CARE HOMES FOR OLDER PEOPLE
The Corners Residential Home 34 The Avenue Tiverton Devon EX16 4HW Lead Inspector
Jo Walsh Key Unannounced Inspection 24th August 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 Corners Residential Home DS0000021915.V305673.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 Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Corners Residential Home Address 34 The Avenue Tiverton Devon EX16 4HW 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) 01884 253682 NO FAX Mrs Kathleen Lilian Newton Mrs Kathleen Lilian Newton Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. To admit one named service user in the category of LD (E) The maximum number of placements including that of the named service user, will remain at 8. On the termination of the placement of the named service user, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 23rd February 2004 16th September 2002 Date of last inspection Brief Description of the Service: The Corners Residential Home is situated in Tiverton, Devon. The semidetached property is set in its own landscaped gardens in a quiet residential area on the outskirts of the town. The home is registered to provide personal care to 8 older persons in the category of Old Age and no other. The home does not provide nursing care. The home is owned and managed by Mrs Kath Newton who lives in and oversees the running of the home. Accommodation is provided in six single rooms and one double room. At the time of this inspection one person occupied the double room. Bedrooms are set out on the ground and first floors with stair lifts to enable easy access to the upper floor. The living rooms are on the ground floor and consist of a spacious, well furnished lounge, a dining room and a conservatory. The range of fees is £340 per week. The inspection report is made available to residents and their visitors via a copy being left in the lounge. The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced meaning the home were not made aware of the inspection date. The inspection took place on a weekday in August and lasted for 6.5 hours. Time was spent talking to all 7 of the residents, with the staff on duty and with the manager. Time was also spent looking at some of the key documents, which included the residents’ care plans, medication records, fire log book and staff files. The home had also completed a pre inspection questionnaire, which was also used to help inform the inspection process. Three family representatives were asked their views about the home by phone following the inspection. All said they were happy with the care and support offered by the staff at the home and that they would be confident that should they have any issues that they could discuss these with Mrs Newton and that they would be resolved. What the service does well:
The registered provider/manager Mrs Newton ensures she completes a pre admission assessment on all prospective new residents. This ensures that they can meet all assessed needs and that she has a clear picture of what the individual likes, dislikes and their preferred routines and level of support needs. Each resident has a detailed plan of care that is reviewed with them on a monthly basis. This plan clearly sets out individuals’ health, personal care and social needs. Residents’ comments included ‘staff treat us very well’ ‘we all get on very well, everyone is very kind’. The home ensures that health care needs are well met and where possible individuals are enabled to spend their final days at the home. Relatives of a resident who died at the home wrote to CSCI to say how impressed they were with the level of care and dedication shown by Mrs Newton and her staff in caring for their relative until they died. There are sound policies and procedures in place to ensure medications are safely stored and administered. Residents can self medicate once the home have assessed risks and provide ongoing monitoring. The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 6 The daily routines are flexible and suit individuals’ preferences. Residents are encouraged to make decisions and choices about their daily lives and some social activities are offered most afternoons. Visitors are made welcome at any time. The home offers a good range and variety of home cooked meals. All residents said they enjoyed the food and their individual likes and dislikes were taken into consideration. One family member said that the home had gone out of their way to ensure that all their relatives likes were included, and thought that being a smaller home was an advantage as they were able to accommodate special needs more easily. The home has a simple and clear complaints procedure. All residents said that if they had any concerns they could speak to the manager and they would be confident that she would sort any issues out. Three relatives who were contacted by phone also said that if they did have any concerns they would be able to approach the manager, or speak to the staff. The premises are well maintained and provides a safe, clean and homely atmosphere for residents. There is a small staff team who are experienced and trained to provide good quality care. Mrs Newton is qualified and experienced to run the home and she ensures that any requirements made following an inspection, are implemented. What has improved since the last inspection? What they could do better:
