CARE HOMES FOR OLDER PEOPLE
The Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP Lead Inspector
Susan Golphin Announced 03 May 2005 09:15 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 Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Paddocks Address 45 Cley Road Swaffham Norfolk PE37 7NP 01760 723416 01760 722420 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) Lincoln Care Homes Limited Ms Sheila Watts Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 01 November 2004 Brief Description of the Service: The Paddocks is a residential home providing care for 52 elderly people. It is situated on Cley Road, and is within walking distance of the town centre of Swaffham. There are two parts to the home, the older part and an adjacent new wing. In addition to the main building there is a separate building which houses the administrative offices and laundry. The home has 42 single rooms and 5 double rooms. The home is set in mature and attractive grounds. There is car parking at the rear of the home.Medical and nursing services are provided via the local G.P. service. There are plans to extend the home to develop a 22 bedded unit for the elderly Mentally Frail, and the preparation work for this is in progress. The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and the management team had completed some of the pre inspection information which was made available on the day The inspection was carried out between 09.15am and 05.15pm. The Registered provider Dr Kaushall and the Manager Mrs Watts and the Deputy Manager Mrs Bushnall were present throughout the day. Only four comment cards were received by the CSCI prior to the inspection, and they expressed general satisfaction with the service. Major building work is in progress on a proposed 22 bed extension to the front and side of the premises. On completion of the new building, which will accommodate older people with special needs; work on the internal and older parts of the premises will commence and include general refurbishment throughout. Due to the number of aspects of the inspection which touched on the new project and the proposed work that will take place during the transitional period only a brief tour of the original and older building was undertaken. All areas were seen, and many of the rooms are arranged and furnished to reflect personal choice and individuality. Three service users were spoken to on the day, one only briefly. Care records for four service users were seen and reflect the assessed care needs of each person and how they can be met. Much of the inspection time was spent discussing ways in which the major changes taking place will impact on both service provision and delivery, and how the management will plan for the growth of the service offered, especially the service to those service users with a diagnosed mental frailty and special needs . The provider, manager and the deputy manager have begun the planning process and are looking at ways in which the project can be managed both from the site / building aspect and continuing to meet the service users needs with the minimum disruption through the transitional stage. What the service does well:
This is the first inspection to be carried out by this inspector and due to the ongoing activity to a large part of the premises and changes in some of the way care is delivered it has been difficult to assess what the home does well at this stage. Service users were complimentary about the care they receive from staff and one service user gave positive examples of care and support they receive. The staff group appear to be coping well during this unsettled period and by adjusting some of the routines are finding ways of meeting the needs of service users with the minimum of disruption.
The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 7 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 Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 The homes statement of purpose and service user guide provide prospective service users with detailed information about the home enabling them to make an informed decision about admission to the home. Since the last inspection the home have implemented a revised and improved process for assessing the needs of service users EVIDENCE: Information packs giving details of the service provision are readily available to prospective clients and placing agencies. There is also a brochure giving a brief summary of the services in the home which is available to people making early or first enquiries about the home. The management are reviewing the information as part of the variation in the service provision. The revision will reflect the new extension and how the care of the service users with and without special needs will be managed and delivered. ( see requirements) The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 9 The management have already begun to implement new assessment processes for people with special needs and or a mental frailty and are developing the plans for the first 16 service users. This needs to continue and a requirement has been made. The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 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) 7,10 Since the last inspection improvements and changes to the care planning process have been introduced, which provides staff with the information they need to meet personal care requirements. Personal support is provided in the home to promote the privacy and dignity of the service users. EVIDENCE: Two service users commented favourably about the care they receive and gave examples of personal support and help. Under the current circumstances the service users personal and communal space is restricted due to building works and closed off areas for safety reasons. Recommendations have been made to increase the sitting and dining room space which will then offer service users an alternative room The management and staff have been asked to be vigilant about maintaining service users dignity and privacy throughout the critical periods and ensure that the care practice and delivery of service is not compromised. ( see requirement). Work on the care planning review is in place. The new format is designed especially for service users with a designated dementia, and call for detailed history and good assessment of healthcare needs. The management are
The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 11 looking to adopt the format and process for all the service users to maintain continuity and consistency of assessment and recording. Service users or their representatives will be involved in the process and asked to sign the agreed plan of care. Key staff will also be asked to contribute. The revision and update of the plans is at an early stage and will be looked at in more detail at the next inspection ( see requirement) The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 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) 12,15 The home needs to make progress to improve the menu and meal planning for the home so that service users have a greater choice and control over their diet. The home has an activities programme in place to meet social and recreational needs of service users. EVIDENCE: Only two service users were asked about the menu and their choice of meals, and therefore acknowledged that the percentage of service users asked about meals is not representative of the home. Nonetheless, both service users said that they were not always aware of the menu or choice of meals available and could not recall what they had selected for lunch. The menu for the day is displayed on a board in the hall, otherwise staff will tell service users what the main meal of the day is to be. The chef has prior knowledge of service users likes and dislikes and will cater accordingly to their stated preferences. The management were asked to consider ways in which an alternative meal to the main meal of the day can be offered and also to look for ways in which the information about the menu can be accessed by service users or their representatives. High tea is the last meal of the day and is served between 4pm and 5.30pm and breakfast from 7.30am until 9am which means the interval between the
