CARE HOMES FOR OLDER PEOPLE
The Conifers 253-255 Seymour Grove Old Trafford Manchester M16 0DS Lead Inspector
Val Bell Key Unannounced Inspection 26th October 2006 09:30 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 The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Conifers Address 253-255 Seymour Grove Old Trafford Manchester M16 0DS 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) 0161 881 9380 Mrs Santosh Trehan Mrs Santosh Trehan Care Home 12 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (8) of places The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. All service users fall within the category of old age and may additionally have a physical disability. A variation has been granted in respect of four named older service users who require care by reason of dementia. The home provides day care for up to three service users in a specially designated area of the home. 23rd January 2006 Date of last inspection Brief Description of the Service: The Conifers provides residential accommodation with personal care for up to twelve service users within the category of old age (OP) and who may have a physical disability (PD) and four with dementia. The Conifers also provides additional day care for up to three (3) service users although no day care was being provided at the time of this inspection. On the day of the inspection there were ten service users living at the home. The home is owned and managed by Dr & Mrs Trehan and is located in an established residential area of Old Trafford close to the village of Chorlton, close to shops, bus and train routes and other amenities. The home is a two storey Victorian property set in its own grounds and consists of 10 bedrooms (eight single and two double), one dining room and two lounges. Stair lifts are installed on both sets of stairs. The home has gardens to front and rear of the property, which are well maintained. Parking is available to the rear of the premises. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during daytime hours on Friday 26th October 2006. During the inspection various records, including care plans, were examined and a tour of the building was undertaken. Conversations were held with residents, staff and management and the inspector joined a group of residents at their midday meal. At the time of inspection the homes fees were £374.81 or £383.05 depending on whether residents were funded by Trafford, or Manchester councils. Action had been taken to meet the requirements made at the last inspection. What the service does well: What has improved since the last inspection?
Significant improvements had been made to the written content of residents’ daily records, which were now being written in a positive and non-judgemental way.
The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 6 Medications administration recording had also improved. The records were found to accurate and up to date. The environmental requirements made at the previous two inspections had been addressed. Two windows had been replaced, the privacy lock on a bathroom door had been repaired and a privacy lock had been fitted to bedroom 2. 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. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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 The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A robust system of needs assessment ensured that residents’ needs would be identified and a decision taken on whether the home could meet that persons needs. EVIDENCE: Residents had all been issued with an information folder to keep in their bedrooms. These contained summaries of the Statement of Purpose and other relevant information. Three residents’ files were examined in detail. Each contained comprehensive information relating to multi-disciplinary assessments of need. The inspector was told that on receiving a referral an experienced member of staff visited the prospective resident to undertake an in-house assessment of need. The information from the two assessments enabled a decision to be made on whether the home could meet the person’s needs. Wherever possible, prospective residents were invited to visit the home prior to admission so that people could decide if the home would be suitable for them.
The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents could be confident that their needs would be met according to their preferences and in a dignified and respectful manner. EVIDENCE: Three care plans were examined and it was evident that the progress identified at the time of the last inspection had been maintained and further developed. This had established a comprehensive audit trail from the assessment of needs to monitoring and review. The evidence demonstrated that the home had achieved best practice in this area and this was commended. Care plans had been developed from information contained in residents’ assessments of need. Of particular note was the attention paid to detail in developing resident’s profiles and in recording their preferences relating to daily routines and cultural and religious needs. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 10 Care plans clearly detailed what staff needed to do to meet resident’s needs. Up to date risk assessments paid particular attention to the prevention of falls. Care plans had been reviewed every month and updated to reflect changes in residents’ needs. A good practice recommendation was made to archive out of date care plans so that files do not become too bulky and to ensure that staff are following the correct care plan. Excellent progress had been made in the type of information that staff were recording on a daily basis. These records detailed the daily experiences of people living in the home and the specific care that they had received. Additional monitoring sheets were included if residents had specific needs such as poor diet or challenging behaviour. Care plans also provided evidence that residents had access to regular health care services. District nurses were visiting the