CARE HOMES FOR OLDER PEOPLE
Homestead (The) 101 West Bay Road Bridport Dorset DT6 4AY Lead Inspector
Amanda Porter Key Unannounced Inspection 15th May 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Homestead (The) DS0000026822.V336861.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. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Homestead (The) Address 101 West Bay Road Bridport Dorset DT6 4AY 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) 01308 423338 SAME adrianbutler@hstead.eclipse.co.uk Mr Adrian Charles Winslow Butler Mrs Susan Patricia Butler Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: The Homestead residential care home is registered to provide care and accommodation to a maximum of 13 older people over the age of 65 years. The home is owned and managed by Susan and Adrian Butler, who live on the premises with their family and occupy a private flat on the 2nd floor. The Homestead is situated halfway between the Market town of Bridport and the seaside resort of West Bay, approximately 1 mile from both places. The accommodation for residents is arranged over two floors in a substantial Georgian building. There is no passenger lift and therefore the home mainly accommodates people who retain sufficient mobility to manage stairs and/or manage to use the stair-lift. There are 11 single and one double bedroom. The Homestead is a pre-existing home (prior to implementation of National Minimum Standards) with 7 bedrooms providing space above 10 square metres and 5 with less than 10 square metres. There are bathing and toilet facilities on both floors and 4 single and the 1 double room have en suite toilet facilities. Communal rooms comprise a ground floor lounge and dining room. The home has a sunny and attractive ‘sensory’ garden to the front, with pleasant areas to sit, which is well used by service users in the warmer weather. The rear garden is steeply sloped, set to lawn with a vegetable patch, which is rarely used by service users due to inaccessibility. A parking area is available for visitors at the front of the house. The current fees range from £433 to £450. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 15th May 2007 over a period of approximately four hours. The purpose of the inspection was to review the requirements made in the last report and assess all of the key standards. The Registered Provider, Mrs Butler, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The home’s completed annual quality assurance assessment. • 4 comment cards completed by residents, 3 from relatives/advocates, 3 from GPs and 4 from a healthcare professional. All comments received were very positive and all those completing them appeared satisfied with the service. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Three residents and two members of staff were spoken with and asked their views on the service provided at the home. Comments received in comment cards and through discussion included: “The service is good, plenty of help.” “The staff are all very good.” “I doubt if the majority of people at the home choose to be here. That said the home do their very best to make life comfortable and acceptable.” “Staff have great respect for all the people who live there.” All the staff and residents were welcoming and helpful. The home was accommodating 10 residents at the time of inspection. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 6 What the service does well:
The home continues to provide a homely and comfortable atmosphere in which to live. Residents are cared for by well-trained and experienced staff. Residents say that staff are very kind and considerate and their privacy and dignity is respected at all times. The home carries out assessments prior to residents moving in and this includes finding out about social interests, hobbies as well as health and personal needs. Assurances are given that individual needs can be met. Residents’ health needs are well met by the home and community health professionals. Medication is well handled at the home to promote the health and well being of residents. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. The complaints and quality assurance procedures reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The house and gardens are maintained to provide residents with a comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. The home has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. Mrs Butler manages her home very well and she is supported by very competent and committed staff who ensure the home is run in the best interests of the residents living there. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at the home. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. Homestead (The) DS0000026822.V336861.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 Homestead (The) DS0000026822.V336861.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. Prospective residents are encouraged to visit the home to help them when choosing where to live. EVIDENCE: Care documentation reviewed showed that pre-admission assessments were thorough and that information gained at that time was used to formulate a plan of care. Residents confirmed that they and their families were encouraged to visit the home before making a decision to move in. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place to make sure that staff have the information they need to meet residents needs. The health needs of the residents are well met with evidence of good support from community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy upheld. EVIDENCE: The care documentation for two residents was reviewed. Since the last inspection the home has introduced a new set of documentation. Files contained a variety of assessments including:
Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 11 • • • • Moving and handling Risk of falls Environmental risks Nutrition. Information from the assessments was used to formulate plans of care. Comprehensive care plans were in place. They were easy to read, to the point and informative. They clearly set out individual care needs and how they are to be met. Residents and/or their chosen representatives were invited to be involved in drawing up care plans, which were reviewed regularly. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, the district nurse, chiropodists, opticians and dentists. Health professional commented: “With relation to my occasional interventions with residents the staff’s knowledge and interventions have always been very good.” “I am always made to feel welcome and given advice is usually acted upon and information is fed back.” Records and stocks of medication in the home evidence good practice and medication is managed in accordance with legal requirements. Comments received from residents and their relatives/visitors confirmed that staff treated them with respect and were supportive and kind. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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. 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. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. There is a sense of homeliness and inclusion of family and friends in life at the Homestead. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Residents spoken with said that they were “free to make decisions about how they spent their days” and they were happy with the lifestyle that living at the Homestead afforded them. Some chose to spend time on their own, pursuing individual hobbies and interests, but knew they could join in with any organised activities if they so wished. Recent activities included: Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 13 • • • • • Trips out to places of interest. Birthday celebrations Dancing Bingo Gentle exercises. These activities are based on the preferences of the residents. One visitor commented: “Birthday/Festivals/Christmas are all special occasions. In summer my friend is frequently taken to enjoy the seaside and the country.” Pets are accommodated and can live with residents in their own rooms, if practical. Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. One visitor commented: “When you arrive at the Homestead the door is opened to you by a friendly member of staff and you are offered a cup of tea or coffee.” All residents spoken with confirmed they enjoyed the food provided. Records showed that residents’ likes and dislikes with regard to food were known and residents were aware that alternatives to the main menu were always available. A record of what residents have eaten is maintained. Since the last inspection the Registered Manager has reviewed the menus and mealtime arrangements and reported in the annual quality assurance assessment of the home: “Meals are better balanced, the atmosphere is more relaxed, unhurried and staff are more aware of need to give sensitive help and monitor food wastage. A new nutritional policy has been drawn up and new food preferences list for each resident is written and kept under review. Quality assurance questionnaires regarding food have been undertaken and the results put into practice. Hydration has been given a higher priority ensuring drinking water is actively encouraged between hot drinks. Fluid balance sheets are used if there are concerns about a resident’s fluid intake. There is also opportunity to try new foods and old favourites that have not been eaten for a long time are put on the menu.” Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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. 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. The home has a complaints procedure that enables service users and/or their representatives to address any concerns they might have. The policies and practices of the home ensure that service users are safeguarded from abuse or harm. EVIDENCE: All the residents spoken with during the inspection said that they would be able to talk to any of the staff about any concerns that they had and that the manager was “very approachable”. No complaints had been raised since the last inspection. The home had a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good providing residents with a homely and safe place to live. The home is kept clean and smells pleasant thereby making daily life for all in the home more pleasurable. EVIDENCE: The home has a programme of routine maintenance and the home provides a comfortable environment in which to live. Since the last inspection some areas of the home have been redecorated and refurbished. Although some radiators remain unguarded there are individual assessments for all residents in place to minimise potential risks of burns and scalds. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 16 All areas of the home were clean and there were no unpleasant odours. The laundry was well managed and adequate supplies of clean linen were seen to be available. Homestead (The) DS0000026822.V336861.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The deployment and number of available staff is sufficient to meet the needs of the residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are well trained and experienced and residents could be confident they would be well looked after. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. During the inspection call bells were answered promptly and residents commented that staff were on hand when they needed them. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care and over 50 of the care staff hold the minimum of a level 2 award in care. Records show that staff receive mandatory training on a regular basis. Staff spoken with during the inspection confirmed this. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 18 Three staff recruitment files were reviewed. The files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 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 run by a committed and competent manager/provider, who creates an open and positive atmosphere, which supports good care practices for residents. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents and relatives and the home is run in their best interests. Residents are assured of sound management of their financial interests. The health and safety of the service users and staff are protected by the policies and procedures followed at the home. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Butler, who is well supported by a loyal staff, manages the home effectively. Residents said that all the staff were very approachable and if they had any concerns they would be happy to talk to them knowing that they would be listened to. There is an effective quality assurance and quality monitoring system in place. The home takes steps to review its performance regularly and resident surveys are conducted and results analysed. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home’s record keeping is up to date and accurate. The Registered Manager has ensured that the Commission for Social Care inspection is kept informed of any changes at the Homestead. Records showed that most staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP29 Good Practice Recommendations A photograph of each member of staff should be kept in their personnel file. Homestead (The) DS0000026822.V336861.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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