The registered provider must ensure that staff are only employed in post and work unsupervised once a satisfactory CRB and POVA check is completed and returned. This will ensure that residents are protected. There has been a recent new staff member who took up post without their CRB being returned. The CRB check did have disclosures and Mrs Newton informed CSCI and gave the individual notice.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 7 The home should still seek the advice of the clinical nurse specialist in respect of safe practice for sluicing of commode pans. This will help with the risk of cross infection. When new staff completes an induction programme, this should be recorded, including what topics have been covered. Mrs Newton should collate the results of the residents’ and relatives’ surveys and make the results available to them, with a copy sent to CSCI. This will help to inform the quality assurance programme, and let people know what the home does well and what areas they are planning to improve on. 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 Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 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 the following standard(s): 3,5 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Needs are fully assessed prior to any new resident moving into the home. Prospective new residents and their relatives are given the opportunity to visit the home to assess the quality, facilities and suitability. EVIDENCE: The files of the two newest residents were viewed and discussed with Mrs Newton. Mrs Newton ensures she visits the prospective new resident either in their home or invites them to visit The Corners, so that she can assess their needs and check what their likes, dislikes and preferred routines of daily living are. She also ensures she obtains a copy of the care management assessment and care plan. This information is then used to develop a care plan of the individual.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 10 One of the residents said that she was able to visit the home with her relative prior to moving in. A relative also confirmed that they were made welcome to visit the home that all likes and dislikes were discussed and that the home had gone out of their way to ensure that needs were met. The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10,11 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Care plans clearly set out residents’ person, health and social care needs. Residents’ health care needs are well met. The home has a robust medication procedure in place to ensure residents are fully protected. Residents are treated with respect and privacy. EVIDENCE: Three care plans were viewed during this inspection. They detail individuals’ needs and wishes and are reviewed with the individual on a monthly basis. One resident said they enjoyed spending time looking at their care plan with the manager and was able to make any changes she wished.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 12 Residents’ health care needs are fully documented within the daily records and all residents spoken to said that they could see their GP when they wished, and that district nurses came in when needed. Mrs Newton confirmed that she provides transport to appointments and keeps relatives informed of any major health care issues. Three relatives spoken to said that they thought that they were kept well informed and that all health care needs were met by the home ensuring any issues were followed up. The CSCI received a letter from a family in April, praising the staff and dedication of Mrs Newton for the care and attention given to their relative during an illness and their final days at the home. The family said that the home had showed great care and were grateful their relative was enabled to remain in the home for her final days. The staff are to be commended for this. The home’s medication storage and records were viewed. One resident currently self medicates. This is risk assessed and monitored on a regular basis by the home. The individual concerned has lockable storage in their room to keep medications safe. All other medications are safely stored, and records are well maintained to ensure that residents are protected form errors. Only staff that have completed medication training are able to administer medications. During this inspection staff were observed to be providing support in a respectful manner. All residents spoken to said that the staff were very kind and treated them well. Comments included ‘staff treat us very well’ ‘we all get along and every one is very kind’. The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents’ social needs are met and daily routines of the home meet their expectations and preferences. Residents are able to make choices in their everyday lives. The home offers a good balanced diet with choice and variety. EVIDENCE: During this inspection all seven residents were spoken to. They said that staff spend time in the afternoons playing games such as bingo, skittles or quizzes with them. One resident is able to access the community independently and staff ensure that meals are kept if they are intending to be back later. Residents confirmed they are able to get up and go to bed when they wish, can choose where they eat their meals and where they spend their time. Several residents enjoy knitting and doing crosswords and like to spend their mornings together in the communal lounge. Several residents mentioned that they had recently all been out to a garden party and that they go out on trips in the car occasionally.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 14 All residents and three family members contacted by phone, confirmed that visitors are made welcome. Visitors are always offered drinks and are able to visit at any time. Residents are able to have their own phone installed or make use of the homes phone in private. The home offers a good range and variety of meals. All residents said they enjoyed the food and their individual likes and dislikes were taken into consideration. The main meal is served at lunchtime and was observed to be served in a relaxed and unhurried manner. One family member said that the home had gone out of their way to ensure that all their relatives likes were included, and thought that being a smaller home was an advantage as they were able to accommodate special needs more easily. The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 15 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 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Complaints are listened to and acted upon. Policies and procedures are in place to protect residents from abuse. EVIDENCE: The home has a simple and clear complaints procedure. There have been no new complaints since the last inspection. All residents said that if they had any concerns they could speak to the manager and they would be confident that she would sort any issues out. Three relatives who were contacted by phone also said that if they did have any concerns they would be able to approach the manager, or speak to the staff. Policies are in place to ensure staff are aware of what to do if they suspect abuse. The home has safe procedures for handling residents’ finances. These were checked and discussed with Mrs Newton. Only she has access to residents’ personal monies if they need to be kept on their behalf. It was suggested that she ensure that relatives are given a written receipt for any monies they bring in for residents’ personal spends. Currently this is recorded on the individuals’ sheet, but is not signed by the relative or the individual concerned.