home regularly to prepare insulin injections and to treat a resident who had developed a pressure sore. This resident had been provided with the relevant pressure-relieving equipment. An example of the good practice undertaken at the home was in the completion of skin integrity charts when residents were bathed. Weight charts were up to date and action had been taken if weight loss was apparent. Records relating to the administration of medication were accurate and up to date. However, staff are required to provide evidence that they check incoming medication to ensure that it has been dispensed as prescribed. This can be accomplished by staff initialling the records when the medication is checked. Further minor shortfalls were found as follows: • • One of the residents had been prescribed medication for epilepsy although there was no diagnosis of this condition in her records. This should be queried with the resident’s general practitioner. A resident was being administered Movicol on ‘an as required’ basis, although the records stated that this medication must be taken twice daily. The general practitioner must be requested to amend the prescription so that the pharmacy records agree with what is being administered. Four residents were asked if their privacy and dignity was being maintained. These residents confirmed that staff always treat them with respect and that their personal care is always delivered in private. One resident said, “The girls are marvellous. They always go that extra mile to make sure we have what we need.” The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents’ social, cultural and religious needs were being met in a creative way. The home celebrated the diversity of the ethnic and cultural mix of staff by providing residents with learning and stimulation from new experiences. EVIDENCE: During the inspection a resident asked to speak to me. She told me that she had been involved in fundraising for the Red Cross for 25 years. During September she had completed her 25th wheelchair marathon and had been presented with a plaque by the manager and players of Manchester football club marking her achievement. She said that she had received all the support necessary from the home to accomplish this. This resident also told me about life in the home. She had developed good relationships with the staff and she valued the excellent care that she received. A telephone had been fitted in her bedroom so that she could keep in regular touch with her brother who lived some distance away. The resident also told me that she was chairperson of the residents committee and there are always regular activities provided, although it is sometimes difficult to motivate other residents to become involved.
The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 12 The resident was asked about the meals provided. She said, “The meals are very good and we are given choices. I have no complaints. I am diabetic and staff always ensure that I eat regularly.” When asked what she would do if she had any complaints the resident replied, “I would speak to the deputy or the manager and they would sort it out, but I don’t have any complaints. I like living here.” A varied activity programme was provided and this was posted weekly on the notice board in one of the lounges. The home employed staff from many different cultures and their diversity was being celebrated by sharing cultural experiences with residents by organising themed nights. For example, the home had recently recruited a member of staff from France and had staged a French evening earlier this month. Staff and residents had dressed in French clothes and French music and food had been provided. This was considered to be an area of best practice and the home received a commendation. Future planned activities included a Halloween night and a hundredth birthday party. A female entertainer provided fortnightly activities and the home also arranged bingo, skittles and exercise classes. Residents’ religious needs were also being catered for. For example, a Roman Catholic resident was receiving regular Holy Communion. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Robust policies and procedures for dealing with complaints and allegation or suspicions of abuse provided protection to the welfare and safety of residents. EVIDENCE: The home had a complaints procedure in place and residents were provided with written information on how to make a complaint. The provider maintained daily contact with all the residents and said she would address any issues that residents had at source. Residents spoken to were confident that any problems they might have would be resolved. No complaints had been made since the last inspection. The home had adopted Trafford council’s policy and procedures on the protection of vulnerable adults from abuse. There had not been any allegations or suspicions of abuse made at the home. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were provided with a pleasant and comfortable living environment. However, health and safety issues identified in the home potentially placed the welfare and safety of residents at risk. EVIDENCE: On a tour of the home it was noted that a pleasant and comfortable living environment was being provided and it was evident that a rolling programme of re-decoration was in place. Fixtures and fittings were domestic in nature and the home was clean and hygienic and no unpleasant odours were present. The requirements made at the last inspection to replace two windows, mend a privacy lock on a toilet door and provide a privacy lock to a bedroom had been addressed. Further environmental issues identified at this inspection were as follows:
