CARE HOMES FOR OLDER PEOPLE
Old Parsonage (The) The Street Broughton Gifford Melksham Wiltshire, SN12 8PR Lead Inspector
Susie Stratton Unannounced 15th July 2005 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. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Old Parsonage (The) Address The Street Broughton Gifford Melksham Wiltshire SN12 8PR 01225 782167 01225 782167 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) Roseville Care Homes (Melksham) Limited Mrs Christine Ann Jones Care Home with Nursing 20 Category(ies) of DE(E) Dementia - over 65 (20) registration, with number MD(E) Mental Disorder - over 65 (20) of places D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The staffing levels set out in the Notice of Decision dated 23 December 2004 must be met at all times. Date of last inspection 27th January 2005 Brief Description of the Service: The Old Parsonage is a 19th century listed building that has been converted for use as a care home and is situated on the edge of Broughton Gifford village in the north west of the Wiltshire countryside. The home is registered to provide residential and social care for 20 people with dementia and/or mental disorder who are aged 65 or over. Accommodation is provided on 2 floors of the home and consists of 14 single rooms and 3 double rooms. There is an accessible paved courtyard area to the rear of the building. Parking space is available. The home was purchased by Roseville Care Homes Ltd on 24th December 2004. The responsible individual is Mrs Dinka Knezevic. The registered manager is Mrs Chris Jones, who is a registered mental health nurse, she leads a team of nursing, care and ancillary staff. Broughton Gifford is about 10 minutes away from Melksham to the north and Bradford on Avon to the south. Both towns have railway stations. The M4 is about 30 minutes drive away. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Friday 10th July 2005 between 10.10am and 3.10pm, in the presence of Mrs Chris Jones, registered manager and Mrs Edith Parkin, responsible individual designate. During the inspection, the Inspectors also met with two registered nurses, three care assistants and a domestic. The inspectors met with or observed care for all of the residents who were currently in the home and met one visitor. They reviewed documentation relating to five residents in detail, two of whom had been recently admitted and also reviewed records including the fire log book, medicines records and activities records. They inspected the recruitment file of the one person who had recently been employed. The Old Parsonage had three visits, all of which related to one matter, which was raised anonymously during March and April 2005. A requirement was set, which did not relate to the complaint, this had been addressed by this inspection. What the service does well: What has improved since the last inspection?
Many improvements have been made to the home since the previous inspection. The Old Parsonage had a history of under investment from the previous owner. Improvements include a new heating system and oil storage tank and new wash hand basins and vanitory units in bedrooms. An action plan has been developed to improve the home environment and work will commence across a range of areas shortly.
D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 6 The home have commenced providing an activities programme to residents. All unsafe furniture and an unsafe wash hand basin has been made safe. An audit of mattresses has been performed and new mattresses provided. Four new variable height beds have been provided and three low airloss mattresses for resident who are assessed as being at risk of pressure damage. All the wheelchairs have been serviced. The laundry has been improved by changing staffing systems, providing a system for reducing the handling of linen by staff to a minimum and sealing the washing machine plinth. All clinical waste is now placed in foot pedal operated bins. Safe systems, by use of disposables, have been put in place for commodes. A Legionellum Certificate has been obtained. Information on residents’ advocates has been obtained. Care records of allegations made by residents are made. More registered nurses have been recruited, an interview assessment toll for staff has been developed and the induction programme is now signed by the trainer and inductee. Of the thirteen requirements from the previous inspection, all have been met apart from the one which is not due. Of the nine recommendations, eight have been addressed and plans are in place to address one area. 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
D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 7 contacting your local CSCI office. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 Assessments are carried out on all prospective residents, to ensure that the home can meet their needs. The inspection showed that the home could meet the needs of persons admitted with complex mental health care needs. EVIDENCE: Prospective residents are assessed by the manager prior to admission. Assessments are detailed and include all relevant nursing and care assessments. The manager also re-assesses residents who have been admitted to hospital for a period of time, to ensure that their needs can continue to be met in the home. The Old Parsonage provides nursing and care to residents who have complex mental health care needs, a review of documentation, observations of care and discussions with staff indicated that the home could meet these complex needs. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10 Residents have care plans in place which reflect their needs and are regularly evaluated, a few areas need to be developed to further improve care. Residents’ need for dignity is respected by all staff. Medicines are largely managed in accordance with guidelines, however residents could be put at risk by insufficient storage for all drugs. EVIDENCE: All residents have care plans in place, which outline their nursing and care needs. These care plans are regularly reviewed and up-dated if a resident’s condition changes. All care plans are drawn up by one member of staff, this means that for some care plans, more detail could be included in certain areas. For example one resident was noted to have a past history in relation to alcohol consumption and it was not clear from their current care plan what alcohol they were allowed to drink. A new part-time registered nurse has now been employed and once she has completed her induction, she can assist more staff in becoming in drawing up and reviewing of care plans. Residents are assessed for risk, including risk of falls. Where risk is identified, a care plan to reduce risk is drawn up. As footwear has been shown to be a factor in elderly people who fall, an assessment of the residents’ foot wear should be included in any risk assessment.
