CARE HOMES FOR OLDER PEOPLE
Summercourt Shute Hill Teignmouth Devon TQ14 8JD Lead Inspector
Sharon Goldsworthy Announced 9 November 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. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Summercourt Address Shute Hill Teignmouth Devon TQ14 8JD 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) Classic Care Homes (Devon) Ltd 01803 778580 01803 778782 Mrs Rebecca Louise Coulson CRH 20 Category(ies) of Old age not falling within any other category(20) registration, with number of places Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Mrs Rebecca Coulson to complete NVQ level4 and RMA. Imposed 24/05/05 Date of last inspection Brief Description of the Service: Summercourt is registered to provide care to elderly people from the age of sixty five. Summercourt is a detached house (listed building) that has been extended, situated less than half a mile from the town centre. There are two residents’ lounges and there are good views of the sea from several of the bedrooms. The garden area is landscaped and includes level areas leading to a a small pond area as well as new wooden seating. All bedrooms are currently used as single rooms and one double room is available. All bedrooms have an en suite WC. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2005, Summercourt was purchased and is now owned by Classic Care Homes (Devon) Ltd. This is a small company owned by four individuals, all of who have input into the running of the care home on a daily basis. Mrs Rebecca Coulson is the Registered Manager and Mrs Henrietta Coxon is the operational manager. Mr Simon Coulson and Mr George Coxon undertake strategic, planning and financial roles. As such this is the first inspection to be undertaken under the new ownership of this home. This inspection was announced and took place on the 9th November 2005 and took 6 hours to complete. The Inspector spent time with the Mrs Coulson and Mrs Coxon, with staff on duty, spoke with six residents individually, although met with all residents and made a tour of the premises. A sample of care records and related documentation was viewed. The Inspector received pre inspection questionnaires from twelve relatives and six residents as part of this inspection process. What the service does well:
The home was clean, well presented and well maintained. Residents spoken to confirmed that they found the home to be well presented and clean at all times. Residents spoke highly of the staff and the new owners and of the care they received. All confirmed that the food in the home is extremely good. Other residents stated that they enjoyed the location of the home, being able to access the town and local facilities independently. Other residents who are less able to access the local town as easily confirmed that their families and friends help them with this. Care practice observed on the day of this visit was individual, caring and appropriate. Comments received from relatives include; “my relative is looked after with great care and kindness by all staff, who treat him with dignity and respect at all times”, “staff are very caring and courteous at all times”, “there has been a noticeable improvement in the home since the new owners have taken over” and “very well run home”. The new owners have introduced a number of changes since they purchased the home in April 2005. Staffing levels have been increased and a great deal of time has been given to staff training and development.
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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.
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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 Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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, 6 Prospective residents are given a Service User Guide to ensure that they have sufficient information to make an informed decision about moving into the home. All residents are adequately assessed prior to being offered a place at Summercourt. Summercourt does not offer intermediate or rehabilitative care. EVIDENCE: The new owners developed new Statement of Purpose and Service User Guides as part of the registration with the CSCI. Both documents are detailed and provide the prospective resident and their representatives with sufficient information with which to make a decision about moving into this home. The owners state that both documents are continually under review as they make changes to the home. These documents will again be reviewed at the next inspection visit to ensure they are being kept up to date. A sample of five residents records were viewed on the day of this visit. All included detailed referral documentation and detailed assessments of their level of needs and were used to inform the initial care plan.
