CARE HOMES FOR OLDER PEOPLE
Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth BH10 4HG Lead Inspector
Jo Palmer Unannounced 01 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. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Talbot View Address 66 Ensbury Avenue, Ensbury Park, Bournemouth, Dorset, BH10 4HG 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) 01202 537571 01202 547328 enquiries@care-south.co.uk Care South Mrs Anne Lippitt Care Home only 59 Category(ies) of DE(E) - 30 registration, with number OP - 29 of places Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Two service users (names known to the CSCI) in the category MD(E) excluding learning disability or dementia - over 65 years of age may be accommodated Three service users (names known to the CSCI) in the category LD (Learning Disability) may be accommodated. One service user (known to CSCI) in the category of LD(E) (Learning Disability - over 65 years of age) may be accommodated. One service user (name known to CSCI) in the category of DE (Dementia) may be accommodated. Date of last inspection 13 October 2004 Brief Description of the Service: Talbot View is part of the Care South (formerly Dorset Trust) group of homes and is managed by Anne Lippitt. The Dorset Trust was established in 1991 having purchased several homes across Dorset from the local authority, the Trust has now expanded and provides care in homes Dorset, Hampshire and Somerset resulting in the name cahnge to Care South. Care South is a nonprofit making organisation. Talbot View provides accommodation for a maximum of 59 older people who require personal assistance due to old age and frailty and or dementia type illnesses. The premises were purpose built by the Trust in 2000 and provides accommodation in 59 single rooms, all with en-suite facilities on ground and first floor levels. The first floor is reached by a passenger lift or one of three stairways. Accommodation is arranged in four houses; Wareham Way and Lollipop Lane accommodate people with dementia care needs, Butlers Brook and Highmoor Heath accommodate older people with general personal care needs. Both dementia care houses have key pad entry systems to ensure residents safety. Each house provides single room accommodation and shared, communal areas consisting of lounge and dining room areas.
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection on 1st November 2005 lasted for four and half hours, Mrs Anne Lippitt, registered manager was present who assisted with the inspection process. The purpose of this inspection visit was to monitor progress in addressing a requirement of the last inspection and to review practices in relation to some of the National Minimum Standards, this inspection concentrated on the outcomes of care and services for residents. The inspector spoke with ten residents, six members of staff and the manager, the deputy manager and administrator were also spoken with briefly; took a tour of the home and examined relevant records. Of the ten residents spoken with, five lived in Lollipop Lane and Wareham Way, the dementia care houses; these residents had varying degrees of confusion and required high levels of support and care and were unable to express their feelings or views about the care received or services available. However, although their capacity to clearly express their views and engage in meaningful dialogue was limited the inspector was able to establish through observation and those brief conversations had, that residents were comfortable in their environment and in relations with staff, were clean and well presented and at liberty to move freely about the home. What the service does well:
The admissions process at Talbot View is well managed with prospective residents being provided with sufficient information prior to moving into the home and subsequently by being involved in the assessment process and kept up to date with information about the services provided. New residents have their needs assessed to identify the level of care they require, from these assessments, care plans are produced that clearly direct the care staff to provide the necessary care to meet these needs. Caution is needed to ensure care plans remain current. There was good evidence of a multi-disciplinary approach to care where necessary with involvement of care managers, GPs, district nurses etc. and although district nurses attend to any necessary wound care in the home, requirement has been made regarding care staff management of wound sites. Staff demonstrate an implicit understanding of the residents rights to privacy and dignity both through their working practices and written reports.
