CARE HOMES FOR OLDER PEOPLE
The Conifers Care Home 15 Bakerdale Road Bakersfield Nottingham NG3 7GJ Lead Inspector
Linda Hirst Unannounced Inspection 7th October 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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 Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Conifers Care Home Address 15 Bakerdale Road Bakersfield Nottingham NG3 7GJ 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) 0115 9110024 0115 9110024 Mrs Debra Frances Yates Mrs Debra Frances Yates Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: The conifers in an adapted and extended property situated in the heart of a residential area of Bakersfield. The home provides accommodation and personal care for up to 10 residents within the category of old age. It does not provide nursing care. The accommodation is well maintained throughout. Four bedrooms have en suite facilities. The bedrooms are on the ground and first floor and there is a stair lift to provide access to the upper floor. There is a dining room and a pleasant and homely lounge to the rear of the property overlooking well kept gardens. Local shops, public houses and public transport are easily accessible from the home, although the road has a slope so people with mobility difficulties may need assistance to go out. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit involved one inspector who was at the home for half a day. The main method of inspection used was called ‘case tracking’ which involved selecting two residents and tracking the care they receive through checking their records and discussion with them, in one case a relative was interviewed. The home is currently expanding and an examination of the new rooms was undertaken. Arrangements regarding residents’ finances were checked; staff files and medication were also examined. Most of the core standards were inspected on the previous visit to the home. What the service does well: What has improved since the last inspection?
Residents and their relatives have seen the care plans and know how staff intend to help them. Staff files have all of the necessary documents to prove identity and protect residents from harm or abuse. Resident questionnaires are now dated. Some parts of the home have been redecorated but there is major construction going on in respect of the new build.
The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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 Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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): 5 Residents get the chance to visit the home if they wish before admission and feel settled and happy at the home. EVIDENCE: One of the “case tracked residents had lived at the home for 6 years and had the home recommended to her. The relative of the other resident said she already knew the home well as she had attended for day care and was on the waiting list for a placement there. Both residents have settled well at the home. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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, 10 Residents and relatives are involved in care planning, although these documents need more detail to properly guide staff in meeting residents’ needs. The residents’ health needs are properly assessed and provided for and medication practice is safe and well managed. Staff show respect for the personal dignity and privacy of the residents. EVIDENCE: There is an outstanding requirement to provide more detailed care plans and risk assessments so that staff are properly guided about how to meet residents’ needs. This matter has not yet been addressed because of the building work being undertaken, though the manager assures me it will be addressed once this is completed. Those spoken with had seen their care plans and confirmed that staff discuss their needs with them and evidence of signatures was seen on care plans. There is also an outstanding recommendation to obtain personal histories on all of the residents to make sure that staff understand key events and people in their lives. This has not
The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 10 yet been done, though again the manager gave assurances that it will be completed shortly. One resident confirmed that she attends outpatient clinics and said that the staff go with her to these visits. She said if she was unwell the GP or the District Nurse is called in straight away. This resident walks with a mobility aid and knows her own limitations but said she can get frustrated at not being able to do more for herself. The medication arrangements were checked to make sure they are safe and that the residents get their tablets as prescribed by their GP. Medication is stored safely and separate cold locked storage is available for medication requiring this. The Monitored Dosage System is used to administer medication and to reduce the possibility of staff error. The Medication Administration Records were inspected and offer good, clear records with good evidence of management oversight of medication issues. One of the residents who was interviewed was immaculately dressed with her hair done and jewellery on, she said she is mainly self caring but that staff help her in and out of the bath to make sure she is comfortable and safe. She said the staff never intrude on her privacy. A relative stated that her mother is always clean, well dressed and groomed and she feels her dignity is respected and she is well cared for. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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 The frequency and range of activities could be improved to enable residents to lead busier and more fulfilling lives. Relatives are kept informed and are well supported they can visit when they like enabling relationships with residents to be maintained. The residents have freedom to choose their own lifestyles. EVIDENCE: Residents and relatives said there could be more activities planned and provided and that it can be a “long day” for residents. Though one said staff will sit and play cards with her, she has used the garden a lot and gets out two to three times a week with her family or staff. She has a daily newspaper and enjoys crosswords, and said parties are arranged “sometimes.” Residents said they could have relatives to visit whenever they wish, there are no restrictions, and the relative interviewed confirmed this. The relative said she is always made welcome, she can see her mother in private if she wishes and she feels staff communicate well with her, keeping her well informed. One of the residents confirmed she gets up when she wishes and that the staff bring her a drink, she said one resident she knows of has his breakfast in bed
The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 12 but she prefers to come down for hers. She goes to bed when she likes and often watches TV in her bedroom at night. She is a smoker sits by the French doors in the dining room in Winter but prefers sitting outside in the garden in the Summer. She feels she has freedom to choose her own lifestyle at the home. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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, 18 Residents and relatives know how to complain and are confident that if they did so the manager/owner would respond appropriately. They have never seen staff act in an inappropriate manner and feel well protected. EVIDENCE: Those interviewed had never complained, but they were well aware of the process and both expressed absolute belief that the manager would sort the issues out straight away. The manager is said to be very approachable. Neither had ever seen staff respond inappropriately to anyone, but the relative said she would report the matter straight away. There is an outstanding recommendation to provide formal training to staff regarding issues of abuse. The manager has approached the Adult Protection Unit, but they have significant waiting lists, so the training has not been arranged as yet. In house training has been provided in the interim and a copy of the Procedures to be followed in the event of an allegation is available to staff. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 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): EVIDENCE: The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 The recruitment and recording procedures in respect of staff are robust and protect residents from harm and abuse. EVIDENCE: Relatives and residents commented that the staffing levels are adequate to meet the needs of the residents, and staff were said to be “friendly,” “chatty,” and “will do anything for you.” Staff files were inspected and these were found to be acceptable, containing the information and documentation required by Law to protect the residents from harm or abuse. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 The proprietor must fulfil her obligations to undertake a quality assurance audit on the service provided at the home to ensure there are no significant shortfalls in standards. EVIDENCE: There is an outstanding requirement for the manager/provider to undertake a quality assurance audit for this year. She will be undertaking this once the new building work is completed and has the documentation in place. The previous questionnaires have been dated as recommended, as will all future ones. The resident and the relative interviewed said they had not completed any questionnaires, although both said they could express their views to the manager/provider freely. The arrangements for residents’ finances were inspected. The manager is not the appointee for any of the residents and no finances are held on behalf of
The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 17 residents at the home. These are brought in as needed by relatives or residents manage their own money. The standard is not applicable. The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X N/A X X X The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 14 Requirement Timescale for action 18/11/05 2 OP33 24 3 *RQN 37 Care plans and risk assessments must be more detailed and give clear guidance to staff about how needs should be met. Timescale of 23/8/05 not met. Undertake a quality assurance 01/12/05 audit of the home. Timescales of 1/4/05 and 23/8/05 not met. All notifiable incidents as 18/11/05 specified in Regulation 37 must be notified in writing to the Commission for Social Care Inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP12 OP18 Good Practice Recommendations Obtain personal histories on all of the residents (Outstanding) Improve the range and frequency of activities in the home. Provide formal training on abuse to staff. (Outstanding)
DS0000002194.V255983.R01.S.doc Version 5.0 Page 20 The Conifers Care Home The Conifers Care Home DS0000002194.V255983.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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