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10 Residents health, personal and social care needs are being met. Residents are protected from errors and given medications safely. EVIDENCE: A sample of five residents records were observed on the day of this visit. The new owners have introduced and implemented new care plan and daily record documentation. All documentation was found to be complete and up to date. There were a couple of examples of risk assessments, short term care plans and pressure care assessments that were not dated and as such could not be judged as to whether they were being adequately and regularly reviewed. However, most other documentation was dated and evidenced that regular reviews are undertaken and amendments are made when required. Daily records, although up to date, need to include a lot more detail, in order to evidence that appropriate levels of monitoring and evaluation is taking place. This was particularly evident, where a resident has had a fall or is ill. The records completed following these events need to be very specific and more detailed. New falls monitoring policies and monitoring documentation have been introduced. These demonstrate that staff are aware of the need to monitor
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 10 residents who are considered to be at risk of falls. As mentioned above, some of the monitoring records need to be more detailed and used specifically to monitor and record injuries or the resident’s general well being following a fall. Care plans indicate that residents are accessing chiropody, dentists, opticians and district nursing services as required. On the day of this inspection visit opticians were present in the home attending to a number of residents. Residents themselves confirmed that they have access to health care services as and when required and that they are offered the choice to access these services in the community rather than at the home if they wished. On the day of this visit, one resident was felt to be very poorly. A GP was called immediately and she was regularly monitored until the GP attended. The medication system was viewed and medication administration was observed alongside senior care staff on the day of this visit. Medication was found to be stored and administered appropriately, with two staff taking responsibility. Records were signed at the time of its dispensing. The staff on duty stated that this was how they had been taught. Medication records need to be signed to indicate that a resident has taken the medication prescribed or has not and for what reason. The staff on duty immediately changed their practice and this was discussed with the Registered Manager. Residents spoken with confirmed that they are treated with respect and sensitivity at all times. Relatives and residents responding to the preinspection questionnaire confirmed this also. On the day of this visit staff were seen to offer care to residents with kindness, sensitivity, discreetly and with respect. All staff were observed knocking on residents bedroom doors and waiting for an answer before entering. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 Most residents feel that their social care needs are being met. Residents have access to relatives, friends and the local community as they wish and feel they can exercise choice and have control over their lives. Residents receive a balanced, nutritious and varied diet. EVIDENCE: The home has allocated a good budget for activities and events and has implemented a flexible and varied activity programme. Recent activities include; outings, manicures and pedicures, pottery, entertainment and parties in the summer and for fireworks night. It is hoped that additional ideas for activities will soon be arranged such as flower arranging and cookery. The Registered Manager is keen to seek resident’s views and look to provide a varied and individualised activity programme. A small percentage of residents spoke to the Inspector about their concerns about activities, and felt they needed more to occupy their day time hours. One relative, who responded to the pre-inspection questionnaires, felt residents need to be kept more active and offered more exercise groups. All residents spoken with confirmed that their relatives and friends can visit at any time, and that many of them regularly go out with relatives or friends independently of the home. No relatives were seen on the day of this visit to be able to discuss this further.
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 12 All residents spoken with spoke highly of the food offered in the home. They confirmed that they receive varied and well-balanced meals at flexible times. Some residents stated that they have their breakfasts in their bedrooms in the mornings. A small amount of residents have all meals in their rooms, because they choose not to socialise with other residents. They also stated that they are offered a choice of meals. Two residents stated that they often get hungry in between meals. In response to this, the owners have recently introduced a fruit bowl out in the dining room for residents to help themselves. The two residents had forgotten this – as this had only very recently been introduced. One of these residents was later seen coming out of the kitchen, having been given a biscuit by a member of staff. Staff on duty confirmed that residents are given biscuits, fruit and drinks as and when they ask for them. This was also observed when the Inspector was in a room with a resident. This resident asked for a drink when a member of staff came into the room. The drink was immediately brought to the resident. The owners also plan to look at the provision of vegetable dishes on the tables to offer residents the ability to choose for themselves what vegetables and the amount of vegetables they wish to have. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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 standard(s) 16, 18 Residents can be confident that complaints are taken seriously and dealt with appropriately. Residents can be confident that the homes policies and procedures and staff recruitment processes should protect them from abuse. EVIDENCE: The home has a complaints policy and procedure in place. This is included in the Statement of Purpose and Service User Guide. Four relatives who responded to the pre-inspection questionnaires stated that they are not aware of the homes complaints procedure. The owners stated their intention to look at this issue and how they could best advertise this procedure more prominently. The home does not currently have a complaints log in place. This document or book is required to evidence that complaints are logged, recorded and responded to appropriately and according to the homes policies and procedures. All residents spoken to felt confident that they could approach any member of staff or the new owners should they have the need to report a complaint or concern. The home has policies and procedures in place in relation to the Protection of Vulnerable Adults from Abuse. They have the Devon Alerter’s Guide and Department of Health’s video “No Secrets”, which all staff have access to. The owners have recently introduced a training programme, which they believe will constantly reiterate the need to protect residents from abuse or being placed at harm. All staff are given supervision six times a year with the Registered Manager and staff recruitment records indicate that appropriate checks are carried out on all staff currently working in the home.