D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 11 The availability of adequate cupboards for proper storage of medicines had been discussed with the previous owner and a further cupboard had been provided, however this cupboard is very small and at this inspection, it was noted that, following the admission of two new residents, there was not enough space for their medicines to be stored in either the trolley or drugs cupboards. The drugs cupboard are in the clinical room which is locked most of the time, but there was evidence that it is not possible for it to be locked at all time, so sufficient lockable cupboards, which comply with pharmacy guidelines, need to be available, to ensure that all drugs can be locked away at all times and mentally frail residents who may not be aware of the risk presented by drugs, are protected. The home are recording the temperature of the medicines fridge, however it was noted that during the past few weeks its temperature had been in excess of 6C on several occasions, the ice compartment of the fridge showed that it was in need of defrosting and this may be why it has a raised temperature. Drugs requiring cold storage need to be stored at a temperature at or below 6C. The care plan of one resident for management of their individual needs in administration of medicines was not clear and should be up-dated. Nursing and care staff were observed to treat residents with respect at all times, even if they were exhibiting complex behaviours. Staff managed residents without raised voices, by cheerful and gentle support. Personal care was provided behind closed doors. Although the majority of the residents are doubly incontinent, it was much to the credit of staff, that residents’ dignity was respected and there were no unpleasant odours anywhere in the home. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 standard(s) 12 & 15 Residents have been supported by the recent introduction of an activities programme, staff also see spending personal time with residents as part of their role. Staff support resident at mealtimes and the new owners are planning to improve the dining facilities. EVIDENCE: The new owners have set up a system for provision of activities to residents and records are maintained, showing who have taken part in activities and their responses. External entertainers are also coming into the home. Mrs Parkin reported that she could already see a change in some residents as they began to respond to activities. Carers also saw social support as their role and were observed to sit and chat with residents. A choice of meals is offered to residents. Most residents sit in the dining room to eat, although those who wish to can have their meals in their rooms. The dining room furniture has now been made safe for residents and the new owners have an action plan in place to improve the dining room. Staff supported residents in eating meals. Although some residents need liquidised meals, the number is kept to a minimum. Staff observed residents closely during meals, supporting residents who became distracted forgetting to eat and assisting those who needed help to eat their meals. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 standard(s) 18 Staff attitude and awareness showed that residents are protected from abuse. EVIDENCE: Staff at all levels spoken with showed a good knowledge of the protection of vulnerable adults. Restraints are not used and there is very limited use of drugs to manage behaviours. Some of the residents show complex behaviours and records show that they can be aggressive at times. Staff manage such behaviours effectively, supporting residents in expressing themselves and calming down if they need to, not intervening if they feel that this will complicate the situation. Staff were observed not to react if residents made personal comments, letting the resident calm down and then caring for them in a cheerful, helpful manner. The accident book showed that there was minimal aggression from residents to residents or resident to staff. The manager has experience of working within local vulnerable adults procedures. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24 & 26 The home environment continues to improve. New specialist equipment has been provided for residents, however a lack of assessments of manual handling care by appropriate professionals may place residents at risk. The home was largely clean throughout, apart from a few certain areas which need attention, to prevent risk of spread of infection. EVIDENCE: The Old Parsonage had a history of under-investment in the environment from the previous owner. The new owner has reviewed the environment and has already begun to make major improvements. A new boiler has been provided, this means that the hot water and heating system now functions effectively. An up-grade of the bedrooms has commenced, with new wash hand basins and vanitory units. Mrs Parkin reported that a full upgrade of all areas of the home will commence shortly, to replace the drab finishes throughout the home. Requirements relating to making bathrooms safe from the last inspection have all been met and an up-grade of the bathing facilities is planned as part of improvements of the home environment.
