CARE HOMES FOR OLDER PEOPLE
Glade, The 32 Lancaster Road Southport Merseyside PR8 2LE Lead Inspector
Margaret Van Schaick Unannounced Inspection 8th December 2005 09:00 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 Glade, The DS0000005322.V271104.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. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Glade, The Address 32 Lancaster Road Southport Merseyside PR8 2LE 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) 01704 566699 01704 569288 Mr David Winston Jackson Mrs Susan Jackson Ms Deborah Jane Lawrance Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 25 OP This service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection 1st June 2005 Date of last inspection 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 accommodation 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 is part of a small group of homes privately owned by Mr and Mrs Jackson and is managed by Antonia Gillette. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over three days and lasted 9 hours. This was the second unannounced inspection carried out this year as part of the regulatory requirement for care homes to be inspected at least twice a year. The Manager has just recently been appointed. As part of the inspection process most of the home was viewed. Care records and other nursing home records were inspected as part of the process. Discussion took place with the Owner, Manager, Deputy Manager and one to one interviews with two of the care staff. Several residents were also spoken with. Four residents were interviewed on a one to one basis and their views of the home and the care provided obtained. Three visitors were interviewed and their views of how the home was run and the care provided obtained also. What the service does well:
Without exception all of the residents spoken with in the home were complimentary about the staff. Residents stated that “staff are very good” and “everyone is very kind”. One of the residents stated, “staff are superb, it’s a superb place to be” and “staff are very approachable, all are”. Comments from the residents and relatives about the care received include “I’m happy with the care” and “my relative is well cared for and happy”. One relative stated, “ I am highly delighted and cannot recommend the home enough. Staff sit with mum when she is ill, it takes a lot of worry off my self and sister”. Relatives interviewed stated “staff listen to you if you have any concerns and always ring to report back following GP visits”. Families and residents interviewed confirmed various entertainments and activities are in place on a regular basis, which are enjoyed by the residents and visitors who wish to take part. Visitors to the home confirmed that visiting hours are flexible and staff welcome you always. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Individual contracts for residents must include a breakdown of fees payable and by whom. Staff signatures need to be evidenced for every occasion that medication is administered. An annual audit of the home needs to be carried out to identify and prioritise the improvements needed to ensure the home is well maintained. The external fire escape is in need of repair and discussion took place with the registered provider during the inspection visit to have an assessment of the repair/refurbishment required. This was arranged following the inspection visit and the registered provider informed the Commission that he has received a verbal report with regards to this. The registered provider is to provide the Commission with a written report and action plan as to how the fire escape is to be repaired. Staff induction needs to be improved to include a more structured and formalised training programme to ensure all meets with the National Training Organisation.
Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 7 The home is short of domestic hours and this was apparent during the inspection visit. The weekend cook has not been replaced and senior care staff were having to cook food at the weekends. This needs to be looked at and addressed as soon as possible. Following discussion with staff it is apparent that some feel staffing levels should be improved as they are concerned that, as quoted “we have a couple of residents who are very demanding”. Some of the residents at the home require a high level of input from care staff therefore their needs cannot be compromised. Due to the loss of domestic hours and the absence of a weekend cook this puts a burden on care staff, which needs to be addressed. One of the residents has a communication problem. This is highlighted in the care plan. Staff interviewed stated, “you have to be very patient and through using gestures and particular words are able to communicate at a basic level”. Although the dietician has been contacted with records confirming it, this resident is nutritionally compromised and needs an urgent weight measurement and further advice from health professionals as to how the home is to meet their needs. This resident also rings for attention regularly and appears to be isolated as their room is located well away from the general activity of the home. It is therefore necessary to review this residents needs and to communicate with the family as discussed with the Manager during this inspection visit and to try and locate a more suitable bedroom closer to the activity of the home where they may not feel so isolated. The practice of removing the call system from the bedroom by a member of staff must cease. A member of staff interviewed stated “We try to encourage this resident to go into the lounge but they like to spend most of their time in their bedroom”. The home needs to consult with the residents on a regular basis and have their views listened to and acted on where possible to ensure the home is run in the best interests of the residents. 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. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 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 Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 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): 2 Residents now have contracts in place but a breakdown of the fees payable needs to be evident to ensure all residents are aware of what services are included and identifies how the cost is met. EVIDENCE: Resident’s contracts are now being implemented and were viewed during the inspection, although as discussed the breakdown of fees needs to be included to ensure costs and how they are met are identified. Relatives interviewed confirmed they had a copy of the contract. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 10 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 Some care plans identified the resident’s signature to agree care. The care needs of the residents are generally well met although one resident still requires some further health professional input or their health may be compromised. Medication records are not always signed for which can put residents at risk. EVIDENCE: Care plans evidence some residents signatures to agree care and this must be developed to include all residents or their relatives where agreed. Residents and relatives interviewed stated “Mum was assessed at home prior to being admitted and is highly delighted with the care” and “care staff sit with my mum when she is ill”. Relatives also stated “we have discussed care and are always informed if there are any new issues”. One resident has more complex needs and requires the additional input of other health professionals to ensure all their needs are addressed and met. This was discussed with the Manager and further assistance has been identified as needing specialist input via the GP.
Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 11 Medication records evidence lack of staff signatures on occasions following administration of medication. The staff members responsible for this error need to be identified and retrained where necessary to prevent any resident from being put at risk. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 12 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): 14,15 Daily life and routine is flexible to suit the resident’s individual needs enabling personal choice where possible. Mealtimes are enjoyed in pleasant surroundings. The absence of a weekend cook is compromising the time senior staff are spending caring for the residents. EVIDENCE: Residents interviewed stated they are able to express their choices in how they live their lives in the home. Relatives interviewed stated “My mother and I were able to visit the home prior to admission and choose the bedroom” other residents interviewed commented on how “visitors are made welcome at any time and receive refreshments”. One resident stated she preferred to have female carers to attend to her needs and this is accommodated. There are various activities on in the home and residents interviewed confirmed they are able to join in where wished and go out on the regular mini bus outings weather permitting. Residents are encouraged to manage their own financial affairs where possible. Some of the residents have personalised their bedrooms with ornaments and photographs. One of the residents interviewed stated “I can get up whenever I wish or go to bed when wished, I just ring the care staff when I’m ready”. The menu was not on display due to recent decoration but this could be set up temporarily in the sitting room as discussed. Residents interviewed stated “food is excellent, good choice” and “food is very nice with plenty of choice, I
Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 13 have gained weight since I’ve been here”. The cook speaks with the residents on admission to identify their needs. Diets provided at present include diabetic diets and blended diets where needed. As discussed previously in this report one resident is nutritionally compromised and this is being addressed. Other residents are weighed on a regular basis. The home has no weekend cook at present and senior care staff are providing this service. This needs to be addressed as soon as possible so that care needs are not compromised. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 14 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): 18 The local authority adult protection procedure is now in place therefore this ensures staff are aware of the correct procedure to follow in the event of any suspicions or evidence of abuse. A specified residents account is to be opened at a local bank to ensure all monies held on behalf of any residents is secure. EVIDENCE: The local authority adult protection procedure is now in place. Staff employed at the home attends elder abuse training. A whistle blowing policy is in place. Discussion took place with the registered provider with regard to monies held on resident’s behalf. Since the inspection visit the registered provider has informed the commission that he has been in touch with a local bank to consider opening a residents account which will provide a secure place for residents monies where there is no alternative. Financial records will continue to be kept with individual records open to inspection. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 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): 19,26 Some parts of the home still require refurbishment and the external fire escape requires repair to ensure residents live in a safe environment. Some parts of the home lack regular cleaning and tidying, which can compromise resident’s safety. EVIDENCE: During the inspection visit it is apparent that some of the requirements made from the previous inspection have been actioned. The remaining pre set valves to be fitted to the hot water outlets on the top floor has yet to be carried out. The inspector raised the problem of frayed carpets on the staircase to the registered provider who advises that he has asked for quotes to be forwarded from carpeting firms for the downstairs public rooms and staircase. Flooring is due to be replaced in one of the bedrooms the following week. The external fire escape needs repair and the registered provider contacted the commission following the inspection visit to advise that the fire escape repairs
Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 16 has now been assessed and an action plan will follow to advise of repair programme. An external waste pipe at the rear of the building appears to be leaking. One of the toilet windows next to the rear fire escape has a rotten frame and needs replacing. The first floor bathroom next to room 19 is not used often. Staff interviewed thought a shower facility could be of more benefit to the residents. Bedroom 16’s carpet needs to be repaired as the join is separating and could cause a risk to residents. Bedroom 12 window restrictors require lowering to the left window. An internal and external audit needs to be carried out and a planned maintenance programme needs to be in place to ensure the home is maintained for the safety of residents. Some areas of the home were not as hygienic or tidy as they should be due to a shortage of domestic staff, which needs to be rectified as soon as possible to ensure resident’s health needs are not compromised. In particular the laundry and basement area. The rear garden has also full refuse bags, which need removing. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 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): 27,29 The home continues to have insufficient domestic staff in place to ensure a good standard of hygiene. Staff files need to be audited to ensure all staff employed at the home have the necessary pre employment requirements in place and training records need to be updated to ensure all staff employed attend the mandatory training required. EVIDENCE: The home has still not got sufficient domestic staff in post to ensure a good standard of hygiene and cleanliness is in place. The home has no weekend cook in place with senior staff taking on this role. This compromises the time spent caring for the residents and supervising junior staff in their role as carer. Not all staff files are up to date although the new member of staff appointed has pre employment details in place. An audit of staff files needs to be carried out to ensure all pre employment checks and records are in place. An assessment of individual staff training needs has to be carried out also. The induction programme set up by an external agency has been attended by new staff but a structured programme of formal induction with records kept needs to be put in place to ensure the induction training meets the required standards of the Training Organisation for Personal Social Services as discussed. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 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): 33,35,38 EVIDENCE: The registered provider has been providing the commission with the monthly Regulation 26 reports. Residents meetings have not yet been arranged. Residents and relatives interviewed were complimentary about the way the home was run and felt confident that the staffs were capable and caring. Resident’s comments included “staff are always approachable and I speak with them regularly”. One resident stated, “if I am worried, staff are there for me”. Relatives interviewed have completed satisfaction questionnaires in the past. Residents/relatives questionnaires have been completed with results available for inspection. The responses were positive in the majority. Staff meetings have been held and minutes are open to inspection.
Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 19 Requirements made from the previous inspection are being implemented although fire-training records are not yet completed. This needs to be looked at as a matter of priority as discussed with the Manager. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 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 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 21 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 OP2 Regulation 5 Requirement The registered provider must ensure that each residents contract includes a breakdown of fees payable and by whom. The registered Manager must ensure that the resident discussed have a full review of their health needs with specialist intervention provided where needed. Staff signatures must be recorded following administration of all medications / creams prescribed. (Previous timescale of 01/07/05 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/deputy Manager and published in this report as requiring repair or refurbishment The absence of pre set valves to some hot water outlets must continue to be installed and prioritised as discussed in the previous inspection visit of 01/07/05
DS0000005322.V271104.R01.S.doc Timescale for action 27/02/06 2 OP8 12 16/01/06 3 OP9 13 16/01/06 4 OP19 23 23/01/06 5 OP19 13 27/06/06 Glade, The Version 5.0 Page 22 6 OP27 18 7 OP29 19 8. OP30 18 9 OP33 24 10 OP38 13 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). The registered Manager must carry out an audit of all staff files to ensure all staff employed at the home has full and satisfactory pre employment checks as discussed, to include POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau Record) checks are in place and all Schedule 2 documentation. The registered Manager must ensure all staff training records are updated and staff employed at the home attends all mandatory training and other training thought to be of benefit to the residents of the home. The registered Manager must ensure there are qualitymonitoring systems in place to ensure resident’s views are sought and the home is run in their best interests. The registered Manager must ensure all staff have received fire safety training and that the staff induction training programme is set to meet the TOPSS training requirements as discussed. 06/02/06 06/02/06 06/02/06 06/02/06 16/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Glade, The Refer to Good Practice Recommendations
DS0000005322.V271104.R01.S.doc Version 5.0 Page 23 1 2 Standard OP7 OP8 3 4 5 OP15 OP19 OP22 6 7 OP26 OP35 The registered Manager should continue to have residents sign their care plans (where practicable), to confirm their agreement with the plan The registered Manager should ensure that the resident discussed has their psychological health monitored regularly and an alternative bedroom be made available if that is what they wish to ensure they are not isolated. The menu should be displayed in the sitting room area whilst the other public areas are being decorated. The collection of black bin bag rubbish should be cleared regularly from the rear garden. The registered Manager should ensure that all residents have access to the call bell system as discussed, in particular to stop the practice of removal of the call bell system by a member of staff. The laundry and basement area of the home should be kept tidy and clutter free. It is recommended for the registered provider to arrange to follow up his enquiries with regard to the safe keeping of residents monies as discussed. Glade, The DS0000005322.V271104.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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