The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 13 meals is more than 12 hours which is too long (see requirement). The management and staff are attending training sessions about nutrition and catering for service users with a mental frailty and special dietary needs. There is a designated activities organiser, and regular group sessions are in place . A review of activities and recreational interests for the service users is to be carried out to incorporate and develop appropriate programmes to promote individual social activity as well as group sessions and outings. The review will look specifically at the needs and interests of those who are mentally frail ( see requirement). The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 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 has a satisfactory complaints process in place Information is on display and can be accessed by service users and their representatives. Adult protection training and knowledge of procedures is improving with evidence that staff are becoming aware of their personal role and responsibility in protecting service users from harm. EVIDENCE: The complaints procedure and correspondence ( forms and pre addressed envelopes) are on display in the home and can be discreetly and confidentially used by service users or their families. The management have dealt with three complaints recently, and two through the CSCI. Any action arising from the outcomes has been actioned and the management will be continue to monitor progress. A complaints log has also been instigated and any issues or concerns are recorded and maintained in chronological order. Three staff confirmed that they have completed adult protection training and were clear about their roles and responsibilities to protect service users from harm or abuse. Further training is being explored to include meeting the needs of those service users with recognised challenging behaviour through the application of good practice techniques. The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 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 standard(s) 0 This standard not inspected EVIDENCE: This standard not inspected on this occasion The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.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) 27,28 Progress is being made to promote the stability and skill mix and training of the staff group to establish and maintain the consistency of care in the home. EVIDENCE: The home employ a high number of staff from other countries with a care / nursing qualification. And the managers have recently reviewed the daily routines and practices to ensure there is a good skill mix of staff on duty each day. The staff seen on the day confirmed that the professional and working relationship between the staff has improved since the review and minor changes in the shift arrangements and routines. The managers are continuing to promote team building exercises through training and will be meeting with staff on a regular basis to update them on the progress of the building works and changes in the service provision at each phase of the project. From the duty rota provided on the day it showed sufficient numbers of care staff on duty to meet the numbers and needs of the service users. The care staff are supported by domestic, catering and administrative staff. The management team are reviewing the staffing levels and increase to meet the needs of service users with dementia as part of the project proposal. Three staff have completed NVQ training to level 3 and a further two staff will be considered this year. ( see requirement) The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.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) 32,33 The management need to promote the development plan and vision for the home and effectively communicate the plan to the service users, their representatives and the staff group. Arrangements for seeking the views of the service users and their representatives are in place, and the outcomes of the consultations are being acted upon. EVIDENCE: The home’s quality assurance survey was issued in April this year. Some of the initial comments have highlighted issues around food, activities and the need to have good communication systems between staff and relatives. The management are addressing the issues raised directly. The completed review and any agreed action will be made known to the service user and their relatives and to staff.
The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 18 The Manager and the Deputy manager direct care input has been reduced and they have been afforded designated days to monitor and oversee the new building project and set out the working priorities to meet the proposed changes in the service provision. The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.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 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x x x x x The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 20 yes 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 1 Regulation 4.1 &5.1 Requirement The providers must review and revise the statement of purpose and service users guide to include information about the changes in service provision in the home The providers and management must complete the assessments of needs of those service users with a designated mental frailty(acknowledged as work in progress) The providers and management must complete the review and revision of the care planning for all service users and especially those with assessed mental health needs.(acknowledged as work in progress) The providers and management must make adequate communal accommodation available to service users during the variation process and building changes. The providers must review and revise the social and recreational needs and wishes of service users to promote individual as well as group activities and interests including those service Timescale for action ongoing and by commissio ning date for building. ongoing and by 31st May 2005 ongoing and by 1st August 2005 2. 3 14 3. 7 15.1 4. 10 12.4a 23g ongoing and throughout building process. ongoing and by 30th September 2005 5. 12 16.m&n The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 21 users with a mental frailty. 6. 15.3 &7 16 The providers and management must ensure that information about meals and meal choices are clearly stated on the menu and that service users receive the information in a format to suit them. The interval between the last meal of the day and the breakfast meal should be shortened. The providers and management must continue to promote and provide training opportunities for staff to undertake NVQ training at all levels. immediate and by 31st May 2005 7. 28 19 immediate and ongoing. 8. 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 32 Good Practice Recommendations It is recommended that the management group meet regularly with staff, service users and their representatives to keep them informed abouit the building project and the changes in the service provision for the home. This will promote a clear sense of direction and encourage involvement and commitment and a positive interest in what is happening in the home. The Paddocks I55 s27321 The Paddocks v217084 (an) 030505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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