CARE HOMES FOR OLDER PEOPLE
The Old Rectory Spring Lane Lexden Colchester CO3 4AN Lead Inspector
Sharon Thomas Unannounced 17th May 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. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Old Rectory Address Spring Lane, Lexden, Colchester, CO3 4AN 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) 01206 572871 01206 573198 Ashbourne (Eton) Ltd Care Home 62 Category(ies) of Old age, not falling within any other category 62 registration, with number Both of places The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 62 persons) Date of last inspection 8th November 2004 Brief Description of the Service: The Old Rectory is a large fully detached property that was originally constructed as the rectory for the local church in Lexden. The property has been considerably extended over recent years to provide accommodation for up to sixty-two elderly people (over the age of 65) on three floors. Accommodation is provided in fifty-four single and four double bedrooms located on all three floors of the home. Communal space is provided with three lounges and three dining rooms situated on the ground and first floors of the home. Access between floors is made via two passenger lifts. A further small service user smoking lounge is provided on the first floor.To the front of the home there are extensive well-maintained mature gardens. A small fully enclosed patio garden is provided to the side of the home. Limited car parking for visitors is available inside the main entrance gate; further public car parking is available close to the main entrance. The home provides personal care and support for residents with varying levels of dependency. The home is well equipped to meet the needs of the current service user group and provides the apropriate aids and equipment to assist service users with limited mobility. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 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 17th May 2005, and took place over 5.5 hours. Fourteen of the thirty-eight National Minimum Standards were inspected: thirteen were met, and one was nearly met. For the purpose of this report the individuals living in the home spoken with on the day stated that they would prefer to be called residents. The inspection process included: discussions with the manager, six members of staff, the cook, and seven residents. The tour of the premises included observation of fourteen bedrooms, all of the bathrooms and toilets, all of the communal areas, the kitchen and the laundry. There was an opportunity to spend a considerable period of time observing the care being provided by the staff. The inspection included the examination of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). The home was warm clean and tidy. The home provides a calming and caring environment for the residents to live in. The residents spoke highly of the care that they receive in The Old Rectory and spoke highly of the efforts of the staff to give them the care that they need. The Old Rectory has a large number of residents with dementia, and the manager has agreed that the registration for the home needs to be changed to reflect the varying needs of the residents who live there. What the service does well:
The home provides a warm and friendly atmosphere for residents. The furnishings and decoration are of a good standard. Although The Old Rectory is a large home, it has achieved a warm and welcoming atmosphere. All of the residents spoken with on the day stated that the manager and staff were ‘kind and caring’ and the home was ‘very nice’. They reported that their relatives and visitors are welcomed into the home at all times and that the routines in the home are as flexible as possible. Some of the activities provided in the home were specifically designed to provide stimulation for residents with dementia including ‘music to movement’ to promote physical exercise and interaction with the other residents and staff. The staff were observed to chat
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 6 continually with the residents and involve them as they went about their work through out the day. The staff in the home are enthusiastic and committed to giving good quality care. The staff are friendly and approachable, and have built positive relationships with both residents and relatives. Overall the food provided by the home is varied and nutritious. Residents commented that the food is: “good” they had “plenty of choice” and two residents stated that they had “more than enough to eat”. Three of the residents stated that they “preferred the food cooked by one chef” and that “sometimes the food is not tasty” The residents’ healthcare needs are closely monitored and speedy referral is made to appropriate healthcare professionals as required. The district nurse spoken with reported that the staff were able to follow advice, and that the staff regularly contacted the GP and district nurses to refer for treatment. What has improved since the last inspection?
The information held in the home that describes the needs of the residents have been dramatically improved since the last inspection. The care plans now include detailed information regarding the physical, mental, emotional and social needs of the residents, and give clear directions to staff as to what care was needed and how to provide it. Individual risk assessments were completed to identify all aspects of risk. Residents reported that changes to their care were made only after they had been spoken to by the staff. There was evidence of this on the care plans seen on the day. In addition to the care needs being recorded the documents contained a range of detailed descriptions of the likes and wants of the residents. This included what residents liked to eat, what time residents wanted to go to bed, and the newspapers that the resident preferred to read. All staff are trained prior to being able to give medication. There is a thorough and detailed training programme to ensure that they have the knowledge and skills needed to undertake this task. Some staff felt that more dementia training would be a benefit. The staff recruitment programme has been tightened up and the staff recruitment files examined contained all of the information and checks needed when employing staff.
