Inspection on 26/10/06 for The Homestead

This inspection was carried out on 26th October 2006.

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

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

Other inspections for this house

The Homestead 28/05/09

The Homestead 15/05/07

The Homestead 15/05/06

The Homestead 09/03/06

The Homestead 27/10/05

The Homestead 18/03/05

The Homestead 27/09/04

The Homestead 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Homestead (The) 101 West Bay Road Bridport Dorset DT6 4AY Lead Inspector Sally Wernick Key Unannounced Inspection 10:15 26th October 2006 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 DS0000026822.V311738.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. DS0000026822.V311738.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 DS0000026822.V311738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 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. Fee range: £388-£450.00 See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx DS0000026822.V311738.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and began at 10.15am on Thursday 26 October 06. This was a ‘key inspection’ where the homes performance against the key National Minimum Standards was assessed alongside progress in meeting requirements made at the last inspection. A senior carer assisted the inspector, as did other members of care staff. The registered providers/manager were not present on the day of inspection. Methodology used included a tour of the premises, review of records and discussions with service users and staff. The inspector also reviewed the contact sheet for The Homestead and documentation submitted by the registered manager in response to requirements made at the last inspection. What the service does well: What has improved since the last inspection? The updated service user guide has been provided to all residents so that they are informed of the home’s philosophy, services, staff skills and knowledge and commitment to care services. The most recent inspection report is visible and available in the home’s foyer. Care plans are informative and care is delivered by staff in line with the assessed needs of residents. Requirements relating to the health and safety of residents have almost entirely been met and there is a complaints record in place. A programme of re-decoration has added to the comfort of residents at the home and there is a quality assurance system in place, which demonstrates that resident and stakeholder consultation has taken place. DS0000026822.V311738.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000026822.V311738.R01.S.doc Version 5.2 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 DS0000026822.V311738.R01.S.doc Version 5.2 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): 1, 3, 6 Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The current service user guide is comprehensive and provides all of the information about the care and services provided at the Homestead. Information provided about the home and an admissions procedure enables prospective residents to make informed decisions about admission and generally ensures that only service users whose needs can be met by the home are offered places there. The home does not provide intermediate care this standard does not therefore apply. DS0000026822.V311738.R01.S.doc Version 5.2 Page 9 EVIDENCE: The service user guide when viewed at the previous inspection required some updating. An amended copy has now been supplied to each service user and the information provided is both relevant and comprehensive. No new service users have moved into the home since the previous inspection. Care plans examined on that occasion demonstrated that assessments of need are undertaken prior to admission and that prospective residents are advised in writing that the home is able to meet their assessed need. Each service user is offered the opportunity to visit the home to meet staff and residents prior to making a decision about admission. There is also an initial four-week trial period. The Homestead does not provide intermediate care. DS0000026822.V311738.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement is made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care plans do generally allow staff, to have the information they need to satisfactorily meet residents needs but they do not yet demonstrate that the content is in accordance with service users wishes. The health needs of residents are well met with evidence of good support from a range of community health professionals. Medicine storage, handling and recording is properly carried out to ensure that residents receive medicines as prescribed. Residents are treated with respect and their privacy and dignity is promoted. DS0000026822.V311738.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three resident care files were examined and five residents were spoken to. Care plans were quite detailed providing information on how personal care needs were to be met and with instruction to staff. Information was included on moving and handling, areas of risk such as falling or accidents and for some resident’s personal preferences in their daily routine. The senior carer assisting with the inspection confirmed that care plans are in the main based on information obtained through assessment and specific health assessments were evident in some areas using professional guidance, for example in stroke therapy. Some residents at the Homestead do have communication difficulties and short-term memory loss. Staff has undertaken training in these areas and there was some evidence of how this knowledge had been translated into the provision of care for residents although in areas of communication