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 14 Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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, 20, 21, 24, 25, 26 Summercourt is a comfortable, well-maintained, clean and safe environment in which residents can live. EVIDENCE: The new owners have undertaken some refurbishment of the premises since taking over the business in April 2005. Bathrooms have been refurbished, the outside of the home has been painted and two bedrooms have been redecorated and re-carpeted. The refurbishment programme for the home in the next six months includes; new kitchen and kitchenette for residents use, staff room, laundry and the continuation of bedrooms. The home is clean, free from odour and staff were observed working to accepted hygiene practices when dealing with residents, laundry and the kitchen. The outside of the home is freshly painted, the garden is very well maintained. It is level, safe and has new wooden garden seating. Residents’ bedrooms are highly personalised, comfortable and decorated to a good standard. The home itself is nicely decorated and appropriate to the
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 16 resident group. Lighting is appropriate throughout. The home has appropriate aids and adaptations provided throughout, including hoists, grab rails, stair lifts and individual adaptations for specific residents. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 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) 27, 29, 30 Staffing levels are appropriate. Residents are protected by the home’s recruitment policy and practices and staff are trained and competent. EVIDENCE: The new owners have reviewed and increased the staffing levels in the home. There are currently four care staff on duty in the morning, two in the afternoon until 5pm, when an additional two members of staff come on duty. There are two staff on duty at nights; one sleeping in and one waking. Each day there are ancillary staff for cleaning and kitchen duties in addition to care staff. It is felt that given the residents current level of need, this staffing level is sufficient at this time. The home has comprehensive procedures in place for the recruitment of staff. CRB and POVA checks were seen for all current staff. A sample of staff personnel records were seen and found to be in order. The new owners have developed a new training programme, most of which is being provided in house. Staff have recently completed training in falls prevention and monitoring. In September two sets of training commenced in Fire Safety and Keyworking. This will be repeated in November to ensure that all staff have attended. Future training events planned are Privacy and Dignity, Manual Handling, Communication, First Aid, Depression, Health and Safety and Medication. 47 of the care staff team have already obtained an NVQ qualification. The Registered Manager is to undertake training in the near future to enable her to
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 18 be the home’s NVQ Assessor. This will allow the remainder of the staff team to be offered the opportunity to undertake NVQ training. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 19 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) 31, 33, 35, 36, 38 The home is run by competent persons and in the best interest of the residents and their families. Staff are now receiving an appropriate level of supervision. Residents health, safety and welfare are generally well protected. EVIDENCE: The CSCI undertook a full assessment of the owners and Registered Manager earlier this year and agreed to register the individuals in April 2005. The owners are felt to be competent and of good character. From evidence to date it is felt that the owners are running this home in the best interests of the residents. Residents, relatives and staff have been very complimentary of the new owners and feel confident in them. The new owners have started to introduce a quality assurance system. They have surveyed all residents and have put a suggestions box in the main hallway (which is being used and residents are aware of). The views obtained
Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 20 were discussed at a management meeting and an action plan was developed. The management meeting felt that most suggestions made were of a minor nature and are all able to be addressed easily. As a result fresh fruit has been made available in the dining room and it is hoped that vegetable dishes will be made available very soon. A new light has been ordered for the dining room following a suggestion by one resident. It is hoped that the quality assurance system will be further widened to seek the views of relatives, visitors and professionals involved in the home. All staff are now receiving formal supervision sessions with the Registered Manager at least six times a year. A sample of records from these meetings was seen and found to be appropriate. A discussion was held with the Registered Manager about the appropriateness and level of supervision required for part time staff and in particular staff who only work once or twice a month. It has been agreed that these particular members of staff that supervision meetings may be of less frequency or time. A sample of residents’ financial records and monies held by the home was seen on the day of this visit. All records and monies balanced and were found to be up to date and appropriate. A sample of health and safety records were viewed on the day of this visit – such as the accident book, fire safety records and maintenance records. All viewed were found to be accurate and up to date. The new owners are still making their way through the required records and implementing new ones. As such it was felt more appropriate to look at these in more detail at the next inspection visit. Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 21 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 2 x 3 3 x 3 Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 22 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. Standard 7 7 9 Regulation 15(2) 17(1) 13(2) Requirement All care plans and risk assessments must be dated. Daily care notes and monitoring documentation must be sufficiently detailed Medication records must be signed following observation of the resident taking the medication All staff need to receive formal certificated training in the Protection of Vulnerable Adults from Abuse. Further extend the Quality Assurance system to include the views of relatives, friends, visitors and professionals involved in the home. A development plan needs to be made available to all the involved parties and the CSCI annually Timescale for action 30/11/05 30/11/05 09/11/05 4. 18 13(6) 31/03/06 5. 33 24 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 23 Summercourt 1. 2. 3. 4. Standard 12 16 30 37 Further extend the activities programme as planned. Further explore making the complaints procedure more available to residents and their relatives 50 of care staff must be qualified to NVQ level 2. Should this not be met by the end of 2005, this will become a Requirement Continue to develop and implement all the required policies and procedures as planned Summercourt D54-D07 S63892 Summercourt V247576 091105 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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