CARE HOMES FOR OLDER PEOPLE
The Glade 32 Lancaster Road Southport Merseyside PR8 2LE Lead Inspector
Daniel Hamilton Unannounced 1st June 2005 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 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 Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Glade Address 32 Lancaster Road Southport Merseyside PR8 2LE 01704 566699 01704 569288 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr David Winston Jackson Ms Deborah Jane Lawrence Care Home 25 Category(ies) of OP Old age 25 registration, with number of places The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 25 OP Old age. 2. This service should at all times employ a suitably qualfied and experinced Manager who is registered with the Commission for Social Care Inspection. Date of last inspection 12th October 2004 Brief Description of the Service: The Glade is an older property that has been converted into a care home and is registered to provide personal care and support for up to 25 older people. It is situated in a leafy part of Southport close to public transport and within easy reach of the amenities that serve the area. The home provides acommodation over four floors and has lift access. The communal space contains one large dining room and one large sitting room. Toileting and bathing facilities are located throughout. The home has had adaptations such as handrails, hoists and ramps to suit the needs of the residents. There is a call-bell system throughout the home. The front garden is accessible via a ramp and suitable garden furniture is available for the residents and their visitors. The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.5 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There had been no cause for any visits to the home since the last routine inspection in October 2004. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The new manager, deputy manager, two staff, seven of the 24 residents and one relative were spoken to during the visit and their views obtained of the home. What the service does well: What has improved since the last inspection? What they could do better:
Residents must be provided with a signed copy of their contract, to ensure they understand their rights and the terms and conditions of the home. Although care plans were generally well constructed, they had not all been signed by service users or their representatives to confirm they were in agreement with the plan. This should be addressed where practicable. The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 6 The practice of failing to complete medication records following administration of medication was not safe and must stop. In order to ensure a proper response to any suspicion or evidence of abuse, the home should obtain a copy of the local adult protection procedures. Many parts of the home including four bedrooms, communal areas and the external fire escape required repair / refurbishment to ensure residents live in a safe, well maintained environment. An action plan must be developed to ensure the necessary work is completed as a matter of priority. Appropriate pre-employment checks and certificates were not in place for a new member of staff. Staff must be recruited correctly, so that people living in the home are protected and all existing records must be brought up-to-date. Furthermore, staff should complete an induction programme that meets the requirements of the National Training Organisation. Sufficient staff must be employed, to maintain the home in a clean, tidy and hygienic state. The Commission for Social Care Inspection was still not being provided with monthly reports from the provider on the conduct of the care home and this must be addressed. Likewise, the home should continue to develop consultation processes and monitor outcomes, to ensure the home is run in the best interests of users. To ensure the health and safety of the people living and working in the home, the risk of scalding from hot water must be risk assessed for residents that have not had a pre-set valve fitted to their hot water supply. An up-to-date insurance and gas safety certificate and a safe practice and fire risk assessment must be produced and staff should receive fire instruction training at the recommended intervals. 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 Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 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 standard(s) 2 and 3 Service users did not have a written contract, to ensure they were aware of their rights and terms and conditions of residency. Assessments of need had been completed prior to admission, to enable the home to be sure of meeting residents’ care needs. EVIDENCE: Despite a requirement at the last two inspections, there had been no progress in providing residents with a written contract. Individual assessment records were available for each resident. Three files were viewed for residents that had been referred from Social Services and moved into the home since the last inspection in October 2004. Records showed that the manager had undertaken a pre-admission assessment for each resident before they had moved into the home. Assessments and reviews completed by care managers were also on file. The manager confirmed that the information generated from the assessment process was used to develop an individual plan of care.
