CARE HOMES FOR OLDER PEOPLE
The Leys 63 Booth Rise Boothville Northampton Northants NN3 6HP Lead Inspector
Helen Abel Unannounced Inspection 6th February 2008 10:45 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 Leys DS0000012843.V357628.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. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Leys Address 63 Booth Rise Boothville Northampton Northants NN3 6HP 01604 642030 01604 670028 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) Mrs Sheila Samuels Mrs Carolyn Melva Shiers Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18), Physical disability over 65 years of age (2) of places The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. The home limits its services to the following Service User Categories No person falling within the category OP can be admitted where there are 18 persons of category OP already in the home. No person falling in the category PD (E) can be admitted where there are 2 persons of category PD (E) already in the home Total number of Service Users in the home must not exceed 18 To enable the home to admit persons who are in the category old age (OP) To limit the number of persons to be admitted under the category OP To limit the number of persons to be admitted under the category PD (E) To limit the number of persons accommodated in the home Date of last inspection 28th September 2007 Brief Description of the Service: The Leys is situated on the outskirts of Northampton, with good road access. The home offers single and shared room accommodation to 18 service users. The home has a large lounge and dining room, and a conservatory area. Two single bedrooms are situated on the first floor, accessed by stairs or a stair lift. The home has a large garden, which is accessible to residents. The weekly fees are up to £425pw. There are additional costs for individual expenditure such as hairdressing and private chiropody. A copy of current inspection report is displayed in the reception area. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting three people and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. People who live at The Leys prefer to be called “residents.” Planning for this visit included: examining the last two inspection reports and the improvements plan raised from this last inspection; assessing the report from the CSCI Pharmacist Inspectors recent visit to the home; and assessing the service history of the home including the reporting of significant events. The CSCI has not received the Annual Quality Assurance Assessment although two reminder letters have been sent. This was an unannounced Inspection. The Inspection started at 10.45 in the morning and lasted over five hours. The home’s registered manager arrived shortly after the Inspector and assisted with the inspection process. The visit included a selected tour of the building, inspection of records and indirect observation of care practices, and the serving food at a mealtime. The Inspectors spoke with five residents two visitors, members of staff and the registered manager. The quality rating for this service is 0 star. This means the residents who use this service experience poor quality outcomes What the service does well:
Residents receive varied and nutritious meals. Weekly menus are displayed in the reception area with other key information about the home including the current CSCI inspection report. Residents can take part in regular cooking sessions. Residents spoke of playing board games and planning trips out. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 6 Resident’s benefit from a generally comfortable living environment. There is a light bright airy dinning area and the lounge faces the back garden with good views. What has improved since the last inspection? What they could do better:
Review and update all care plans and risk assessments to ensure they are sufficiently detailed to enable staff to fully care for individual residents personal, cultural, health and social care needs. Review and record all resident’s interests, and take account of their wishes and feelings around daily life and social activities. This would ensure all residents recreational preferences can be fully considered and met. Provide improved cleaning programmes (in identified areas) to ensure residents surroundings are kept clean and free from unpleasant odours. Ensure staff are confirmed in post following on the required checks have been carried out. This is to provide a safe environment for vulnerable adults. An Immediate Requirement was made around this aspect.
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 7 Produce, and action a staff training and development programme. This would ensure trained and competent staff cares for, residents. Training to be included- Record keeping for care plans. This would ensure staff understand why and how best to record information on residents care plans. The registered provider and registered manager to review operations, and ensure The Leys is promoting and providing proper provision for the health and welfare of all the residents. To draw up an action plan of roles and responsibilities around for example -Staff Recruitment, Record Keeping. These steps would enable managers to identify areas for improvements and recognise and manage them well. The codes on medication records should be followed and completed properly, and the identified resident who self medicates should sign their risk assessments to do so. This would improve medication record keeping and protect resident’s care. To update the homes complaints procedure and include the name and address and telephone number of the CSCI. A summary of the arrangements made for dealing with complaints should be included in the Statement of Purpose. This would ensure anyone wishing to complain has the correct information to do so. To ensure all residents requests, suggestions and views are following through from residents meetings and the outcome be clearly recorded. This would confirm resident’s views are taken seriously and the home is run in the best interests of the residents. It is recommended staff meetings and staff supervision meetings are re-established to ensure staff are appropriately supervised and residents needs are being met. 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. The Leys DS0000012843.V357628.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 The Leys DS0000012843.V357628.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): 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good admissions procedures to the home. EVIDENCE: The service user guide and statement of purpose is in the process of being updated and printed and will be in place by the end of February 2008. A colour brochure is currently available to prospective residents. A notice board is in the reception area and displays the current inspection report and other information. The registered manager carries out assessments for people who might like to come and live in the home to find out about their care needs and whether the staff will be able to support them. Resident’s contracts have been updated by