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 7 The number and skill mix of the staff are appropriate to the needs of the residents living in the home. The home’s complaint procedure has been improved to ensure that all residents and relatives are aware of how to, and whom to make a complaint to. 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 Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.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 The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.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 The home has a thorough pre-admission system in operation that ensures that the needs of prospective residents are fully assessed and could be met. The home demonstrated that the service it provided was able to meet the assessed needs, including specialist/changing needs of the current individuals living there. EVIDENCE: Five care files were sampled, three of these were the newest admissions to the home. All three of these contained the information required for an appropriate and effective admission into the home. Full social services and/ or hospital assessments were found on the files along with the home’s own pre-admission document. The home’s pre-admission assessment document included all aspects of the resident’s care needs. Two residents who had recently moved into the home commented that their families had visited on their behalf, and stated that the staff had been very “kind and considerate” since they had moved into The Old Rectory. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.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 & 9. Residents health and personal care needs are well met; individual care plans detailed the care and support required. Staff showed a caring approach towards residents treating them with dignity and respect. The home has a clear system for the administration of medication that ensures that medication is given safely. EVIDENCE: Resident files contained a clear and detailed care plan, which gave precise information for care staff on how to meet personal, social and psychological needs, ensuring consistent and structured support. They also provided evidence of the resident’s choices and preferences with regard to their personal support needs. Individual night care programmes were in place for residents detailing individual preferences such as time, pillows, warmth and hot drinks and how needs were to be met to promote a good night sleep. Two residents spoken with stated that the staff were able to “attend to their needs” and that “all of the staff know what I need throughout the day”.
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 11 Two residents living in the home who were able to self medicate had risk assessments attached to their medication administration record sheets. The medication was securely locked away. The records of the administration, receipt and disposal of medication were accurate and well maintained. The staff spoken with who were responsible for giving medication confirmed that they had received appropriate training and support, and were confident that they ensured the safety of the residents when giving medication. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.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) 14 &15. The home provided the residents with variety and choice with regard to their daily lives. Their expectations and preferences with regard to lifestyle are well met, and the capacity of individual residents to make choices is central to the care provided in the home. The residents were provided with a wholesome, nutrional and appetising diet. The home enabled residents to exercise choice over what they ate. Records relating to specialist nutritional needs of individual residents were available to staff. The staff did not have 24 hour access to the full range of foodstuff for residents. EVIDENCE: The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 13 The manager confirmed that the home does not act as appointee for any of the residents living in the home. The residents spoken with on the day were aware of the advocacy service, one resident reported that they “knew that there was someone to speak to”. This information was displayed in the home. Arrangements for residents to bring in possessions were discussed prior to admission, and records of possessions were available. One resident reported that their room was “full of ornaments and paintings and other things from my home”. The care plans examined indicated personal preferences in terms of food, clothes and other daily choices. The residents spoken with on the day stated that they felt that their rights and choices were respected. One resident confirmed that they felt “free to come and go as I please” and that staff were interested in helping them to “do the things I used to do before I came to live here” such as “reading the books I used to read when I was younger” From discussion with residents and staff and examination of the home’s menu’s it was clear that the home provided a wholesome and well-balanced diet. Care plans indicated that special dietary needs were provided for. On the whole residents comments were positive with regard to the quality and quantity of meals and snacks provided by one particular chef. All of the residents commented that “meals were more appetising and satisfying” when this particular chef was on duty. Many residents reported that some “meals were not appetising or appealing and they had to be sent back”. Residents were observed eating in the dining room, communal areas and in their rooms if preferred. Assistance was provided if required. From discussion with staff and records examined on the day it became clear that after the chef had finished for the day the staff on duty did not have access to the food stocks in the home. This had resulted in shortages in basic items such as bread, tea, and biscuits. On one occasion there was a shortage of food at tea-time, the staff had to use the local fish & chip shop to ensure that all residents had received an adequate meal. The manager agreed that this was an ongoing issue and agreed to have another set of keys cut on the day. These would then be made available to the senior on duty to guarantee access to food stocks. The comments provided by the residents were passed on to the food contract manager who was visiting the home on the day. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. The home had a clear and concise system for dealing with complaints. Residents were confident that complaints were dealt with swiftly and effectively. The home operates appropriate practices and procedures to protect vulnerable adults. The manager and staff actively promote awareness of adult protection issues. EVIDENCE: The Old Rectory had a clear and informative Complaint Procedure that was on display in the foyer of the home. The complaint log was examined and four new complaints had been recorded since the last inspection. The issue regarding these complaints was recorded, as were the response, the action taken and the outcome of the complaint. Residents reported that they were aware of a Complaint procedure and that they were clear that they could report a concern or complaint to a member of staff or the manager. The residents reported that they felt that complaints were taken very seriously and that they would feel safe making a complaint. One resident stated that when they did make a complaint that this was “dealt with quickly and there was no come back”. The home had a comprehensive and clear set of protection of vulnerable adult abuse policies and procedures. The home had clear guidelines for staff to follow should an allegation of abuse be made. Copies of the relevant national
