CARE HOMES FOR OLDER PEOPLE
The Old Rectory Spring Lane Lexden Colchester Essex CO3 4AN Lead Inspector
Sharon Thomas Unannounced Inspection 19th January 2006 09:30 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 Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 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 Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Old Rectory Address Spring Lane Lexden Colchester Essex CO3 4AN 01206 572871 01206 573198 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) Ashbourne (Eton) Limited Ms Paula Maddams Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (62) of places The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 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) 15th June 2005 Date of last inspection 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 the 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 resident 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 resident group and provides the appropriate aids and equipment to assist individuals with limited mobility. The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This second unannounced inspection took place on 19 January 2006, and took place over 4 hours, ten of the thirty-eight National Minimum Standards were inspected: eight were met, and two were 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, area manager two members of staff, and two residents. The tour of the premises included observation of six bedrooms, all of the bathrooms and toilets, all of the communal areas, the kitchen and the laundry. The CSCI had received a complaint regarding the issue of menus and food provided by the home. An initial unannounced visit to the home took place on 22 December 2005 where the complaint was first discussed. The complaint was again discussed at the point of inspection and the outcome of this can be found in the content of this report (Standard 15). 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 homely atmosphere for residents. The home has created a family atmosphere despite its size. The Old Rectory has a strong, caring staff team, and has a low staff turnover; staff that have left have done so for genuine reasons. The staff group in The Old Rectory are enthusiastic, knowledgeable and skilled. The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 6 The residents spoken with on the day stated that the manager and staff ‘kind and caring’ and the home was ‘very nice’. Residents reported relatives and visitors are welcomed into the home at all times. The staff observed to chat continually with the residents and involve them as they about their work through out the day. were that were went The staff enables residents to live in a home that provides flexibility. The routines in the home do, as far as is possible, meet the residents’ needs and personal preferences. The home ensures that residents’ money is secure, and any financial transactions are recorded and receipts are well maintained. The home does not act as appointee for residents. The residents’ healthcare needs are monitored and reviewed on a regular basis. The home has a good relationship with local healthcare services and make prompt referrals when required. What has improved since the last inspection? What they could do better:
The home lacks a structured formal programme of activity; the programme does not provide adequate activities for residents with dementia. The home is planning on varying its registration to accurately reflect the residents currently living there. In order to have the variation agreed by the CSCI the home will be required to address the issue of activities with particular regard to residents identified as having dementia.
The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 7 The home does not involve residents in the planning of the weekly menus. Residents were not being provided with an alternative meal should they not eat the meals provided on the menu. The chef must enable residents to plan for the menu and be open and approachable to staff and residents’ comments. The manager was not reviewing and monitoring residents’ opinions and preferences at the point of the complaint investigation. 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 DS0000017974.V279844.R01.S.doc Version 5.1 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 Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 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 the following standard(s): None of the above standards were inspected – please see previous report. EVIDENCE: The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, & 10. The home’s care planning systems are satisfactory and well maintained. The care plans indicated that the residents’ care needs are identified, planned for and monitored in an appropriate manner. The residents’ healthcare needs are well met in The Old Rectory and the residents’ care plans are detailed and directive. The home provides a service that treats the residents with respect, staff engage positively with residents and demonstrate a good understanding of their needs. EVIDENCE: Three care plans were examined. All three contained detailed information regarding the resident’s needs, the action to address the needs, and the longterm outcome of the care given. The care plans covered all aspects of a resident’s physical, mental and social needs, and were reviewed on a monthly basis. There are detailed risk assessments and manual handling assessments. There was evidence that residents signed care plans and are involved in the planning process. The daily records looked have greatly improved since the previous inspection and reflected the care that is given. The care plans
The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 11 identified the strengths and abilities of the residents as well as the areas of need. The care plans contained individual quotes from residents with regard to their likes and dislikes and the way in which they would like their care to be provided. Residents commented that the staff knew “the little things about me” and that staff “do a very good job to look after all of us”. Staff were observed treating residents with care and sensitivity. Three care plans were examined and all of these contained clear and detailed instructions for the delivery of personal care for residents. Oral healthcare was detailed in the care plans. GP and routine health checks offered such as optician, dentist, and podiatrist are well documented. The home provided residents with access to aids and equipment to support their healthcare needs and issues. The manager stated that the home is well supported by the local primary healthcare team. The care plans contained additional information that included moving and handling, pressure care, and continence assessments. Two service users stated that they were confident that staff would take the “right decision when they were ill” and that “the staff always contact my family when I am poorly”. The two residents spoken with commended the staff with regard to the treatment they received in The Old Rectory. The residents stated that their privacy and dignity was maintained in a variety of ways, including the way staff provided personal