Inspection on 27/10/05 for The Homestead

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 26/10/06

The Homestead 15/05/06

The Homestead 09/03/06

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 Val Hope Unannounced Inspection 27th October 2005 10:00 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 Homestead (The) DS0000026822.V261675.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. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 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 adrian.butler@whsmithnet.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.V261675.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th March 2005 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. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on Thursday 27th October 2005 commencing at 10:30am. The proprietors Mr and Mrs Butler were away on holiday; the inspector was, very ably, assisted by the social care worker in charge of the home and care workers on duty during their absence. The inspector made contact through discussion, comment cards and telephone calls with residents, relatives and prospective relatives, their views and comments are reflected within this report. What the service does well: What has improved since the last inspection? What they could do better: Make efforts to ensure that the management of medication follows the guidance of the Royal Pharmaceutical Society and complies with The Care Homes Regulations 2001. Shortfalls were identified in fire precautionary measures. The interior of the property is in need of improvements designed to brighten, update and upgrade accommodation for the benefit of residents. Shortfalls were identified in maintenance and the standard of the décor and presentation. A number of requirements and recommendations have therefore been made. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 6 Comments received by the inspector included: “I could only rate this home at about 60 - the care is good but the presentation of the inside of the house completely lets it down – badly”; “It is dark and old fashioned and frankly quite shabby, but XX likes the owners and staff and wants to be close to family”; and “The place needs decorating!” 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. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 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 Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 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): 3, 5 and 6 Prior to admission, the needs of each prospective resident are assessed to ensure the home will be able to properly meet them. Prospective residents and/or their representatives are encouraged to visit the home in advance of admission to assist them in making an informed choice. The home does not provide intermediate care. EVIDENCE: Care plan files examined 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 needs. Residents reported that they had (where able) been invited to visit the home to see if they feel they may like to stay, initially on a trial basis. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 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): 7, 8, 9 & 10 Care plans are detailed and of a good standard ensuring staff have the information they need to satisfactorily meet resident’s needs. The health needs of residents are well met and good multi disciplinary working takes place on a regular basis promoting and maintaining (where possible) good health. Residents are respected and their right to privacy is supported. Procedures for managing medication do not meet the guidance of the Royal Pharmaceutical Society, potentially putting residents at risk. EVIDENCE: A sample of 4 care plans was examined. Every service user has a care plan, drawn up from a pre admission assessment. Care plans are comprehensive and were found to contain details of all health needs. The home was able to evidence that service users have access to health care services to meet assessed needs. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 10 Since the last inspection the home has provided a Controlled Drugs (CD) cupboard which is safely secured. Some shortfalls were identified in relation to medication issues. Medication Administration Records were examined. The records of one resident [identified to the home], was unable to demonstrate that medication had been administered as prescribed. In the seven days since the medication was received into the home [21/10/05], according to the records the 8am dosage, had been administered only once and the 4pm dosage had been administered on only two occasions. Details of another medicine [for the same resident], which was hand recorded, did not specify the number of tablets to be given twice daily @ 8am and 4pm and there was no record of the medicine being administered at 8am on 22nd October 2005. The administration record for one other resident also failed to demonstrate that a medicine had been administered, as prescribed on 21 and 22nd October. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 11 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 and 15 Social, cultural and recreational activities are dependent on individual preferences and the resident’s capacity for involvement. The activities provided by the home meets the expectations of residents. 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 reasonably varied diet is provided meals are served hot and in sufficient quantity to achieve a satisfactory vote from residents. EVIDENCE: Residents said that they have choice in all the routines of daily living. Residents said they go out regularly whenever they feel like it. Individual assessments for social needs have been recorded and a record of entertainment/activities is held. Residents said that their visitors are always made welcome and are offered refreshments. Residents said that they are not offered a positive choice for the main meal of the day, however, staff assured the inspector that where a resident did not want the main meal of the day an alternative would be provided. A number of the residents able to articulate a view on the provision of food described the meals as “edible”, “uninspiring”, “edible- nothing special” and “same week in week out really”. ” Further discussion with residents and staff, examination of Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 12 the record of food provided and a view of food stocks concluded that, overall, the food provision was deemed satisfactory. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 13 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): None of these standards were assessed on this occasion EVIDENCE: Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 14 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, 23, 24, 25 and 26 Safety is compromised due to shortfalls in fire precautionary measures, medication matters and low levels of lighting. The comfort and dignity of residents is compromised by the declining presentation of the accommodation. EVIDENCE: Shortfalls relating to fire precautionary measures [see standard 38] and medication issues [see standard 9] were identified. The home has not been subject to a programme of upgrade, redecoration or refurbishment for some time. Comments received by the inspector from residents and visitors to the home indicated that the level of satisfaction in relation to presentation of the accommodation is declining and an upgrade of the premises is expected in order that customers feel they will receive “value for money”. