CARE HOMES FOR OLDER PEOPLE
The Paddocks Springfield Road Wellhead Nr Dunstable Bedfordshire LU6 2JT Lead Inspector
Leonie Milton Unannounced Inspection 20th January 2006 13:20 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 Paddocks DS0000014943.V279385.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 Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Paddocks Address Springfield Road Wellhead Nr Dunstable Bedfordshire LU6 2JT 01582 601317 01582 673287 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) Mr Kenneth Janes Mrs Lilian Janes Mrs Lilian Janes Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (10), of places Physical disability over 65 years of age (10) The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: The Paddocks was registered to provide for ten older persons who may also have physical disabilities and/ or dementia. The registration for physical disabilities was not required because disabilities associated with old age could be met under the category for older people. Mr and Mrs Janes had operated the home since its original registration several years previously. Mrs Janes was the registered manager. The home was located in a small hamlet close enough to the town of Dunstable to take advantage of its amenities but at sufficient distance to retain the peaceful environment of this rural location and the pleasant countryside views from each window. The accommodation, which had been suitably adapted, was distributed over two floors that were accessed by a shaft lift and comprised ten single bedrooms with washbasin and call bell facilities. Adapted toilets and bathrooms were located for convenient access on both floors. Communal sitting areas, three interlinking rooms, lounge, dining room and an all weather conservatory were located on the ground floor as was the kitchen. An office was in the basement as were the proprietors private living quarters. An extension to the building housed the laundry storage areas and another office. The previous inspection had noted that building changes to these areas had not been formally reported to the CSCI or to the Environmental Health Services or the Fire Officer for their approval. Formal approval was still outstanding from the fire services at this inspection. The rear of the property overlooked an attractive garden and extensive other grounds used to grow vegetables and fruits for the home. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focussed on the core standards not assessed at the first visit. During this inspection the arrangements for the care of one service user were assessed. Her case file was reviewed. Conversations took place with this service user, briefly with one other and two members of staff. The lifestyle for service users in the main lounge was observed as the inspection progressed. The manager was not present at the beginning of the inspection but arrived for the latter part and received feedback at the conclusion of the inspection. It is recommended that this report be read in conjunction with the report of the inspection carried out in June 2005 for a complete overview of the standard of the operation between these dates. What the service does well:
The Paddocks is a small family run service. The proprietors had been able to create a very home like environment. Given the numbers of service users it had also been possible for those caring for them to become well acquainted with their current needs, significant events from their past lives that may impact on their current life and to develop effective relationships with the service users and with their families. The atmosphere in the home was relaxed, informal and welcoming. The staff on duty were observed to treat service users with respect and were particularly sensitive in their approaches towards service users with dementia. The main lounge was much like an average domestic environment, the aids and adaptations required for service users’ welfare being mostly unobtrusive. The two staff on duty, whilst relatively inexperienced in their roles, presented as competent and able to care, during the absence of the manager, for the six service users in residence at this inspection. One service user who had been interviewed at the previous inspection and who remembered the occasion, stated that she had not changed her opinions about the service and that she was still “glad to live here”. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 6 The other service user who contributed to the inspection stated that she wouldn’t want to live anywhere else, described members of staff as “very nice” and stated that they spoke to her with respect. She also confirmed that her personal linen was well laundered, a hairdresser saw to her hair, that she was content with her bedroom and that there were no house rules that restricted her life within the home. What has improved since the last inspection? What they could do better:
Problems with the hot water supplies had been noted at the previous inspection to a few areas of the building as being too cool. The proprietor explained at this inspection that remedial works had been carried out but they had not fully solved the problem and that other work was planned. The requirement to supply water of an adequate temperature will be carried forward. It was evident that the service users were well cared for. However, the documentation on the care file that was assessed, that should be in place to evidence that the home had assessed the service user’s needs prior to admission to determine that the home was able to properly care for her, and the subsequent plan of care to show how these would be met, were insufficiently detailed. In addition the service user had been put at risk shortly after admission because inadequate steps had been taken to ensure that medication was given as prescribed. The records for medication given on the day of inspection to this service user were also not sufficiently detailed and could result in an error. The previous inspection had raised concerns that the manager had not retained sufficient overview of the day-to-day operation of the home. This inspection raised similar concerns. Whilst responsibilities may be delegated to others the manager is legally accountable for the conduct of the home. The person with the responsibility for the medications had only been in a care post for seven months and had been promoted to a senior role within that time. It was to be expected than she would have received the necessary supervision until fully