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 6 Examination of social calendars and discussion with residents demonstrated that there is sufficient stimulation for residents who either enjoy more active social and leisure pursuits and those less able. Family and friends are able to visit at any time and resident’s care records detailed the extent of their involvement. A committed staff group and a comprehensive activities programme support those residents who are unable to make autonomous choices in their daily routines. Procedures are in place to ensure that any complaint received will be managed effectively and sensitively, and any adult protection issues will be addressed in line with local authority requirements. No complaints or incidents have been reported. Talbot View is clean and well maintained; the home provides good facilities for residents to enjoy their own rooms, communal space and the gardens. Although a large home, there is a homely feel in the lounge areas and in resident’s own rooms where they are at liberty to bring items of their own furnishings and items to decorate their rooms. The home provides adequate bathing and toilet facilities. There are sufficient numbers of well-trained staff on duty that are committed to the care they provide, the inspector was impressed by the staff group’s loyalty to, and respect for the residents individuality, and dignity. Management systems at Talbot View are well organised and managers are supported by Care South in policy development and quality assurance processes. Staff and residents spoken with confirmed that communication is good regarding developments, changes or any significant matter affecting their lives and work in the home. What has improved since the last inspection? What they could do better:
This inspection has identified that some improvement is required to care planning systems. Not registered to provide nursing care, Talbot View ensures that any resident requiring a nursing service receives this from the district nurse. In respect of wound care, it is required that advice is sought from the district nurse regarding the action that would be necessary should any wound
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 7 dressing become damaged or soiled between the district nurses visits, any action necessary should be detailed in the residents care plan. All care plans should remain current, where a resident has changing care needs, these must be reviewed and documented and a plan of care available for staff reference that directs care staff to take appropriate action to meet current, assessed needs. It has also been recommended that care records written by care staff are reviewed by senior staff to ensure that any concerns noted or changes in residents welfare, can be reviewed appropriately. 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. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 4. Standard 6 is not applicable. The home’s Statement of Purpose and Service User Guide provide detailed information about the care and services provided at Talbot View. The admissions process is such that it ensures resident’s needs are assessed prior to admission and that the home is able to meet these needs. EVIDENCE: Although not directly examined during this visit, a copy of the home’s Statement of Purpose and Service User Guide are held on file with the Commission and the manager confirmed that these were the up to date copies (with the exception of the change of name from Dorset Trust to Care South), that are provided to residents and other interested parties. A review of the Service User Guide demonstrated that all relevant information is provided in order that prospective residents can make an informed decision about moving to the home. Care files examined for recently admitted residents evidenced that all preadmission processes are undertaken appropriately. Pre-admission assessments are undertaken in order that the assessor (usually the manager or deputy) can
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 10 assure the resident that based on the findings of the assessment the home is able to meet their needs. Assessment information is signed by the resident or their representative indicating their agreement with the assessed need outcomes. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 11 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 & 10 Care plans provide sufficient detail for staff to be aware of resident’s health and welfare needs and how to meet them; care needs are mostly reviewed appropriately. Systems are in place for resident consultation and participation in the assessment and care planning process. Resident’s rights are respected and their right to privacy is supported through care delivery, relationships with staff and confidential record keeping practices. EVIDENCE: Care plans examined detail how resident’s needs are to be met in relation to physical health, safety, mental health, daily living (including personal care), elimination, mobility and diet and other areas of assessed need. Care plans generally provide detailed instruction to the caregiver on how needs are to be met and most care plans seen evidenced that regular reviews are undertaken. One resident whose care file was examined had very complex needs that had changed in recent weeks, the manager explained that the reassessment and the care plan had yet to be reviewed as the home was waiting on information from this resident’s care manager. It is expected however that the registered manager ensure that all care records are up to date and current and provide basic, general instruction for staff detailing how care needs are to be met.
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 12 For a resident who was receiving wound care from a district nurse there was no care plan available advising staff of what action to take, if necessary, should the dressing become dislodged, wet or soiled. In such instances, a contingency plan is needed with advice from the district nurse sought on the correct action necessary to manage the wound. Records are written by care staff at the end of each shift detailing the care they have provided to residents and any other significant information. Reviews of these evidenced that all care is provided as planned and records provide a satisfactory account of the residents lives in the home and daily routines. However, some entries detailed events where it would be considered necessary to review the care approach for example, during a routine bath of a resident, some specific personal hygiene concerns were noted and recorded by the carer. The care plan for this resident indicated a level of independence with personal care routines. Whilst not wanting to take away this person’s independence, a reassessment of their abilities in maintaining a satisfactory level of hygiene and a review of the care plan to indicate the level of support required by staff is necessary in order to retain this persons hygiene, dignity and skin integrity. It would therefore be expected that where care staff record daily care provided to residents, that senior staff review these records to ensure that any reassessments and reviews are undertaken as required. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 13 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 Some residents are able to benefit from self-determined activity as far as their health and general abilities allow, they are supported in maintaining contact with their friends, family and the local community and in making decisions about their lives in the home. A committed staff group and a comprehensive activities programme support those residents who are unable to make autonomous choices in their daily routines. EVIDENCE: The home’s social activity programme was examined and demonstrated a weekly schedule of the activities to be provided for the month of November, this included a quiz, games, bingo, church service, holy communion, birthday party and sessions named ‘seasonal activities’ and ‘sensory activities’. The home’s recently appointed activities coordinator was spoken with who demonstrated a commitment and enthusiasm for her role and who creatively arranges small group and one to one activity for individuals less able to join in with organised games. Records examined and residents spoken with confirmed that friends and family are received warmly at any given time with no restrictions. Care assessments detail a brief social history and identify those activities and leisure pursuits residents have preferred to participate in, care records demonstrate the resident’s participation in the process indicating their agreement with the assessed care need outcomes.