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 15 guidelines were available to staff. Four members of staff spoken with on the day were aware of the guidelines and all of these had been on training courses that deal with this issue. One resident stated that they “felt very safe in the home” and “trusted the staff”. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26. The home provided a safe and well maintained environment for residents. The home was clean, warm and homely in nature and had systems in place to prevent the spread of infection. EVIDENCE: The Old Rectory is a large property that has been adapted to meet the needs of the residents. The home has a maintenance programme for the year. This provided evidence of the planned redecoration of resident bedrooms. The grounds were well maintained and safe. The Fire Officer and Environmental Health reports were examined and there were a number of concerns from the environmental health report, these were being addressed at the time of the inspection. On touring the home all areas were found to be clean, tidy and free from odour. The furnishings and decoration were of a high standard and gave the home a warm and welcoming feeling. The temperatures of the hot water from the taps in the bathrooms were recorded and were found to be at the appropriate levels. The home’s communal and private areas are naturally ventilated. All bedrooms are centrally heated and radiators are guarded to
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 17 ensure the safety of residents. The residents spoken with reported that the “home was always clean and tidy” and that “the staff are really good at keeping my room clean” and that the “staff even clean the skirting boards”. The home’s laundry facilities are located away from communal areas and individual bedrooms reducing the risk of cross infection. The equipment in the laundry is suitable for the needs of the residents. The home has two sluices in operation and these were clean and well-maintained. Residents confirmed that their clothes were returned from the laundry “smelling nice” and “my clothes never go missing now”. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 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 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 & 30 The home provided the residents with a well trained and knowledgable staff group. Staffing numbers were sufficient to meet the needs of the residents. Staff were provided with training appropriate to the needs of the current resident group. The stable staff group ensured that residents received consistent care delivery. The recruitment procedures in the home were comprehensive, and provided safeguards to ensure that appropriate staff were employed. EVIDENCE: The staffing levels on the day of the inspection met the levels agreed with the CSCI; from discussion with staff and residents, staffing levels were well maintained, and were appropriate to the needs of residents. The home rarely used agency staff, and any staff shortages due to sickness or annual leave were covered by care staff working extra shifts; this enabled good continuity of care within the home. The staff personnel files examined contained all of the information needed to ensure the safety of residents through the recruitment process. All three files examined contained a POVA first/Criminal Reference Bureau check, two references, a photograph of the member of staff and personal ID. The home provided the staff with a full and comprehensive programme of training. The programme included: first aid, fire safety, moving & handling, food hygiene, infection control, medication, continence, pressure care prevention, falls prevention, and the protection of vulnerable adults. The staff
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 19 spoken with reported that the training provided was relevant to their roles in the home and helped them to do their job to a higher standard. One member of staff had not received Dementia training and stated that this would be discussed within their supervision. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 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 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 & 38. The manager of the home is skilled, knowledgable and fit for the job. The records in the home are maintained to a level that ensures the ongoing health, safety and welfare of the residents. EVIDENCE: Feedback from staff, residents and relatives indicated that standard 31 is being well met within the home. The manager was observed working in the home. The manager was seen to provide clear direction and guidance to staff on a range of issues, she has clear vision of the service provided in the home, and demonstrated a positive and supportive approach when listening to a concern raised by a resident. Staff continued to report that they find the manager approachable and supportive; residents and relatives spoke highly of the internal management of the home, and felt there was good communication. The manager is leaving the home to work in another Ashbourne home, staff were genuinely upset by her departure, but were re-assured that Ashbourne had replaced her with another established and skilled manager known to them.
The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 21 Residents spoken with stated that they knew who the manager was, and “trusted her to make things right” and that “she is a very nice person”. The home provided staff with appropriate Health and Safety training. Risk assessments of the premises were undertaken and regular Health and Safety checks of facilities and equipment were also undertaken, certificates of these were examined on this occasion. The manager was aware of relevant Health and Safety legislation and was committed to the welfare of both the residents and staff group. Hot water, fire alarm and equipment checks were accurate and up to date. The staff spoken with were able to identify potential hazards in the home and the actions that they would take to make the hazards safe. The staff stated that they would report any safety hazard to the manager who would take the appropriate action. Staff were aware of Health and Safety issues around the home and wore personal protection clothing when needed. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 23 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 OP7 Regulation 15 (1) Requirement The registered person must ensure that daily records contain details of the care being provided. The registered person must ensure that staff have complete access to food stocks to ensure that shortages do not occur. Timescale for action 30.06.05 2. OP15 16 (2) (i) 30.06.05 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 OP1 Good Practice Recommendations The registered person should consider varying the registration of the home to reflect the current resident group. The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ 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 The Old Rectory I56-I05 s17974 Old Rectory v228063 170505 stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