this could be expanded further. Care plans whilst containing some information do not yet contain resident’s social histories or daily lifestyle preferences. It would benefit residents if the home were to consult service users and their families about their social and cultural interests and explore ways of how these might be further promoted within the home. None of the files examined contained recorded evidence of consultation with service users and/or their families although from discussion with staff and residents it is clear that there is good communication between staff, residents and the people who support them. In addition whilst care plans were kept under review this appeared to be on an ad-hoc basis and not as required on a monthly basis. Daily notes support and evidence the delivery of care to residents. These notes give a picture of the daily lives of residents, the care that is delivered to them by staff at the home and by visiting community health professionals such as Opticians, G.P’s and district nurses. Residents confirm that access to health care is promoted by staff that were described by two residents spoken to as “very kind”. It was evident from observation during the inspection that staff through their knowledge of the individuals they cared for are generally well informed. Records and stocks of medication in the home evidence good practice and medication is managed in accordance with legal requirements. DS0000026822.V311738.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people who use the service. Entertainment and some recreational activities are provided that enable residents to enjoy some of their leisure time. Residents are supported in maintaining contact with their friends, family and the community and they are helped to exercise choice and control over their lives promoting independence. A varied diet is provided and in sufficient quantity to achieve a satisfactory response from residents. EVIDENCE: Residents spoken with confirmed that they have a choice in all routines of daily living and confirmed there was some stimulation in the home. It was evident that there is a good relationship between staff and residents and there is a programme of activities each afternoon, which includes games “theme days” and use of the “memory box”. Family and friends are made welcome and are able to visit at times which are flexible. Where practicable residents are able to bring personal possessions into the home and are encouraged to manage their DS0000026822.V311738.R01.S.doc Version 5.2 Page 13 own affairs for as long as they are able to do so. Pets are accommodated and can live with residents in their rooms again if practical. Some residents within the home are increasing in frailty and short term memory loss. It is important therefore that the detailed plan of care contains social history and preferred lifestyle activities in order that stimulation at appropriate times may be offered. For some residents afternoon activities are not the most suited. Consideration should be given therefore to providing activities at a time when service users are able to be more receptive. A varied diet is provided and individual tastes can be accommodated at meal times. For example one resident prefers beans on toast for breakfast and staff tell me that efforts are made to provide residents with “what they fancy”. There is always a cooked lunch teatime offers a variety of snacks and sandwiches. Food is fresh and offers variety. Some residents choose to eat in the dining room although others prefer the privacy of their own rooms. DS0000026822.V311738.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. A system is in place to deal with any complaints that might be made about the home to ensure that concerns will be listened to and acted upon. There is a policy and procedure in place for the protection of vulnerable adults. EVIDENCE: A written complaints procedure is in place and is contained in the service user guide. In line with a recommendation made at the previous inspection there is now one record for complaints, which has space to include details of investigation and any action taken. A record of audit is also included. There is adult protection policy/procedure and staff records evidence that some staff has received relevant training including “No Secrets”. Staff, spoken to was aware of what action to take if concerns were expressed by or on behalf of residents. DS0000026822.V311738.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Recent investment in redecoration has improved the appearance of the home creating a more pleasant and safer environment for those living there. Some unguarded radiators however, continue to place residents at risk. The home is clean, pleasant and hygienic. EVIDENCE: In line with a requirement from the previous inspection a programme of works has been undertaken which has resulted in pre-set water valves being fitted and with radiators being guarded although there are still some that remain unguarded. Individual risk assessments have been undertaken for all residents and heating is monitored during night hours in order to ensure their safety and comfort. In a telephone call with the registered manager subsequent to the inspection Mrs Butler explained that some residents have requested that their DS0000026822.V311738.R01.S.doc Version 5.2 Page 16 radiators remain unguarded this information has now been included in care plans and will be reviewed at the next inspection. The programme of refurbishment is evident rooms were bright, well decorated and comfortable. The home was clean and pleasant throughout and it is clear that staff work hard in order to achieve this good standard. DS0000026822.V311738.