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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 standard(s) 7, 9 and 10 Overall, care plans identified residents’ needs and the support required to meet them. Medication records were not always completed. This shortfall has the potential to place residents at risk. Care was provided appropriately, in accordance with the needs and expectations of residents. EVIDENCE: Three files were viewed for residents that had recently moved into the home. Each resident had an individual plan of care that identified relevant aspects of their health, social and personal care needs and was reviewed on a monthly basis. A resident reported “I have never seen a care plan” and two of the care plans viewed had not been signed by residents or their representatives. A medication policy was in place. None of the residents self-administered their medication. Three medication records viewed showed that records had not always been completed following administration. A resident spoken to said; “I think the staff treat me very well” and another reported, “I am treated with dignity and sensitivity.” Discussion with staff confirmed their awareness and understanding of how to respect the rights of residents receiving care. The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 10 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 standard(s) 12 and 13 Daily life and activities within the home were flexible and varied to meet the expectations, preferred routines and needs of residents. EVIDENCE: The home produced a monthly activities programme that residents could choose to participate in. The programme was displayed on the hall notice board. Residents spoken to confirmed that they were satisfied with the activities available. One resident said, “there are enough activities for me. We have films, trips out, bingo and entertainment.” Another reported, “as far as I am concerned there are enough activities but I don’t participate in many.” Residents were able to organise their daily life and maintain preferred routines. Comments from three residents included “there are no restrictions or routines in the home”, “I can live my life as I please” and “I visit my friend every day.” Residents reported that the home had an open door visiting policy. A resident advised that, “I can have visitors whenever I want” and another said; “my family visit me every week. My son and daughter visited today.” A relative spoken to during the visit confirmed that she was able to visit at any time and was always made to feel welcome. The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 11 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 standard(s) 16 and 18 There had been no complaints since the last inspection but residents were confident that their concerns would be listened to and acted upon. Although some safeguards were in place, a copy of the local authority procedures was not available to ensure an appropriate response to any suspicion or evidence of abuse. EVIDENCE: The home had a ‘Complaints Procedure’ and a ‘Compliments, Concerns and Complaints’ record book. The complaints record showed that no complaints had been received since the last inspection. Residents spoken to confirmed that they had no complaints and that they were confident that any complaints would be acted upon. A resident said; “I would speak to Antonia or Yvonne if I had a complaint, I know they would deal with any issues” and another reported; “the staff are on the mark and would deal with any issues.” The home had developed policies for ‘Abuse’; ‘Whistle blowing’ and ‘The Management of Service Users’ Money and Financial Affairs’, to provide guidance to staff and to safeguard the interests of residents. A copy of the local adult protection procedures could not be located on the day of the visit. Some staff had completed abuse training during their employment at the home and staff spoken to demonstrated a good understanding of the different types of abuse and their duty of care to protect the people living in the home from abuse. The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 12 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 standard(s) 19 and 26 Some parts of the home were in need of repair / refurbishment, to ensure residents benefit from safe, clean and comfortable surroundings. EVIDENCE: Despite a requirement at the last two inspections, a tap in a bathroom was still missing, no planned programme of routine maintenance had been developed and pre-set valves had not been fitted to all water outlets. The external fire escape was badly corroded and metal parts had broken away from the structure. Furthermore, some parts of the brickwork securing the fire escape had cracked. Other general maintenance work that needed action included; a broken sash rope in a bedroom, a hole in a corridor ceiling and a loose bath panel. Some communal carpets were threadbare in places. This created a poor first impression of the home. Four bedrooms viewed were also in need of attention. A bedroom floor had started to collapse beneath the carpet and another bedroom had uneven carpet that presented a trip hazard. Additionally, one bedroom carpet was badly stained and another room had an offensive smell. Some areas of the home were full of clutter and untidy.
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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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 There were insufficient domestic hours in place, to ensure the home was maintained in a clean, tidy and hygienic state. The procedures for the recruitment of staff remained poor and did not safeguard the people living in the home. Staff had not received all the necessary induction training, to ensure competency in their role. EVIDENCE: Inspection of rotas and direct observation confirmed that three care staff were on duty during the day, with two waking night staff during the night. The manager worked flexi-time, according to the needs of the service. Despite a requirement at the last inspection, domestic hours had not increased and some areas of the home were still not in a clean or tidy state. Residents complimented the standard of care they received. Comments included “the staff are very kind, helpful and friendly” and “the staff treat me exceptionally well, they are very caring.” One member of staff had commenced employment at the home since the last inspection without a Protection of Vulnerable Adults (POVA) check or a Criminal Record Bureau (CRB) certificate. Another file was also checked and this did not contain all the necessary pre-employment documentation. Staff spoken to and training records viewed confirmed that staff had access to a range of training and had completed a number of safe working practice courses. Although staff had completed the home’s induction programme, this did not meet the specification of the Training Organisation for Personal Social Services (TOPSS).