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 10 the registered manager and confirm the fees to pay and terms and conditions of the home. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. Residents health and care needs are not well looked after, however care around medication is better ensuring residents are protected. EVIDENCE: A resident told the Inspector they had not been bathed for some time. Care records indicated over two weeks ago, but the registered manager confirmed the resident had been bathed the previous week but this was not recorded. The same residents’ hair was grubby and a relative visiting raised this with the registered manager. The registered manager spoke of all residents being strip washed in the morning but this wasn’t evident from any care records. Daily records gave little detail about the residents care. Some care plans were not completed with
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 12 risk assessments, monthly reviews and regular recording of weighing programmes. The same aspect around poor record keeping was evident at the previous inspection in September 2007. A resident told the Inspector of feeling “a bit embarrassed” about the toileting programme and the bedroom door being opened and closed whilst using the commode. The registered manager agreed to look into this. General health records lacked detail and some aspects of care were not recorded although the registered manager gave clear reports of developments with health practitioners for individual residents. The registered manager confirmed all the residents had been transferred over to one doctor’s surgery but had not consulted with the individual residents around their wishes and preferences around the choice of a doctor. The Pharmacist Inspector visited the home in October 2007 and assessed the management of medication in the home and requested improvements. Medication records were in good order and well organised. The registered manager undertakes regular audits of medication across all aspects of medication administration. The registered manager confirmed her intention to meet with the residents GP practice to go through each resident’s medication records. This would give the manager and her team a better understanding of all resident’s medicines. New medication policies and procedures are now in place to protect residents. The Inspector recommended the codes on medication records are completed properly, and residents who self medicate should sign their consent to do so. This would further protect resident’s care. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. The residents report the food is good quality and well presented and receive a satisfactory lifestyle in the home. EVIDENCE: Residents told the Inspector, “ I do cooking activities with the staff, went to the theatre recently to see Dad’s Army, and have been to Tesco’s with staff.” “Its nice here but a bit monotonous.” “ I would like to go for a walk around the park but no-one takes me. It’s a bit boring here.” “We play horsey horsey, quiz and various board games.” Some residents were observed watching television in the lounge, and reading magazines and others were in the conservatory overlooking the large garden
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 14 area. One resident had gone out with a family member. A visitor told the Inspector, “I am made welcome whenever I came to the home.” Residents had suggested activities and written plans were in place but development and progress of these plans was not always evident. New menus were displayed in the reception area and the cook confirmed she asked the residents for feedback from meals served and is planning more varied menus around their comments. All residents spoken with were very happy with the meals provided and made the following comments: “ Very nice food, better meals.” “ Lovely menus. We had pancakes for pancake day.” “ The cook is very good, lovely.” The registered manager confirmed a move towards providing a more varied diet with fresh fruit each day. The Inspector sampled a freshly cooked pudding and found this to be very tasty and enjoyable. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents concerns are not taken seriously and acted upon. EVIDENCE: A visitor was overheard raising a concern with the manager. The registered manager didn’t appear to listen and take this seriously, or see the need to improve the quality of life for the individual. Complaints procedures remain in the process of being updated. Training around Adult Abuse and associated policies and procedures will be inspected at the next inspection. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 16 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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable living environment with some improvements needed around aspects of hygiene. EVIDENCE: During the visit, the Inspector looked around some parts of the home. A sample of bedrooms, bathrooms and toilets were checked. The downstairs areas viewed were clean and tidy and well organised. New lounge chairs are to arrive at the end of February and some residents were overhead talking about the new chairs arriving. The whole of the upstairs area smelt unpleasant this was reported to the registered manager on the day of the visit. Residents told the Inspector they felt comfortable in the home and had what they needed in
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 17 their bedrooms. The outdoors area appeared well maintained with rear mature garden with trees and border plants. There are systems in place for making sure laundry is done efficiently. Staff told the Inspector about safety precautions for controlling the spread of infection, and there are procedures in the home to make sure that staff work safely. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Residents are not protected by the home’s recruitment processes. EVIDENCE: Residents gave a range of comments about the staff that cared for them: “ Very good staff” “ Some of the staff are better than others.” “ Very nice, good staff.” “ Mediocre staff” “ I speak to the manager, she is a good women” The Inspector checked a sample of staff records. These showed that staff were not recruited properly and that the registered manager did not ensure checks are carried out so that she can be confident that staff are safe to work with residents – such as POVA and Criminal Record Bureau checks. The Inspector made an Immediate Requirements around this aspect. Staff are receiving training around POVA and have had booklets to complete to go with this training. Other staff spoken with did not comment on any recent
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 19 training being made available. The registered manager is looking into suitable First Aid Training; and to develop a staff training plan to identify new training to be provided and improve their ability to care for residents in the home. Currently training provided is limited and weak with areas not being identified and targeted. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 20 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): 31,32,32, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are receiving a deteriorating quality of service and are not adequately protected in this home. EVIDENCE: The registered manager runs the home in an open way. The training, development and supervision of staff inconsistent and staff lack leadership. Some residents felt the registered manager was difficult to talk with and are not always listened too. A visitor raised a concern with the manager upon the Inspectors visit. The registered manager didn’t appear to take this seriously or see the need to improve the quality of life for the individual resident.
