CARE HOMES FOR OLDER PEOPLE
Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG Lead Inspector
Jo Palmer Unannounced Inspection 10:00 23 February 2006
rd 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 DS0000003899.V283092.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. DS0000003899.V283092.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Talbot View Address 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG 01202 537571 01202 547328 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) Care South Mrs Anne Lippitt Care Home 59 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (29) of places DS0000003899.V283092.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. One service user (name 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 (name 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. 1st November 2005 Date of last inspection 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 leased several homes across Dorset from the local authority, the Trust has now expanded and provides care in homes Dorset and Somerset resulting in the name change to Care South. Care South is a non-profit 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 provide 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. DS0000003899.V283092.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection on 23rd February 2006 lasted for two hours, forty-five minutes. Anne Lippitt, registered manager was present and along with a Care Team Manager and the home’s administrator assisted with the inspection process providing necessary information and access to records. The Commission for Social Care Inspection will assess a care home’s performance against the National Minimum Standards, specifically, ‘key’ standards at least once in the inspection year. The inspection of November 2005 assessed the performance at Talbot View against twenty-two standards; this visit was a brief inspection with the intention on focussing on eight standards that had not been assessed during the last visit. For those standards not assessed and reported on, the reader is referred to the report of the last inspection dated 1st November 2005, which can be obtained either from the home or can be viewed on www.csci.org.uk The inspector spoke with the registered manager, the administrator, a care team manager, one care assistant and three residents, examined relevant records and medication systems. What the service does well:
Care plans are well written and detail for staff the action needed to address recognised and assessed care needs. A outline of basic care procedures from each care plan is held in the resident’s room to provide an ‘at a glance’ reference for staff. Care records are reviewed and evaluated appropriately. The provision of meals in the home is good and residents spoken with briefly confirmed that an appetising variety of meals are offered. Records examined evidenced that there is a choice of dishes at each meal which residents take advantage of. No complaints have been received by the home although a written complaints procedure provides residents and their relatives with assurances that any concerns they have will be managed effectively. Staff are recruited with care to ensure they are suitable to work with the resident group, recruitment practices ensure appropriate screening of staff prior to them taking up post. Care South is committed to providing a range of training events for staff; records seen evidence that most staff have undertaken appropriate levels of training to equip them with the skills necessary to carry out their duties. DS0000003899.V283092.R01.S.doc Version 5.1 Page 6 There are good procedures for recording and safekeeping of resident’s money and evidence that regular audits of the accounts are undertaken. Fire precautions in the home are good and safeguard the residents, staff and premises. 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. DS0000003899.V283092.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 DS0000003899.V283092.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): None of these standards were assessed. The last inspection dated 1st November 2005 reported that standards 1, 3 & 4 were met; standard 6 is not applicable. EVIDENCE: DS0000003899.V283092.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, 8 & 9 Care plans provide sufficient detail for staff to be aware of resident’s health and welfare needs and how to meet them and are reviewed appropriately. Medication systems are generally well managed although are let down by a fault of the recording systems which do not provide a clear audit trail of medicines used. EVIDENCE: Examination of three resident’s care files demonstrated that personal care, health and welfare needs are identified through assessment, are reviewed and a plan of care is established and up dated in order to inform staff of the action necessary to meet needs. Care plans are well written and informative and consideration has been given to ensuring that resident’s choices are enabled with regard to self-care and levels of independence; caution is needed to ensure care plans are signed and dated. Records demonstrate that residents maintain contact with their GP and other health care staff as required. Ms Lippitt confirmed that a précis of a resident’s immediate care needs was held in their rooms for ease of reference for care staff. Residents spoken with confirmed that a kind and considerate staff group meet their needs in the home.
