CARE HOMES FOR OLDER PEOPLE
The Homestead 6 Elwyn Road Exmouth Devon EX8 2EL Lead Inspector
Anita Sutcliffe Unannounced Inspection 12:00 23 . February 2006
rd 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 Homestead DS0000022056.V273916.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 Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Homestead Address 6 Elwyn Road Exmouth Devon EX8 2EL 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) 01395 263778 01395 273371 Homestead Homes Ltd Mrs Hazel Joan Neville Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24), Physical disability over 65 years of age of places (24) The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th September 2005 Brief Description of the Service: The Homestead is a detached Edwardian house set in large well kept gardens in a residential area of Exmouth close to shops and all local facilities. Accommodation is provided in 18 single bedrooms, 15 of which have en suite facilities, and 3 double bedrooms with en suite facilities. There are 2 lounges, and a dining room. One of the lounges provides day care facilities for residents and people who live elsewhere and visit the home for the day. There is also a small quiet sitting area plus a large entrance conservatory with a couple of chairs where some service users enjoy sitting. The home provides personal care for up to 24 older people who may also have a physical disability. There are waking staff on duty at night. The home places a high priority in providing a wide range of activities and outings to suit all interests. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection began at 12 midday and lasted 3 hours. Several key standards were inspected. Long conversation was held with two service users (residents) and many were met. Discussion was held with all staff on duty plus the manager. Most of the home was visited including the laundry, which is located outside. Medication was looked at in some detail and information about staff training obtained from the home’s records and staff. CSCI information about the inspection, which includes details on how to contact the Commission, were left at the home. What the service does well: What has improved since the last inspection? What they could do better:
The home handles medication in a conscientious and meticulous way. However, because of a change in the paperwork provided by their pharmacy, and because prescribed items have taken longer to arrive than expected, they have changed practice which might increase the likelihood of error. They intend to correct this as a priority. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 6 The location of the laundry makes hygienic management difficult and there are plans to change this. Staff were knowledgeable about how to handle laundry safely. 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 Homestead DS0000022056.V273916.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 Homestead DS0000022056.V273916.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): Not inspected on this occasion. EVIDENCE: The Homestead DS0000022056.V273916.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): 9 The system used for the recording and storage of medicine to be administered to the residents was diligently managed but steps should be taken to further ensure safety. EVIDENCE: Residents are able to look after their own medicines if they wish and are supported to do so. Medicines administered by the home are securely stored, records neatly kept and staff trained in administration. However, because delivery is weekly, and the accompanying record sheet has insufficient space, the home has stopped recording that they have checked the medicines into the home, which is a precaution against error. In one case a medicine had arrived without a printed label, and their hand transcribed information was unchecked by a second member of staff for accuracy, and where a cream had not been delivered for a resident staff had used that prescribed for another. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 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 the following standard(s): 14 Residents are supported to have a fulfilled life in the manner that they themselves choose. EVIDENCE: Residents are involved in decision making at the home. Recently they chose a colour scheme and paintings for the home. Individual bedrooms are decorated to their choice and contain their own furnishings and fittings. Hobbies, interests and personal items make each bedroom an individual and unique living space. Residents confirmed that they are supported to live a lifestyle that suits them and are consulted regarding every aspect of their care. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 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 the following standard(s): Not inspected on this occasion. EVIDENCE: The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 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 the following standard(s): 19 & 26 The home is well maintained, safe, comfortable, and meets current residents needs. Hygiene and cleanliness are well managed in a less than ideal situation. EVIDENCE: Residents expressed their complete satisfaction with the home, and their bedrooms reflect individual style and taste. The home is well maintained, contains quality fittings and furnishings, warm, light and comfortable. Adaptations, which help residents maintain their independence, do not impact on the homely environment. The home has introduced a method whereby a resident may leave their door open if they wish, without compromising fire safety. The grounds are attractive and can be viewed from many parts of the home. A resident confirmed that they are well used in the warmer weather.
The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 13 Staff have to leave the main building to get to the laundry, which involved a walk in the snow on the day of the inspection. Hand washing is in the main building not the laundry itself. Changes are already planned which will much improve this arrangement. Laundry equipment is of a commercial standard and suitable for its required use. Staff are fully aware of hygienic practice and confirmed that they are able to achieve this. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 14 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): 28 & 30 Residents benefit from staff who are trained competent in their work, but this will be further assured as more achieve qualifications in care. EVIDENCE: Residents said they had confidence in the staff. Staff talked of the different training they have received and that which is planned for the near future, which will keep them informed and updated. An assessor for the NVQ qualification in care visited during the inspection; six care staff are currently undertaking this and five have completed it. The qualification ensures a certain standard of competence. When all complete the home will have exceeded the 50 considered the minimum necessary at this time under the national standard. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 15 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 & 32 Residents’ benefit from a home in which is professionally run. The home has a culture of friendliness and cooperation. EVIDENCE: The manager succeeds in achieving high standards through her leadership, and with support from the owner/providers. Residents know her well and feel she does a very good job. She is close to completing the Registered Managers’ Award, which sets a standard of competence. She also undertakes regular training in the provision of care and health and safety, consults with residents and staff, and empowers all at the home, which helps to make it a happy environment. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 16 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X X The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? Not applicable 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 21/02/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. [This refers to: - the use of an ointment by a person to whom it was not prescribed - no record that medicines are checked into the home] Requirement 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. 1. Refer to Standard OP9 OP28 Good Practice Recommendations It is recommended that hand transcribed information on the medication chart is checked and signed by two staff. The home should achieve 50 of staff qualified to NVQ level 2 or equivalent at the earliest opportunity. The Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Homestead DS0000022056.V273916.R01.S.doc Version 5.1 Page 19 - 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!