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff knowledge and understanding of Adult Protection issues helps provide a safe environment to protect residents from abuse. EVIDENCE: A complaints record is held detailing any complaints received. Two complaints received at Talbot View have been recorded since the last inspection, records evidence that both were managed sensitively to a satisfactory conclusion. Receipt of complaints from residents or relatives is not an indication of a poor service; it demonstrates that the residents are comfortable raising concerns and that staff and management are open to criticism. The Commission has received no complaints. Although not assessed during this inspection, the last inspection reported that an adult protection policy is in place with procedural guidance for staff to follow should any incident of abuse be reported or suspected. Staff spoken with confirmed their understanding of the home’s adult protection policy and training in areas relating to elder abuse has been provided. Talbot View D55 S3899 Talbot View V233451 011105 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, 20, 21, 23, 24 & 25 Residents live in a safe, comfortable, clean environment with their own belongings around them and with sufficient aids and equipment to assist their mobility and comfort. Bedrooms, bathrooms and communal areas provide sufficient room for residents and communal space is sufficient for the size of the home. EVIDENCE: Talbot View was purpose built five years ago and has been built to meet the specifications of the National Minimum Standards and the best interests of the resident group. The home is arranged in four houses, two of which have secure entry and exit by means of electronic keypads to ensure those residents who are vulnerable due to dementia type illness cannot wander. Each house is decorated to a good standard and provides communal areas, a kitchenette, single, en-suite bedrooms and shared bathroom facilitates where aids and adaptations are in place to assist those that may have difficulty getting in and out of a conventional bath. Not examined on this occasion but reported on following previous inspections, Talbot View has been assessed by suitably
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 16 qualified persons to ensure it provides adequate aids and adaptations to aid access around the home. A tour of the premises and visit to several resident bedrooms evidenced that they are at liberty to bring items of their own to decorate their rooms such as pictures, ornaments and small items of furnishings if they choose. All areas seen were clean and well maintained. Resident care files examined held reviewed risk assessments to identify any risk of scalding from hot surfaces, the home was a sufficient temperature for the time of day and weather conditions and radiators have low surface temperature covers. All areas were well lit and ventilated. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 The deployment and number of available staff is sufficient to meet the needs of the residents. Care South provide a good training programme which staff at Talbot View participate in to the benefit of residents. EVIDENCE: Care staff shifts are worked between 7.15am and 2.45pm, 2.30pm and 10.00pm and the night shift between 9.45pm and 7.15am. Wareham Way and Lollipop Lane houses have three staff each morning and afternoon shift. Butlers Brook and Highmoor Heath have two staff each morning and one each afternoon. During the afternoon there is a ‘floating’ member of staff who assists in any unit as required. There are three carers on each night shift. Additionally, a senior staff rota shows that there is one Care Team Manager (CTM) on duty each daytime shift and one sleeping in/on call at night. The manager and deputy manager work flexi shifts but generally during office hours throughout the week. There are sufficient ancillary staff with a chef, assistant chef, kitchen domestics, general domestic and laundry staff, additional staff are also employed as bed makers and cover seven days per week. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 & 33 The management arrangements of the home support good care practices for residents, the manager is supported well by senior staff with all staff demonstrating an awareness of their roles and responsibilities. The home regularly reviews aspects of its performance through a good programme of self-review and consultations, which include seeking the views of residents, staff and relatives. EVIDENCE: Anne Lippitt, registered manager, demonstrated a good understanding of the management of the home’s administration. Mrs Lippitt has attained an NVQ level 4 in care and registered managers award. Care South is a large care provider and has systems in place to manage and review practices within its homes. Mrs Lippitt confirmed that good relations are maintained between herself and senior managers at Care South who are
Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 19 available for advice and support. Within Talbot View, management structures are in place and Mrs Lippitt is supported by a deputy manager, administrator and a senior team of care team managers. Residents and staff spoken with confirmed that management arrangements are inclusive and that their views are sought regularly, residents stated that Mrs Lippitt is always available to speak with should they need to. Staff supervision records were not examined but staff confirmed that they receive regular supervision and training opportunities are good. A review of the quality of services and care was seen briefly, Mrs Lippitt confirmed that a copy of this would be sent to the commission. A brief examination of the quality report indicated that residents, relatives and staff were consulted to obtain their views on the home. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 x STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x x x Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 21 No 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 7 Regulation 15 Requirement Timescale for action 31.12.05 2. 8 15 The registered persons must ensure that service users care plans are kept under review and where a service users change of need is noted, care must be planned in a systematic manner providing clear instruction to staff on how assessed needs are to be met. Where a service user is in receipt 31.12.05 of wound care from a district nurse, the home must establish a care plan identifying the action necessary should the dressing become damaged or dislodged between the nurses visits. This care plan must be written on advice from the nursing service. 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. Refer to Standard 7 Good Practice Recommendations It is recommended that a system is established to ensure effective communication in addition to daily care records. where concerns are noted, these must be made known to
D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 22 Talbot View person responsible for reviewing the assessed needs and care plans. Talbot View D55 S3899 Talbot View V233451 011105 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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