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 15 A number of areas in the home now need improvement/updating through a programme of repair, decoration and refurbishment [these have been identified in detail to the proprietors under separate cover]. Some ground floor areas would benefit from improved lighting levels for the benefit of residents with the propensity for failing eyesight. The recommended programme of fitting approved locks to bedroom doors and providing lockable storage facilities for valuables/medication prior to a room being re let after vacation is in place however progress is slow. Although risk assessments are in place in relation to hot radiators, some were found to be in excess of 61°C. The only protective measures in place, in some instances, was the use of furniture being placed in front of the radiator; not necessarily where occupants of the room would like the placing of furniture. A programme of fitting radiator guards should be implemented, with priority decided through resident preference and the risk assessment process. Overall, a good standard of cleanliness is achieved, however, in one area [identified to the home] a strong odour of stale urine was prevalent. Should shampoo of carpets and soft furnishings fail to eradicate offensive smells, it is the expectation of the Commission that the floor be treated and carpets and any soiled soft furnishings replaced. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 16 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 The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and the good condition of the premises. Procedures for the recruitment of staff are robust and designed to minimise the risk of unsuitable staff being employed EVIDENCE: There have been no changes in the staffing ratios. Service users said that they feel there are sufficient numbers of staff on duty and that staff were kind and patient. There has been a turnover in staff since the last inspection with 4 leaving and 4 new recruits made to the staff team. One new recruit described the induction process currently being undertaken. There were three members of staff on duty the morning of the inspection and the rota demonstrated that two staff were on duty at other times. During the absence of the proprietors there were two staff awake throughout the night. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 17 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): 38 Shortfalls identified in relation to fire precautionary measures, medication and issues around the environment have the potential to put residents at risk. EVIDENCE: The bolts on the front door must be removed or de-activated as this is a fire exit. The fire warning system had not been routinely tested at the required weekly frequency. The fire records were unable to evidence that all night staff had received fire training at the required quarterly intervals. The record of fire drills did not contain all the necessary information including time the drill took place, the time taken to complete the drill, the scenario of the fire and the record of the drill held prior to 20/8/05 was undated. Shortfalls relating to medication issues were identified [see standard 9]. Poor lighting levels have the potential to impact upon safety [see standard 25]. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 18 Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 19 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 x 17 x 18 x 1 x x x 3 2 1 2 STAFFING Standard No Score 27 3 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 20 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. 1 2 3 4 5 6 7 Standard OP9 OP9 OP19 OP19 OP25 OP26 OP26 Regulation 13[2] 13[2] 23[2][b] 23[2][b] 23[2][p] 13[3] 16[2][k] Requirement Medication records must be signed at the point of administration. Medication records must accurately record the prescribed dosage to be administered Extractor fans in en suite toilets must be thoroughly cleaned. The water damaged ceiling must be repaired and the décor made good. Improved lighting must be achieved in communal areas of the home. Toilet pans must be thoroughly cleaned and de-scaled. Offensive odours must be eradicated; where cleaning of carpets and soft furnishings does not achieve this, replacement must take place. Bolts on the front door of the house must be deactivated or removed. The fire warning system must be tested at the required weekly intervals. Night staff must receive fire training quarterly. DS0000026822.V261675.R01.S.doc Timescale for action 27/10/05 27/10/05 15/11/05 31/12/05 31/12/05 30/11/05 15/11/05 8 9 10 OP38 OP38 OP38 23[4][c] [iii] 23[4][d] 23[4][d] 27/10/05 27/10/05 27/10/05 Homestead (The) Version 5.0 Page 21 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 2 3 4 5 6 7 8 9 10 Refer to Standard OP19 OP19 OP19 OP19 OP19 OP19 OP19 OP19 OP19 OP19 Good Practice Recommendations The stair “knob” should be secured to the banister at the bottom of the stairs.. Two splash-back mirrors to be replaced. Peeling wallpaper should be satisfactorily repaired or rooms redecorated. Pipe-work in a number of areas in the house should be boxed in and the décor made good. Unsightly wiring should receive appropriate attention. Damaged flooring in en suites should be replaced with non-slip covering. Stained carpets should be cleaned. Stained bath in first floor bathroom should be repaired. The ground floor shower room should be subject to complete refurbishment and decoration. An assessment of the entire premises should be undertaken and recorded and a programme of redecoration and refurbishment produced. A programme of fitting the following upon vacation of each room :• • Lockable storage facilities; Approved bedroom door locks with a key provided to the service user unless a risk-assessment demonstrates otherwise. This is repeated from previous inspections. The programme of fitting radiator guards and pre set DS0000026822.V261675.R01.S.doc Version 5.0 Page 22 11 OP23 12 OP25 Homestead (The) valves which have fail safe devices fitted should be completed with priority given as a result of the risk assessment process. This is repeated from previous inspections. 13 OP38 The record of fire drills must contain the date, the time the drill took place, the time taken to complete the drill and the scenario of the fire. Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 23 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 Homestead (The) DS0000026822.V261675.R01.S.doc Version 5.0 Page 24 - 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. 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