care, toileting issues, respect for visitors, and the provision of private areas in the home that enabled residents to see visitors in private. Observation of staff during the inspection indicated that staff were friendly, considerate and respectful toward residents. Residents commented that the “staff are wonderful”. The care plans examined provided information of various ways that respect for residents is maintained. The care plans contained personal quotes from residents regarding their care preferences and evidence that these preferences were met, were found in the daily records. The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, & 15. Overall the home provides an appropriate range of activities for residents and provides the residents with a variety and choice with regard to their daily lives. The residents 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 Old Rectory has ongoing issues with regard to menus and food provided to residents. EVIDENCE: The timetable for recreational activities on offer for the forthcoming week are displayed throughout the home. The activities included art and crafts, board games, bingo and one to one sessions with residents. Residents spoken with reported that “there is always something to do” and “I am not forced to take part in activities”. The home does not currently provide activities that address the needs of residents with dementia. The manager confirmed that the home does not act as appointee for any of the residents living there. The manager confirmed that arrangements for residents to bring in possessions were discussed prior to admission, and records of possessions were available in care plans. The inspector observed routines in the home and found that they were flexible and residents’ individual choices were addressed. Residents and staff confirmed that they (residents) are able to meet with visitors in a quiet area of the home and if this is not available
The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 13 they may take visitors to their bedroom. Visiting times are not restricted and relatives and friends were observed being welcomed into the home throughout the inspection visit. The standard relating to menus and food was not inspected, however a complaint was received regarding this issue and the details can be found below: The Commission had received one complaint (anonymous) since the previous inspection and alleged the following issues: • • • • The quality of food is poor. Not upheld as food stocks were of good quality and quantity. The quantity of food provided to residents is small. Not upheld, meals served on both monitoring and inspection visit were satisfactory. Some meals offered on the menus are not suitable for residents. Upheld – residents stated that they did not like some of the meals and were not involved in the menu planning in the home. The residents are reluctant to approach the chef. Upheld – inspector discussed issue with the chef on the day and found communication difficult. The chef was found to be unapproachable and over reacted to the inspector. Residents are not provided with an alternative when they return food to the kitchen. Upheld – residents reported that they were not offered an alternative to a meal should they send it back to the kitchen. This was confirmed by two members of staff. • The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 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 the following standard(s): 16. The Old Rectory has an effective system in place to enable residents, relatives and others to make complaints. EVIDENCE: The Commission had received one complaint (anonymous) since the previous inspection and alleged the following issues: • • • • The quality of food is poor. Not upheld as food stocks were of good quality and quantity. The quantity of food provided to residents is small. Not upheld, meals served on both monitoring and inspection visit were satisfactory. Some meals offered on the menus are not suitable for residents. Upheld – residents stated that they did not like some of the meals and were not involved in the menu planning in the home. The residents are reluctant to approach the chef. Upheld – inspector discussed issue with the chef on the day and found communication difficult. The chef was found to be unapproachable and over reacted to the inspector. Residents are not provided with an alternative when they return food to the kitchen. Upheld – residents reported that they were not offered an alternative to a meal should they send it back to the kitchen. This was confirmed by two members of staff. • The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were inspected – please see previous report. EVIDENCE: The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 The home provided appropriate training to give staff the skills necessary to do their job. There is a stable and loyal staff team, which ensure consisitency in the delivery of care. EVIDENCE: The manager of The Old Rectory confirmed that the home has 29 permanent members of staff. Of these 12 have achieved their NVQ Level 2, while 12 are in the process of working towards achieving this. The 4 new recruits to the home will start their NVQ Level 2 once they have completed their probationary period. The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 & 35. The Old Rectory has systems in place that enable the care practices in the home to be measured, ananlysed and acted upon. The home has a secure system to safeguard the residents’ financial interests. EVIDENCE: Although the standard regarding quality assurance was not fully inspected, records confirmed that the home has completed resident and relative questionnaires. The results of the survey have not been analysed and the manager agreed to send the results to the CSCI when completed. The inspector examined the personal allowances of 4 residents living in The Old Rectory. The money held by the home was accurate, well maintained, and secure. The records and receipts of resident’s expenditures were accurate and tallied with the money held for the individuals. The manager confirmed that the home does not act as appointee for any resident and financial issues are
The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 18 dealt with by relatives and / or friends. The home has a ‘valuables’ log and this was well maintained and accurate. The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 15 (1) Timescale for action The registered person must 30/04/06 ensure that social activities are provided to meet the social, cultural and recreational need of all residents paying particular attention to those residents with dementia. The registered person must 19/01/06 ensure that resident’s views of the menus are monitored and reviewed on a regular basis, and that the residents are involved in the planning of menus. Residents must be offered an alternative to the meal provided on any given day. Requirement 2. OP15 16 (2) (i) 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
DS0000017974.V279844.R01.S.doc Version 5.1 Page 21 The Old Rectory group. The Old Rectory DS0000017974.V279844.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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