Inspection on 21/02/06 for The Flowers

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Flowers 24/06/08

The Flowers 03/07/07

The Flowers 06/07/06

The Flowers 08/12/04

The Flowers 14/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Flowers 3 Snape Drive Horton Bank Top Bradford West Yorkshire BD7 4LZ Lead Inspector Susan Knox Unannounced Inspection 21st February 2006 09.15 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 Flowers DS0000001161.V283447.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. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Flowers Address 3 Snape Drive Horton Bank Top Bradford West Yorkshire BD7 4LZ 01274 575814 01274 575814 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) Mrs Catherine Ruth Taylor Mrs Catherine Ruth Taylor Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: The Flowers is located in a residential setting overlooking Horton Park. It is close to local amenities and a city bus route. It provides residential care for those with a mild to moderate dementia and other memory loss disorders who are over pension age. The majority of the twenty three service users are accommodated in single bedrooms, approximately half have en-suite facilities. There are two communal areas, one is divided into lounge/dining area. Internally there are ramps between the different levels and a passenger lift to aid mobility. To the outside there is a car park and a secure enclosed garden. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection between 9.15am and 4.30pm. The provider/manager was present during the inspection. Feedback on the findings from the inspection was given at the end. Time was spent talking to service users, a visitor, staff and management and observing practice. Records were checked including recruitment files, duty rotas, care documents and accident reports. Inspectors and relatives thought the care provided in the home was very good. Requirements and recommendations are listed at the end of the report. What the service does well: What has improved since the last inspection? Care planning has improved since the last inspection and addresses individual needs. Recruitment has improved since the last inspection. Efforts have been made to provide additional snacks for those who may not eat at meal times. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 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 Flowers DS0000001161.V283447.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 The Flowers DS0000001161.V283447.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): 2. Financial agreements between service users/relatives and the home are available. EVIDENCE: Contracts were reviewed for three service users. These were in place and signed by relatives. The name of the room to be occupied was included as required under this standard. The Flowers DS0000001161.V283447.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, 9, 10. Care planning is good and health carers are contacted for advice. Medication procedures ensure that service users receive appropriate medication in a safe way. Service users are treated with respect and their privacy maintained. EVIDENCE: Five sets of care documentation were seen. Care planning had improved since the last inspection it was well documented and up to date. Planning clearly addressed individual needs including those related to dementia. Where necessary high dependency care planning is completed for those with increasing needs. Monthly evaluation takes place ensuring that changing needs are identified and appropriate action taken. The signatures of relatives were on some records to indicate their involvement. In one care plan eating difficulties were identified as a need. Action included the use of a plate guard and monitoring of diet. The service user’s weight was checked more than monthly and indicated stability. The manager was advised that the use of a nutritional assessment would provide further safeguards and The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 10 also triggers for staff to action in care plans rather than just recording monitoring. Recognised assessment tools are in use and risk assessments were in place. The manager was advised to introduce body-mapping charts for recording injuries and bruising. In homes for those with dementia slight injuries can occur when staff are not present. One risk assessment was about dealing with verbal abuse from a service user. Good strategies were recorded for staff to use in attempts to defuse situations. District nurses are involved in health care needs. One service user was being seen in relation to tissue breakdown. This had healed and broken down again. The manager was advised to request a referral to a tissue viability nurse. The medication system and relevant records were checked. The home operates with a Monitored Dosage System (MDS) and storage of medication was satisfactory. Records including controlled drugs were well kept. A random check of one type of medication showed that the number of tablets and the record was satisfactory. The administration of medication was carried out in accordance with procedures. Tablets were dispensed from the MDS directly into gallipots to be given immediately to service users. The deputy confirmed that no secondary potting up of medication occurs. Explanations were given to service users and drinks were readily to hand. The deputy confirmed that the local pharmacist provides staff training and also checks the system. A separate fridge is available for the storage of topical applications. Throughout the inspection both inspectors noted that service users were treated with respect. This was also confirmed in discussions with two different relatives. Service users were not rushed in any of the procedures observed during the day. Staff spent time in giving reassurances to individuals. One relative said that a number of visits to the home are made and that the staff were always kind and considerate. The Flowers DS0000001161.V283447.