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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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34 and 38 There was no registered manager and limited arrangements were in place, to ensure the home was run in the best interests of service users. Some records were not available to safeguard the health, safety and welfare of residents. EVIDENCE: A new manager had been appointed and was in the process of applying for registration with the Commission. Despite a requirement at the last two inspections, the registered provider had not provided the Commission with a monthly Regulation 26 report. No residents’ meetings had taken place since 17/06/04 and the results of a service user survey in April 2005 were not available. The insurance and annual gas safety certificate was out-of-date. The fire alarm system had not been tested on a weekly basis and no fire risk assessment was in place. Some areas of practice had not been risk assessed as previously required. Visual checks and fire awareness training was not recorded.
The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x 2 2 x x x 2 The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 16 yes Are there any outstanding requirements from the last inspection? 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 2 Regulation 5 Requirement Each service user must have a copy of their agreed and signed contract. (Previous timescale of 10/01/05 not met). Staff signatures must be recorded following administration of all medications / creams prescribed. (Previous timescale of 6/12/04 not met).. An action plan (including timescales) must be produced and a copy forwarded to the Commission to rectify the issues identified to the manager as requiring repair or refurbishment The absence of pre set valves to some hot water outlets must be risk assessed for each service user. Planned installation work must be prioritised according to the level of risk identified.. The home must ensure that sufficient staff are employed to maintain a good standard of cleanliness and hygiene.(Previous timescale of 6/12/04 not met). Staff employed from the 26th July 2004, must only be confirmed in post if full and satisfactory information has been
F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Timescale for action 1/08/2005 2. 9 13 1/07/2005 3. 19 23 1/07/2005 4. 19 13 1/07/2005 5. 27 18 1/08/2005 6. 29 19 1/07/2005 The Glade Version 1.30 Page 17 7. 29 19 8. 33 26 9. 34 25 10. 38 13 11. 12. 13. 38 38 23 13 obtained via a POVA check, a CRB has been applied for, two satisfactory written references have been received and the new employeee is supervised by an experienced staff for who the home has received full and satisfactory information / checks All staff records must be brought up-to-date to include all the documentation required under schedule 2 of the care home regulations. The Registered Provider must provide the Commission with a report on a monthly basis as required to comply with Regulation 26. (Previous timescale of 6/12/04 not met). . An up-to-date Certificate of Employers Liability Insurance certificate must be obtained and a copy forwarded to the Commission The Registered Manager must ensure all areas of practice are risk assessed and follow up any areas of concern.(Previous timescale of 21/2/2005 not met).. A gas safety certificate must be obtained and a copy forwarded to the Commission A fire risk assessment must be produced and a copy forwarded to the Commission 1/08/2005 1/08/2005 1/07/2005 1/08/2005 1/07/2005 1/08/2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 18 1. 2. 3. 4. 5. 7 18 30 33 38 6. 7. 8. 38 Service users should sign their care plans (where practicable), to confirm their agreement with the plan A copy of the local authority adult protection procedures should be obtained for the home. All new staff should complete an induction programme within six weeks, that meets the specification of the National Training Organisation. Quality assurance systems and practice should be further developed to ensure the home is run in the best interests of residents. Visual checks and records should be undertaken/ maintained for the emergency lighting and fire extinguishers at intervals recommended by the fire officer.. Night staff should receive fire instruction refresher training every three months and day staff every six months and records maintained.. The Glade F53 F03 S5322 The Glade V226408 010605 Stage 2.doc Version 1.30 Page 19 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor, Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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