The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 7 competent with her delegated responsibilities. The manager should also, in a home of this size be fully conversant with assessments and subsequent arrangements to meet service users needs. 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 Paddocks DS0000014943.V279385.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 Paddocks DS0000014943.V279385.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): 3,6 The most recent pre-assessment of need had not been done in sufficient detail. There was therefore a risk that the home was fully prepared to meet the all of the service user’s needs. The home did not provide an intermediate care service. EVIDENCE: The case file for the service user most recently admitted to the home did not contain any documents from the placing authority. There was little evidence to show where the information on file, which was very brief, had come from, and from whom it had been obtained. The documents were not signed or dated to indicate when and who had carried out the assessment. The Paddocks DS0000014943.V279385.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): 7,9 The home relied in at least one instance on the knowledge that members of staff had acquired about service users’ care needs rather than the written guidance of care planning documents. This practice could lead to risks that needs unexpressed by service users might be unmet. The administration of medicines was dangerous and had placed a service user at significant risk of harm. EVIDENCE: The care plan assessed at this inspection was not dated. It did not contain any reference to the service user’s name other than a shortened version of her first name. There were only brief entries in each section, which did not provide sufficient guidance about the service user’s care needs. Examples of this were: The section for Profile of Life contained only the following entries, “Hysterectomy” and “ Has £20 in her purse”. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 11 There was no statement in relation to the recent death of the service user’s husband and whether this may impact on the service user’s emotional well being. The section for mobility and dexterity recorded that the service user was unsteady on her feet and was unable to take more than a couple of steps. There was no mention of the arthritis for which the service user was taking pain relief medication and which on observation and discussions with the service user showed that it had affected the joints of her hands. The records for the administration of medication for this service user showed the following: The administration of dosages of Warfarin medication was controlled by the anticoagulant clinic. This was changed the day after admission when the service user had been seen again in the clinic. The written instructions for the dosage were changed on that date to “Contact GP for dosage”. There was no evidence on the service user’s records to show that instructions had been given by the service user’s GP in relation to the dosages that were given on the next two days and than lowered for the following ten days. The manager explained that the service user’s original GP had declined to continue to treat the service user because of the change of address. The service user had then been registered with another practice. The universal communications book showed that the home had attempted to discuss the dosage of administration with the original GP surgery but with no success. There was however, as previously stated, no evidence that a doctor in either surgery or at the anticoagulant clinic had authorised the dosages given by the home until the thirteenth day when the new GP issued instructions to lower the dosage again. The record for the most recent administration of Warfarin showed that it had been given on the day of the inspection as a 1mg dose. The senior person on duty explained that the prescription was actually for a 2mg dose and that she had given 2 x 1mg tablets. There was a record in the communications book to show that the new GP had given instructions for the dosage to be given at 2mgs daily. The issues of evidence via written instructions from the GP or the clinic were discussed in some detail with the manager. The Paddocks DS0000014943.V279385.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): 15 The provision of meals was satisfactory but the introduction of nutritional needs assessments would ensure that the home was fully aware of any deficits/ unmet needs in relation to service users’ diets. EVIDENCE: Service users confirmed that they liked the meals served to them. Menus showed a choice of foods for lunch. Service users stated that there was a choice of foods for breakfast and at teatime. The care plan assessed at this inspection did not contain a nutritional needs assessment. The service user told the inspector about her arthritis, decreasing mobility and that she experienced “an upset tummy” if she overate. No consideration to these issues had been noted on the care plan or record of weight on admission. It is suggested that, where necessary, service users and their representatives should be advised about the risks to health/ lessening of mobility that can be exacerbated by weight gain. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 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 the following standard(s): 18 Satisfactory arrangements were in place to ensure the protection of service users from abuse. EVIDENCE: The home’s policies and procedures had been obtained from a professional advisory organisation and were most detailed. The personnel file for the most recent employee showed that satisfactory checks had been carried out under the requirements to validate identity, previous employment and to obtain checks from the Criminal Records Bureau and POVA First register. Information supplied by the manager after the inspection showed that seven of the twelve care staff had received training in adult protection procedures. The inspector was given to understand that further training was planned during the coming year. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 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 the following standard(s): 25,26 The comfort of service users and hygiene standards in the home had been compromised because the hot water supplies were too cool in some areas for safe hand-washing procedures to prevent the spread of infection. EVIDENCE: Areas of the home seen at this inspection, the communal lounge and dining broom and bedrooms viewed from the corridor through open doorways were clean and orderly. Written procedures for the spread of infection were satisfactory as were written guidance for staff. However the low temperatures of the hot water supplies in some areas meant that hot water had been transported manually into one service user’s bedroom and one toilet facility was without adequate hot water supplies for safe hand washing. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 15 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): 29 The home’s recruitment practices were satisfactory, had ensured the protection of service users and that those employed were of the right calibre to care for vulnerable people. EVIDENCE: The personnel file for the most recent employee showed that the home had followed good practice guidelines for employment procedures that had included an interview, obtaining references, checks from the Criminal Records Bureau and the POVA First register and on identity. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 16 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): 31,35,38. The manager was evidently committed to the welfare of service users but there had been risks some service users because she had failed to check that others had carried out their delegated responsibilities. EVIDENCE: The manager was experienced in the management of the home and was evidently committed to the service users’ welfare. Her kind and considerate care of service user had influenced the delivery of the service to the benefit of service users. However, the report of the previous inspection had noted that the manager had relinquished some aspects of her role but that, “the collective approach of the proprietors and the service manager had ensued that the home had been operated in the best interests of service users.” At this inspection that was not the case. There were risks to service users’ welfare because those with the delegated responsibilities to carry out thorough pre-admission assessment and
The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 17 care planning procedures and the administration of medications had not carried out these responsibilities as required. The manager was did not appear to be fully aware of these shortfalls, as neither had been rectified. The manager stated that it was not the home’s policy to hold monies on behalf of service users and that invoices for other services such as hairdressing and private chiropody were forwarded to service users’ representatives. One service user had admitted with an amount of money that she held for safekeeping. She showed the inspector her purse and stated that she didn’t know what had happened to her money. Given that the service user had some short-term memory loss and had been out of the home to visit with relatives at Christmas, it may be that this money had been used at that occasion and the service user had forgotten. The manager agreed to make enquiries about this matter. A record of this enquiry must be maintained on the service user’s case file. The proprietor had failed to take action on a requirement to provide the CSCI with an updated floor plan to show the annex to the main building or to obtain the fire officer’s approval of the fire safety arrangements in this area. It was unclear whether the connecting doors needed to be or were fire retardant. The inspector contacted the Fire and Rescue Service after this inspection who stated that they had no record of a request from the home to carry out a safety inspection. The inspector therefore has made such a request. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 18 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x 2 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 2 x x x 3 x 2 2 The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 19 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 OP3 Regulation 12(1)(a) 14(1) Requirement A comprehensive assessment of need must be obtained before service users move into the home. This must include, where necessary, information from placing authorities and health care professionals. The record must evidence the contribution of the service user and where appropriate their representative. A care plan that covers as a minimum the details specified by standard 3 and are inclusive of risk assessment strategies relevant to individual service users must be prepared for each service user. Plans must be reviewed each month or more often if required. Care assessment and planning arrangements must include a nutritional needs assessment that includes a monitoring of service user’s weight on admission and at regular intervals thereafter. Medication must given as prescribed by a doctor. A doctor must authorise any changes in
DS0000014943.V279385.R01.S.doc Timescale for action 31/03/06 2 OP7 12(1)(a) 15(1) 28/02/06 3 OP15 12(1)(a) 15(1)(1) (2) 28/02/06 4 OP9 12(1)(a) 13(2) 31/01/06 The Paddocks Version 5.1 Page 20 5 OP9 12(1)(a) 13(2) 6 OP19 13(4)(a) 7 OP25 23(2)(j) 8 OP30 18(1)(a) 9 OP31 10(1) medication. Records must be maintained on the service users’ case files to evidence authorisation to change prescriptions. Written instructions from the GP in relation to changes to prescriptions must be sought ASAP after the change if this has been by telephone. Where there is a variable dose for medication such as Paracetemol, the record for the administration of the medication must show the actual dosage/number of tablets given. The registered person must: Notify the CSCI in writing about the addition to the main house of laundry, storage and other facilities to include an updated floor plan. Agree with The Fire Service and Environmental Health Services, the safety and hygiene arrangements in the facilities recently linked by a corridor to the main building (Previous timescales of 31.01.05 and 31.08.05 had not been met in full). The registered person must provide sufficient supplies of hot water to outlets throughout the home at temperatures that are not too cool but that do not exceed 43 degrees centigrade to service users facilities. (Previous timescale of 14/09/05 had not been met). Staff must be trained in understanding the needs of those with dementia and how these can be met. ( Not assessed in full at this inspection) The person managing the home must demonstrate that they are
DS0000014943.V279385.R01.S.doc 31/01/06 31/03/06 31/03/06 30/09/05 31/01/06
Page 21 The Paddocks Version 5.1 aware of the day-to day operational issues. (Previous timescale of 31/10/05 had not been met in full). 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 2 Refer to Standard OP22 OP15 Good Practice Recommendations The registered person should arrange for the premises to be assessed by a qualified occupational therapist. Where necessary service users and their representatives should be advised about the risks to health/ lessening of mobility that can be exacerbated by weight gain. The Paddocks DS0000014943.V279385.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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