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): 12, 14. A planned programme of activities is provided daily for service users. Staff are aware that nutrition can be a concern for those with dementia. Service users are given the opportunity to help themselves to food. EVIDENCE: The inspectors observed the interaction between staff and service users and found this to be very positive. The daily routine can include staff reading from the daily newspaper; the news, the star signs or television programmes. On the day this generated good discussions. Relatives and staff confirmed that this is ongoing. The patio is visible from the main lounge. It has hanging bird feeders and in the summer there will be scented shrubs and plants that should create a focal point of interest. Service users were very interested in the newly acquired home’s rabbit that can be observed from the lounge. One service user was throwing crumbs from the window and another was describing the antics of the rabbit to another. Some thought has gone into the furbishing of the home both inside and out in order to provide areas of interest for service users. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 12 The board in the lounge gave information to service users about the date, the daily activities and the menu. Staff were seen to walk around the home with those service users who wanted to explore further than the lounge. Staff confirmed that service users are able to help with setting tables; they play simple games and quizzes. They go out into the garden or for walks in the good weather. It was apparent that service users are given choices and encouraged to follow own interests. Since the last inspection the provider has purchased a fridge for the use of service users. This is in the dining area and has a glass door so that service users can see the contents. This is for those who are unable to sit for long at dining tables therefore may not take a good diet. Drinks and snacks are available for staff or themselves to encourage eating. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 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 Relatives are encouraged to speak out about concerns. These must be recorded so that action taken to address issues is clear and open to inspection. The management team should be more aware of how their responses can be interpreted. EVIDENCE: There is a detailed complaints procedure displayed in the home and this is included in the statement of purpose. The manager advised that no complaints have been made since the last inspection. She is aware that complaints should be recorded and an account made of any investigation and action taken. The manager was open in her discussions about matters that had been discussed with her about individual service users. She was advised that some of this should be recorded in the complaint record. In addition discussions were held about a number of contacts made to the CSCI for advice where it was felt that management could not be approached because their reaction may be negative. The inspectors and manager discussed how actions of the management team could be viewed as negative or defensive. An example of this was observed during the inspection. The manager said that she felt that she had good relationships with all relatives. This was confirmed in discussions with two around the time of the inspection. She has set up support meetings with relatives and three events were arranged up to the end of 2005. Attendance dropped so the relatives were asked to arrange these meetings, as they required. Relatives are also The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 14 asked in writing to attend service user reviews. The letter provides an opportunity to list anything they may want to discuss. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 & 26. The home provides comfortable accommodation that is well maintained and meets individual needs. Service user’s rooms are personalised and comfortably furnished. The home is clean with no malodours. EVIDENCE: The building was thoroughly inspected at the last inspection visit. A few bedrooms were seen during this visit. It was noted that in the main areas odour control was very good. These rooms have been furnished with a view to provide comfort, interest and also to calm the client group. Seating is mainly soft furniture with lots of cushions. Continence aids are discreet. A number of easy chairs are recliners for relaxing with foot rests. Bookshelves and displays contain items of interest such as dinky cars, books and magazines. Decoration creates a calming influence and carpets are plain in order to avoid confusing patterns for those with dementia. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 16 The bedrooms were also decorated in calming restful colours and were well furnished. Personal items were seen in bedrooms belonging to service users. Some had bird feeders fitted to the window and also planters to nearby walls for interest in the summer months. The newer bedrooms have en suite facility of washbasin and WC. The manager advised that nurse call alarms are to be fitted in all en suite facilities. This home provides care for residential service users and the majority are ambulant. There is level access into the home and the garden. On one level a ramp ensure easy egress between different levels of the building. There is a passenger lift. The bathrooms and WC’s are fitted with hoists, handgrips and high seats. There is a mobile hoist to use if necessary. The home was clean and warm. There had been problems with the heating in one bedroom. A convector heater was provided until the heating system was checked. The manager advised that the use of the heater was risk assessed. The manager advised that following the last inspection the childproof gate fitted to the back staircase has been removed. No adverse health and safety issues were noted at this inspection. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 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): 27-30 Staffing levels are sufficient to meet service users’ needs. Recruitment procedures make sure that staff are suitable before they start work in the home. The home has a comprehensive training programme to make sure that staff receive the training they need to carry out their jobs. EVIDENCE: A copy of the staff rota showed that staffing levels were satisfactory. The staff team comprise of management, senior carers, care assistants, cook, and housekeeper and maintenance staff. Many of the ancillary roles overlap into the care of the service users. This was seen to be effective as all staff were very positive in their interaction with service users. NVQ training is ongoing with two senior staff studying for NVQ level 4. During discussions with staff it was confirmed that NVQ training was encouraged. Recruitment records were seen for three staff. Procedures have improved since the last inspection. Application forms were completed, Criminal Bureau Records (CRB) had been checked for clearance and two references obtained. The manager confirmed that issues raised in references were discussed with the applicant before work started. There was evidence in all the files of identification checks. The manager confirmed that no one starts work until clearance, either via a CRB or POVA first is received. One file contained a CRB The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 18 from previous employer obtained a week before starting work at The Flowers. In addition only one reference had been received. The manager said a second CRB had been applied for and this and the reference would be pursued. The manager advised that a Human Resources member of staff has been recruited and will take responsibility for staffing issues. Files contained copies of terms and conditions of employment. Also available were induction booklets completed by new staff. Induction includes a six-week foundation course in person centred care. Staff files provided details that confirmed that staff receive training within six weeks about basic care and this is followed by a six-month foundation course. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 19 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): 31-38 The home is well organised and the manager provides effective leadership. The issue of the RMA needs to be clarified. Service users, staff and relatives are encouraged to participate in all aspects of the home and there are good systems of communication in place. This will further improve with regular staff supervision. The health and safety of service users and staff is promoted and protected. EVIDENCE: The registered manager/provider is a Registered General Nurse who confirmed that she has an active registration. She also has a teaching qualification City and Guilds 730. She has had many years of experience in managing care homes. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 20 Discussions were held about the requirement for a registered manager to have obtained the Registered Manager’s Award and NVQ level 4. The manager was advised to put in writing to the CSCI her proposals to overcome this short fall. A number of meetings are held in order to aid communications in the home. Service user meetings are arranged followed by senior carers, then the staff team. Minutes were available for all the meetings. The home is clearly operated with the best interests of the service users to the fore. Staff deal with some service user’s personal allowances. The records were checked and found to be satisfactory. Receipts were available for all transactions including the transactions from the home’s shop of tights and toiletries. An up to date public liability certificate was displayed as required. The manager advised that care staff supervision has been overlooked. This will be dealt with. The manager advised that two fire alarms were not working in the home. This had been reported to the landlord and the home was awaiting replacement of the fire panel. Although it was felt that other fire alarms were working and could be heard, the manager was advised to contact the local fire officer to check whether this was acceptable. She had instigated additional checks through the night until the system was fully working. Accident records were reviewed these were found to be satisfactory and pages are now numbered. Records were available to show that regular checks were kept of fire alarms and emergency lights. Staff also received regular fire drills/training from the maintenance staff. The manager was advised that additional training was required for the responsible fire person. Birkenshaw fire service provide the recognised training that would ensure fire prevention practices were correct. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 21 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 4 4 X 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 4 3 3 2 3 3 The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 22 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 2 3 Standard OP16 OP29 OP31 Regulation 17 19 9 Requirement Ensure that concerns that are raised in the home are recorded in the complaint records. Ensure that the up to date CRB clearance record is located and the second reference is obtained. Confirm in writing the action planned to address the shortfall in registered manager qualification. Ensure that all care staff receive supervision six times a year. Ensure that the responsible person for fire prevention attends relevant fire training. Timescale for action 21/02/06 15/03/06 15/03/06 4 5 OP36 OP38 18 23 31/03/06 31/03/06 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 7 8 Good Practice Recommendations Introduce nutritional assessments and body mapping in care planning. Request a referral to the tissue viability nurse for one DS0000001161.V283447.R01.S.doc Version 5.1 Page 23 The Flowers service user. The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 The Flowers DS0000001161.V283447.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!