as far as possible, care must be taken to ensure that all of the relevant information is in place before any appointments to the home. Copies of the General Social Care Council code of conduct were available in the home for the staff team. The two staff files examined contained evidence of the induction training the staff had undertaken. This training was confirmed by one of the members of staff. The manager stated that staff received at least three days training a year and that this included mandatory training. There was evidence that mandatory training had been provided for all the staff team. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 16 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): 33,35 and 38 The home was well managed with the rights and preferences of the service users being kept central to the running of the home. EVIDENCE: Standard 33 was partly assessed at this inspection. Recommendations in respect of quality assurance made at the last inspection had been acted upon. The home had an annual plan in place reflecting the planned improvements at the home. An internal audit of the home had recently been undertaken although the report had not yet been produced. Records of the money held on behalf of service users at the home were well maintained with all transactions having been recorded. The money for each of the service users was held separately and receipts were kept appropriately. There was a safe in the office where valuables could be held for service users. Standard 38 was partly assessed at this inspection and a recommendation made at the previous inspection was found to have been acted upon. Accident records stored at the home had been stored in accordance with the Data Protection Act.
Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 17 Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 18 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 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO 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 OP18 Regulation 13(6)(7) Requirement The policy that deals with the management of challenging behaviour must be reviewed and amended. Risk assessments for the use of bedrails must be undertaken. The registered person must ensure that all necessary checks have been undertaken and the necessary documentation is in place for all persons working at the care home. Timescale for action 31/05/06 2 3 OP18 OP29 13(4)(c) 19(5) 31/05/06 30/04/06 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. Refer to Standard OP7 OP9 OP9 Good Practice Recommendations A consistent approach to risk assessments should be introduced and these should be reviewed regularly. Any handwritten entries on the MAR sheets should be checked and countersigned by a second member of staff. Guidance for the administration of PRN medication should be drawn up and kept with the MAR sheets.
DS0000005909.V264690.R01.S.doc Version 5.1 Page 20 Stocks Hall 4. 5. OP9 OP9 The record of the non-administration of PRN medication should be reviewed. Advice regarding the secondary dispensing of medication should be sought. Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stocks Hall DS0000005909.V264690.R01.S.doc Version 5.1 Page 22 - 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!
