CARE HOMES FOR OLDER PEOPLE
THE LIBERTY OF EARLEY HOUSE Strand Way Earley Reading RG6 4EA Lead Inspector
Yvonne Souden Unannounced 23 May 2005, 10.30 am 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 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 LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Liberty of Earley House Address Strand Way, Earley, Reading, Berks, RG6 4EA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0118 9751905 Trustees of Liberty of Earley House Mrs Penelope Anne Smith Care Home (CRH) 35 Category(ies) of Old age, not falling within any other category registration, with number of places THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 29 November 2004 Brief Description of the Service: The Liberty of Earley House is a residential care home owned by the Earley Charity, and as a care home is unique in the accommodation provided. The home is a two storey purpose build with a communual lounge, dining room and various seating arrangments on each floor, with a hairdressing room on the first floor; a lift is available to the first floor. Residents accommodation is within 29 individual flats and bedsits, the majority are flats, and accommodate up to 35 people aged 65 or over. There is an attractive courtyard garden with mature plants and seating arranged to provide privacy; the gardens are level and easily accessible. Two of the charity’s admission criteria is that on admission the prospective resident is able to live independantly and that people from the Earley catchment area are given first priority. Public transport is available, and local shops are within a five minute drive; the towns of Reading and Wokingham are within a twenty minute drive. THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Monday from 10:30 to 18:00 by Yvonne Souden and Stuart Mynott; not all standards were assessed. About 70 of the inspection was spent assessing the environment, talking to residents individually and in groups, talking to staff and management and general observation of care practice; the remaining time was spent assessing care plans and other records. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 7 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 standard(s) 1 & 3 Service users are informed of the homes aims and objectives but management do not strictly ensure informed is available on the needs of the service user prior to their admission. EVIDENCE: The home reviewed its statement of purpose and service users guide in March 2004 both were observed to be informative detailing the history of the Earley Charity and of the homes aims and objectives. The service users guide is in a format that is suitable to the current service users. The inspector viewed the records of three service users; records show that a needs assessment had been obtained from the care manager of a service user whilst the service user was receiving respite care, and that this had been updated at each consecutive visit, however on agreement of a permanent placement a full updated needs assessment had not been obtained, and the homes needs assessment was not fully completed with the information required as detailed within standard 3.3. Information required within a full needs assessment was split between various documentation and was therefore not user friendly.
THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 8 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 standard(s) 7, 8, 9, 10 Staff respect service users and service users are involved and informed of their care plan. The health care needs of the service users are met; but care plans and risk assessments do not strictly identify the needs of the service user and associated risks. Safe practice on the administration of medication is not strictly adhered to. EVIDENCE: Some documentation on file and discussions with service user and staff evident that the health care needs of the service users are met and that policies and procedures are in place to support service users in the administration of their medication, and ensure they are involved in the monthly review of their care plans. Observation of staff and service user interaction demonstrated that staff respect the privacy of the service user, and service user accommodation ensures they have privacy with their visitors. As quoted by some service users “we have a review every month and it starts off, how’s your health”, “we have a keyworker and she’s very good, I just have to say what I want and she does it” and “when I came here they got the optician and I was prescribed glasses”.
THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 9 Care plans and risk assessments were not concise, did not distinguish between the identified need of the service user and action plan to meet those needs, and crucial information on the needs of one service user was not evident within their care plan. Individual service user risk assessments did not fully detail the risk or action plan to minimise risk but contained information that would be more appropriately detailed within a plan of care. Staff have received training on the administration of medication and records matched stock in place. The home administers analgesic medication to service users as prescribed by the G.P and as detailed on a homely remedy list that is not individual to the service user or reviewed regularly by the G.P. the inspector was informed that the controlled drugs procedure was not strictly followed so as to support the independence of a service user, however documented authorisation from the service user’s G.P was not in place. THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 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 standard(s) 12, 13 14 & 15 Service users are given every opportunity to maintain their independence and maintain links with family, friends and the local community. A fulfilled activities programme and excellent menu plan is in place. EVIDENCE: The homes programme of activities meets the needs of the service users, evident from discussions with service users and observation of activities taking place. A service user spoke of attending a local church and of a minister who visits the home regularly, and another service user spoke of a visiting library. The home has links with the community for example a group from a local school were visiting on the day of the inspection to complete a six-week project with service users called ‘The Importance of Being Me’ and the inspector was informed that service users visit the school to participate in art and craft with the local senior school children. Meals are of an excellent standard; fresh vegetables are used and the menu plan offers two choices within the main meal, and if this is not to the taste of the service user a further three choices are given. Snacks and fresh fruit are freely available to the service users and safety procedures within food and hygiene are followed.
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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 standard(s) Standards 16 to 18 not assessed at this inspection. EVIDENCE: THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 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 standard(s) 19, 24 and 26 Lovely landscaped gardens accessed from a pleasant and comfortable homely building that is warm and welcoming with safety measures in place. EVIDENCE: Service users spoke positively of their surroundings, observed to be clean and hygienic with infection control policies and procedures in place. A Royal Berkshire Fire and Rescue officer undertook a fire safety inspection of the premises on 10/03/05, and deficiencies listed were promptly met by the home; fire safety records are maintained. The homes garden is accessable to wheelchair users and has been landscaped with walled gardens, mature plants and seating within various enclosures to ensure privacy. The communal lounges and dinning rooms are comfortably furnished, as is the individual flats of the service users; the maintenance person was undertaking décor and repair tasks on the day of the inspection and work was supported by logbooks in place. The home has mainly flats with some bedsits, and of the three-viewed, service users are encouraged and have personalised their own flat/bedsit.
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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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 27 to 30 were not assessed at this inspection. EVIDENCE: THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards 31 to 38 were not assessed at this inspection. EVIDENCE: THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 4
COMPLAINTS AND PROTECTION 4 x x x x 4 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 16 N/A 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. 1. Standard 3.3 Regulation 14 Requirement Timescale for action 23/08/05 2. 7.1 7.2 7.3 13 & 15 3. 9.4 9.7 13.(2) The manager must ensure a full needs assesment of the service users needs is obtained and detailed as in standard 3.3. This must be obtained from either the care manager of the service user where applicable, or undertaken by senior staff within the home so as to ascertain that the home can meet those needs prior to offering a placement to the service user. Care plans must detail the needs 23/08/05 of the service user and must have an action plan to meet the need, assocciated risks should be highlighted to draw the reader to the individual risk assessment that should be attached to the care plan. The risk assessment must detail the risk and detail an action plan to minimise the risk. Controlled medication must be 23/06/05 administered using the Royal Pharmaceutical Society guidelines on the administation of medicine used in a care home. If reasons are given that the procedure cannot be followed dispite decision made that the medication has to be
Version 1.30 THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Page 17 administered to the service user by staff, then this must be authorised by the service users G.P and added to the service users individual risk assessment. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations The home should consider reviewing the various documentation used within their needs assessment process of the service user, and collate into one user friendly document. The document should detail the initial needs assessment and identify associated risks; this would enable the home to compile care plans that are drawn from this information. The home should ensure the G.P reviews the service users medication annualy, and that homely remedy lists authorised by the G.P, are individual to the needs of the service user, and reviewed annually by the service users G.P. The home should consider filing the individual service user information sheet, careplan, risk assessment and daily report sheet into individual sections of what could be a working folder. The folder would give care staff up-to-date information at a glance to meet the needs of the service user and be aware of associated risks. Other records belonging to the service user should be stored within individual folders and used for refrence and inspection purpose. 2. 9 3. 7 THE LIBERTY OF EARLEY HOUSE H52-H51 S11357 The Liberty of Earley House V217448 230505-Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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