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The home employs sufficient staff to ensure the needs of residents can be satisfactorily met. Staff records were available but did not contain the necessary police checks. The owners and staff at the Homestead are committed to a programme of formal training designed to improve their knowledge and skills for the benefit of people living at the home EVIDENCE: Staffing ratios at the Homestead are sufficient to meet resident’s needs and staff, are seen as kind and patient. There were three members of staff on duty on the day of the inspection the senior carer confirmed that this is normal practice. A comprehensive programme of training is implemented and a training folder evidenced completed training for all members of staff. Staff themselves commented that the training was excellent and felt that they were afforded many learning opportunities both for the benefit of themselves and service users. Over 50 of the staff group have completed NVQ 2 and above. DS0000026822.V311738.R01.S.doc Version 5.2 Page 18 The Registered manager was not at the home on the day of the inspection and although staff records were available these were not complete and did not contain the necessary police checks. Similarly whilst the recruitment and selection procedure for staff within the home included written application and references they did not appear to contain full employment histories or detail gaps in employment. Staff spoken to confirmed that CRB checks are requested. The Registered Manager is required to write to commission for social care confirming that all documentation is in place and that this will be evidenced during the next inspection. DS0000026822.V311738.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The registered manager is experienced in care and provides clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. Some quality assurance methods were available on the day of inspection and there appeared to be an on-gong review of aims and outcomes for service users. Resident’s financial interests are safeguarded. The home generally follows practices that promote and safeguard the health, safety and welfare of service users not all recording systems however are fully implemented. DS0000026822.V311738.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Butler has achieved the Registered Managers Award; she is experienced in care and also undertakes up to date vocational training alongside other members of staff. There was evidence in the home through questionnaires and charts of outcomes that the home does have a quality assurance programme in place and that this includes consultation with residents, supporters and stakeholders. As the registered manager was not available on the day of inspection however it was not possible to discuss this with her further. Again this will be more fully reviewed at the next inspection. The senior carer who assisted the inspector was of the opinion that the home does not have responsibility for resident’s finances. Friends, relatives or advocates support those that are unwilling or unable to handle their own affairs. The home in line with regulation does inform CSCI of any significant events within the home such as a death or outbreak of illness. However this should also include any event, which adversely affects the well-being or safety of any service user. The home is advised to consult the guidance on Regulation 37 which, can be found at www.csci.org.uk Examination of records at the previous inspection evidenced that records and testing of fire and electrical equipment was in place. Staff records on this occasion demonstrated that all staff has undertaken instruction in fire training and that a full range of Health and Safety training is in place. The Health and Safety of residents remains compromised however by the current heating system. A requirement for this has been made under standard 25. DS0000026822.V311738.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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 DS0000026822.V311738.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Service users must be consulted with regard to decision-making, processes of assessment and care planning. Where it may not be possible to fully consult relevant parties a note to that effect should be made in the care record. (Repeated from previous inspection failure to meet this requirement on the next occasion will result in enforcement action). Care plans must be reviewed at least once a month and updated to ensure that they reflect the changing needs of service users. The registered persons must demonstrate that they have consulted service users and their supporters about their individual social and cultural interests and make arrangements for them to engage in individual, social and community activities. Service users must be consulted about the programme of activities arranged by the home, which must then provide planned social care that meets assessed need. DS0000026822.V311738.R01.S.doc Timescale for action 1. OP7 15 26/12/06 2. OP7 15 26/12/06 3. OP12 16 26/12/06 Version 5.2 Page 23 4. OP25 13 5. OP37 37 Where radiators do not have low temperature surfaces steps must be taken to ensure that each are guarded. This is necessary to ensure that risks to residents are eliminated. (Failure to meet this requirement which has been repeated from previous inspections will result in enforcement action.) The home must give notice to the Commission of any significant events affecting residents. These must include serious falls and associated injuries. 26/12/06 26/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000026822.V311738.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000026822.V311738.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!