The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 15 • • A fire door on the landing was not closing fully into its rebate One of the bedroom doors was closing very fast and could pose a risk to frail residents These issues must be addressed as a matter of priority. Residents had the benefit of private outdoor space and tables, chairs and a gazebo were provided for their use in clement weather. This inspection was conducted at the beginning of autumn and it was noted that there was a build up of fallen leaves around the home. The provider stated that the gardeners had not been able to remove the leaves as a new garden shed was being installed at the time of their visit. However, one of the residents enjoyed a walk round the grounds every day and the build-up of leaves posed a potential risk to falling. The leaves must be removed on a daily basis. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 16 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents could be confident that their needs would be met by a knowledgeable and regularly supervised team of staff. EVIDENCE: The home rotas provided evidence that the home was deploying sufficient staff to meet the assessed needs of residents. Three staff were on duty between the hours of 08:00 and 22:00 and from 22:00 to 08:00 the home deployed one waking night carer and one member of staff sleeping-in. Nine care staff had achieved NVQ level 2 and the deputy manager was qualified to NVQ level 3. Three staff files were examined for evidence of training, supervision and recruitment procedures. The home had joined the Trafford Training Consortium and staff had regular access to training courses. There was evidence that staff were receiving regular refresher training in mandatory health and safety training and the home provided an induction programme for new staff based on the specifications of the Skills For Care recommendations. Training specific to the assessed needs of residents was also available, such as pressure area care/abuse awareness and it was pleasing to note that staff were attending training in diversity awareness. Future training had been
The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 17 planned for staff to attend a course on the Human Rights Act. Each member of staff had a training development plan, which was subject to review during twomonthly supervision sessions. Evidence demonstrated that ongoing training was a priority and this was commended as an example of best practice. The required recruitment checks, such as two written references and Criminal Record Bureau disclosures had been obtained for all staff working at the home. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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 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): 31, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The views of residents and their representatives matter to the home and feedback is used to continually make improvements to the way staff operate. EVIDENCE: The manager was experienced in the care of older people and was currently working towards the Registered Managers Award. The manager and deputy were present during this inspection and it was evident that there were clear lines of accountability within the staff team. The home had developed a system of monitoring the quality of the care provided. Satisfaction surveys were issued annually to residents, their relatives, staff and district nurses. The most recent survey had been
The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 19 conducted in July 2006. Feedback from the quality assurance programme was being used to make ongoing improvements to the way the service was delivered. The home did not manage the personal finances of the residents. Residents and their relatives took responsibility for this. During the inspection the inspector was told about a recent incident where a resident went missing. Further questioning revealed that this had been dealt with appropriately by the home. However, the home is required to notify the Commission in writing under Regulation 37 of the Care Homes Regulations of these incidents. A sample of health and safety records was examined. Records were generally found to be accurate and up to date and equipment in the home was being serviced and maintained regularly. However, the most recent landlords gas safety certificate was dated in 2003. The manager said that the gas boiler had been serviced since then and the CORGI registered gas engineer re-iterated this although a current gas safety certificate could not be located. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X 2 2 The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13 (2) Requirement The registered person is required to provide evidence that staff are checking incoming medication to ensure that it has been dispensed as required. The registered person must ensure that the medication records agree with the medication actually being administered to residents. The registered person must ensure that fallen leaves are removed from the paths around the home on a daily basis. The registered person must ensure that fire doors are checked regularly to ensure that they close fully into their rebates. Timescale for action 26/11/06 2. OP9 13 (2) 26/11/06 3. OP19 13 (4) 26/11/06 4. OP19 13 (4) 26/11/06 5. OP19 13 (4) The registered person must 26/11/06 ensure that fire door closures are adjusted appropriately so that the speed of door closure does not pose a risk to the safety of frail residents.
DS0000005605.V309737.R01.S.doc Version 5.2 Page 22 The Conifers 6. OP38 37 The registered manager must ensure that incidents affecting the welfare of residents must be notified in writing without delay to the Commission. 26/11/06 7. OP38 13 (4) The registered person is required 26/11/06 to submit evidence to the Commission that the homes gas boiler has been serviced annually since 2003. 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. Refer to Standard OP7 OP9 Good Practice Recommendations The registered person should consider removing out of date care plans from residents’ files. The registered person should query the reason for a resident being prescribed Epilim as she has no recorded diagnosis for this condition. The Conifers DS0000005605.V309737.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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