The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 21 Attention is paid to making sure that residents meetings take place regularly. Resident’s views are asked about the running of the home and their responses recorded. But are not always followed through by staff ensuring the home is run in the best interests of the residents. For example residents had requested at a recent residents meeting specific meal requirements and another resident a change of room. When asked if this had happened, staff and managers didn’t know about the requests. Staff meetings and staff supervision meetings are not held regularly. The registered manager spoke of no one turning up for a staff meeting scheduled earlier on in the day prior to the Inspectors visit. It is recommended staff meetings and supervision meetings are re-established to ensure staff are appropriately supervised and residents needs are being met. Good quality assurance checks are carried out around medication practices. The homes Annual Quality Assurance Assessment (AQAA) has been requested twice with reminder letters, and additional time given to the registered manager for this to be returned to the Commission for Social Care Inspection (CSCI), but has not been provided. This document would provide a further picture of the outcomes for residents living at The Leys. The registered manager reported making many requests for support with carrying out recruitment and other administration duties with the registered provider. The registered provider had agreed to provide resources but this is not evident and the home is struggling to deliver a service. Maintaining good record keeping should be urgently reviewed together with the registered provider to ensure residents rights and best interests are safeguarded. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 22 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 3 3 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 x 3 2 2 x The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 12 Requirement Review and update all care plans and risk assessments to ensure they are sufficiently detailed to enable staff to fully care for individual residents personal, cultural, health and social care needs. This requirement remains outstanding from the last inspection. 2 OP12 12 Make proper provision for the health and welfare of residents. Review and record all residents’ interests, and take account of their wishes and feelings around daily life and social activities. This would ensure all residents recreational preferences can be fully considered and met. Provide improved cleaning programmes (in identified areas) to ensure residents surroundings are kept clean and free from unpleasant odours. Ensure staff are confirmed in post following on the required
DS0000012843.V357628.R01.S.doc Timescale for action 06/03/08 31/03/08 3 OP26 13 20/02/08 4 OP29 19 06/02/08 The Leys Version 5.2 Page 24 checks have been carried out. These include: POVA First/CRB Check, references, full employment history, suitability to work with vulnerable adults. This is to provide a safe environment for vulnerable adults. Immediate Requirement made on the day of inspection Produce, and action staff training and development programme. This would ensure trained and competent staff cares for residents. Training to include- Record keeping for care plans. This would ensure staff understand why and how best to record information on residents care plans. The registered provider and registered manager to review operations, and ensure The Leys is promoting and providing proper provision for the health and welfare of all the residents. To draw up an action plan of roles and responsibilities around for example -Staff Recruitment, Record Keeping. These steps would enable managers to identify areas for improvements recognise and manage them well. 5 OP30 18 31/03/08 6 OP31 12 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 25 No. 1. Refer to Standard OP9 Good Practice Recommendations The codes on medication records should be followed and completed properly, and the identified resident who self medicates should sign their risk assessments to do so. This would improve medication record keeping and protect resident’s care. To update the homes complaints procedure and include the name and address and telephone number of the Commissions for Social Care Inspection. A summary of the arrangements made for dealing with complaints should be included in the Statement of Purpose. This would ensure anyone wishing to complain has the correct information to do so. This recommendation remains outstanding from the last inspection. Provide First Aid training to key staff to ensure staff are trained and competent and residents remain safeguarded. This recommendation remains outstanding from the last inspection. To ensure all residents requests, suggestions and views are following through from residents meetings and the outcome be clearly recorded. This would confirm resident’s views are taken seriously and the home is run in the best interests of the residents. It is recommended staff meetings and staff supervision meetings are re-established to ensure staff are appropriately supervised and residents needs are being met. 2 OP16 3. OP30 4. OP32 5. OP36 The Leys DS0000012843.V357628.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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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