D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 15 The new owners have invested in equipment, providing more variable height beds, pressure relieving equipment for residents who are high risk of developing pressure sores, a new hoist, have audited all mattresses and provided new ones where indicated and have had all the wheelchairs serviced. When the inspectors used the call bell at the request of one resident, the response by staff was very prompt. There is only one lifting sling in the home and this may not be enough to meet the needs of all residents who need assistance with standing. It was also noted that two residents were transferred to wheelchairs by holding them under their arms and when the breaks of the wheelchair were not on, this is unsafe practice. Subsequent discussions showed that this practice was carried out because it was felt by staff to be the only practical way of managing the residents’ needs. Assessment by external professionals is needed to ensure that all residents with such needs are manually handled in the safest possible manner to meet their care needs. As noted in standard 10 above, despite the majority of the residents experiencing double incontinence, no areas in the home exhibited odour. The laundry was very clean throughout and new systems, as recommended in Health Protection guidelines, have been introduced for the management of laundry, these will protect residents from infection. All waste was properly disposed of. The home are now using disposable inserts for commode buckets. Some commode buckets were not clean showing marking and small amounts of debris, dust was observed on some bed frames, picture rails and wardrobes. As dust and debris can be a repository for micro-organisms, all such items need to be clean and dust-free. The home do not have the most up-to-date Health Protection guidelines and it is recommended that they obtain a copy. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 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) 27, 29 The Old Parsonage are staffing the home as required by the Commission and there is continuity of care to residents. Residents are protected by the home’s recruitment system. EVIDENCE: The Old Parsonage is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. There is a low turnover of staff and it is to the credit of the new owners and the current staff that none have left since the owners purchased the home. The manager has recruited a new experienced registered nurse to support the nursing team. As well as nursing and care staff, ancillary staff are also employed. One new member of staff has been employed since the home was last visited. A review of their file showed that all pre-employment checks had been completed. An interview questionnaire has been developed and will be used with the next employee. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 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) 31, 35, 36 & 38 The Old Parsonage is managed by an experienced registered nurse and manager. The new owners are developing safe systems for the management of residents’ money. They have also reviewed health and safety across the home. EVIDENCE: Mrs Jones is an experienced manager and nurse, who up-dates her skills regularly. Mrs Jones has set up a documentary system for staff supervision and anticipates that the requirement date for compliance of 31st December 2005 will be met. The new owners of the home inherited an unsafe system for the management of residents’ moneys and now have clear records, which can be audited. To reduce their workload they are advised that they should try to ensure that as much as possible residents’ moneys are managed by relatives or other appropriate advocates. They should also set up systems to reduce any moneys held for residents in the home to the lowest possible level. The new owners have reviewed all equipment and systems in the home, making sure that all items are regularly serviced and have obtained a Legionellum
D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 18 Certificate. Staff have recently been trained in manual handling. The home environment is regularly assessed for fire safety as directed by the fire brigade, they do not maintain records on weekly checks of means of escape, although this is reported to be taking place. D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 3 2 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x x x 3 2 x 3 D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 20 NO 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 9 Regulation 13(2) Requirement All medicines must be stored in metal cupoards or a trolley, which is fixed to a wall and which conform to pharmacy guidelines. Residents with complex manual handling care needs, where staff need to use techiniques which may put the resident or staff member at risk, must be assessed by an appropriate professional and their advice on manual handling complied with. All commode buckets, bed rails, picture rails and wardrobes must be clean and free of dust. The persons registered must ensure that a system for supervision has been put in place for all staff. (This requirement was identified at the previous inspection, the compliance date was not due at this inspection) Timescale for action 31 August 2005 2. 22 13(5) 31 August 2005 3. 4. 26 36 13(3) 23(2)(d) 18(2) 31 August 2005 31 Decmeber 2005 D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 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. Refer to Standard 7 Good Practice Recommendations More staff should be involved in drawing up and evaluating residents care plans. (This recommendation was identified at the previous inspection and plans are in place to commence actioning it) Risk assessments for falls should include an assessment of the residents footwear. The function of the medicines refrigerator should be checked, and necessary maintenance performed, to ensure that its temperature remains at or below 6C One residents care plan in relation to their individual medication needs should be made clearer or reviewed. More lifting slings should be provided to assist residents with manual handling needs. A copy of the most recent Health Protection Agency guidelines should be obtained to advise staff. Residents relatives/advocates should be asked to manage their moneys on their behalf. Systems should be put in place to reduce the amount of moneys held in the home on behalf of service users to the lowest possible level. 2. 3. 4. 5. 6. 7. 7 9 9 22 26 35 D51_D01_S61474_OLDPARSONAGE_V228135_100605_Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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