DS0000003899.V283092.R01.S.doc Version 5.1 Page 10 Medication management systems were examined; it was evident that in the main, resident’s medication is well managed although some problems were noted with the recording systems used. The supplying pharmacist issues most medicines in twenty-eight day blister packs with pre-recorded medication administration record sheets. Medicines not suitable to be packaged in this way and liquid medicines are supplied in labelled boxes or bottles. Where medicines are changed or reviewed by the GP midway through the twenty-eight day cycle, a care team manager will hand write the new instruction on the administration record, in one instance, a medication was recorded twice. Where this medication had been administered to the resident, the records had been signed in either of the two available spaces on the record sheet. In this instance, and some other boxed medicines, there was no discernible audit trail resulting in an uncertainty of the amount of medicines held. An audit trail of medicines must be available indicating which medicines were received into the home and those which have been administered, the remaining recorded balance must tally with those medicines held in stock. The last inspection dated 1st November 2005 reported standard 10 was met. DS0000003899.V283092.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): 15 Residents are provided with a choice and variety of meals and the home is able to cater for special dietary needs. EVIDENCE: Records of meals provided for residents were examined and it was evident that there is a daily choice of both the midday and evening meal. Breakfasts are served by individual choice to residents with the option of a cooked breakfast once each week. The main, midday meal provides a starter, two choices of main dish or an alternative if required (including salad) and a range of desserts from two dishes daily, a selection from the sweet trolley or ice cream. In the evening, a choice of a lighter meal, a selection of sandwiches, cakes and fruit is provided. Records seen indicated that residents make various choices and the care team manager spoken with confirmed that where residents are unable to make choices, staff assist with good knowledge of their likes and dislikes. For residents who experience difficulty with food, soft and liquidised diets are provided. Residents spoken with briefly who were in the lounge waiting for lunch could not remember their individual choices, although confirmed that the provision of food was good and appetising. The last inspection dated 1st November 2005 reported standards 12, 13 & 14 were met.
DS0000003899.V283092.R01.S.doc Version 5.1 Page 12 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): 16 A written complaints procedure gives residents and their relatives’ assurance that any concerns will be managed effectively. EVIDENCE: Although not inspected directly during this visit, the last inspection confirmed that the complaints procedure was available and Ms Lippitt confirmed that the procedure had not changed since this time. It was also confirmed that no complaints had been received. The last inspection dated 1st November 2005 reported that standard 18 was met. No incidents have been reported. DS0000003899.V283092.R01.S.doc Version 5.1 Page 13 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): None of these standards were assessed. The last inspection dated 1st November 2005 reported that standards 19, 20, 21, 23, 24 & 25 were met. EVIDENCE: DS0000003899.V283092.R01.S.doc Version 5.1 Page 14 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 & 30 Recruitment and employment practices are designed to minimise the risk of unsuitable staff being employed. Learning opportunities for staff are good and appropriate training has been provided to ensure residents are in safe hands and are protected. EVIDENCE: The last inspection dated 1st November 2005 reported that standards 27 and 28 were met. Two staff files examined detailed that all relevant documentation is held indicating the person’s suitability for employment. Prior to an applicant being offered a position, Talbot View and Care South ensure that satisfactory references are received and that CRB* and POVA checks are carried out, applicants must provide proof of identity and complete an application form detailing their employment history and qualifications. One file examined for a recently appointed member of staff held a record of their expected attendance at the Care South induction training event, the training record was not examined although a certificate held on file evidenced that induction training was provided that covered all units of the Skills for Care (formerly TOPSS) training programme which meets National Training Organisation workforce training targets. A separate file held the home’s training records, although the index for each staff member was not entirely up to date, certificates held demonstrated that most staff have attended all
DS0000003899.V283092.R01.S.doc Version 5.1 Page 15 statutory courses including moving and handling, emergency aid, health and safety, food hygiene and adult protection. Few staff have received infection control training although Ms Lippitt confirmed that this subject is covered in other relevant course material such as health and safety, catheter care and the Care South induction programme. It is a requirement however that staff receive training specifically in issues of infection control with emphasis on standard and transmission based precautions and legislation. * CRB – Criminal Records Bureau * POVA - Protection of Vulnerable Adults, a list held by the Secretary of State of persons deemed unsuitable to work with vulnerable adults. DS0000003899.V283092.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): 35 & 38 Resident’s financial interests are safeguarded by efficient record keeping ensuring that resident’s rights and best interests are protected. The health and safety of residents and staff is protected by robust fire precautions. EVIDENCE: Some residents have requested the assistance of Talbot View with the management of their personal finances. Examination of a sample of sets of resident’s records relating to their personal allowances demonstrated that good accounting procedures are adopted. Records indicate income, expenditure and balance held, balances checked were accurate and all money is held securely. Records relating to testing of fire alarms systems, emergency lighting and fire fighting equipment demonstrated that these are regularly checked and maintained and staff receive fire safety and awareness training at the specified intervals.
DS0000003899.V283092.R01.S.doc Version 5.1 Page 17 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 DS0000003899.V283092.R01.S.doc Version 5.1 Page 18 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. Standard Regulation Requirement Records of medicines received into the home and administered to residents must evidence a clear audit trail of all medication movement in order that stocks of medicines held are in accordance with ordering and prescribing instruction. Resident medication administration records must be clear and each medication must be recorded once and signed for appropriately when given. All staff must receive training in control of inspection. Timescale for action 1 OP9 13 31/03/06 2 OP30 18 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 Standard Good Practice Recommendations DS0000003899.V283092.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Poole Office 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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