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 16 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): 19,26 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home is clean, homely, safe and well maintained. EVIDENCE: All parts of the home were viewed during this inspection and were found to be very clean and fresh smelling. Since the last inspection the manager has ensured that all radiators are now covered and followed up on the fire officers recommendation to ensure that self-closures on fire doors are regularly checked as part of the fire safety checks. The manager has not yet consulted with the clinical nurse specialist in respect of how they sluice their commode pans. They currently use the communal bathroom, and although very few residents use commodes, this practice needs to be checked to ensure that they are not at risk of cross infection.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 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 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): 27,28,29,30 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The staff group are experienced and trained to meet the needs of the residents. Recent recruitment practice has not fully protected residents. EVIDENCE: The staffing levels are sufficient to meet the needs of the current resident group. There is normally two staff on per shift and two sleep in staff. The home does not offer waking night cover. The owner/manager lives on site and together with another staff member provides all the sleep in cover. The home completed a pre inspection questionnaire and this evidenced that staff receive regular training opportunities, including all health and safety topics and NVQ training. The staff group have remained fairly stable until recently. One staff member needed to leave at short notice and Mrs Newton took on a worker she had known and worked with many years ago. This person had a clear POVA check and had started employment, but was not confirmed in post until their CRB was returned. When the CRB came back there were disclosures that the individual had not declared. Mrs Newton did contact CSCI immediately and gave the person notice, and assuring that they would not work unsupervised.
The Corners Residential Home DS0000021915.V305673.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): 31,33,35,38 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” The home is well managed and run in the best interests of the residents. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are protected. EVIDENCE: Mrs Newton holds the Registered Manager’s Award. NVQ Assessor’s Award D32/33 and is a Level 1 Registered Nurse and has eight years of experience of managing The Corners.
The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 19 Regular surveys are given to residents and their family members to ensure they are satisfied with the care and support provided. These now need to be collated and results made available to residents and their relatives and a copy sent to CSCI. Mrs Newton ensures that where possible relatives deal with individuals’ monies, and where amounts are kept for safekeeping, an audit trail and receipts are kept. These were accurate and well maintained, although as previously stated in the section about protection, Mrs Newton should ensure that where any monies are given by family, that a receipt is given or that they sign the book where amounts are entered. The pre inspection information details that all equipment is regularly serviced and that there are policies and procedures in place for all safe working practices. Staff spoken to confirmed that they have updated training in all areas of health and safety and have access to the policies. One staff member said that they are often asked questions about policies and procedures as part of their ongoing learning and supervision to ensure they are fully aware of them. During this inspection the fire logbook was seen and appeared to be well maintained. Other records viewed included accident reports and staff records. Again these were well maintained. Information was available to show that staff have induction training in line with TOPSS specification, although this is not always formally recorded as recommended. The Corners Residential Home DS0000021915.V305673.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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Corners Residential Home DS0000021915.V305673.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 OP29 Regulation 19 Requirement The registered provider must not employ anyone to work unsupervised unless all checks are satisfactory, this includes a CRB check being completed. Timescale for action 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP18 OP26 Good Practice Recommendations The home should ensure that receipts are given for any monies relatives leave for individuals’ personal spending. The home should consult with the clinical nurse specialist in infection control regarding their current sluicing facilities for commode pans. The home should ensure that all induction training is recorded 3. OP38 The Corners Residential Home DS0000021915.V305673.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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