CARE HOMES FOR OLDER PEOPLE
The Paddocks Springfield Road Wellhead Near Dunstable LU6 2JT Lead Inspector
Leonorah Milton Unannounced 7th June 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 Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Paddocks Address Springfield Road Wellhead Near Dunstable LU6 2JT 01582 601317 01582 673287 kenjanes@supernet.co Mr Kenneth Janes and Mrs Lilian Janes. 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) Mrs Lilian Janes Care Home 10 Category(ies) of OP Old Age - 10 registration, with number PD(E) Physical Disability over 65 - 10 of places DE(E) Dementia over 65 - 10 The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 02.12.04 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 disabilties 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. 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 locaqted on the ground floor as was the kitchen. These areas of the building had been well maintained and were well decorated and furnished. 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. 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. The rear of the property overlooked an attractive garden and extensive other grounds used to grow vegetables and fruits for the home.
The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 4.45 hours with the assistance of Mrs L Janes, co-owner who was also the registered manager, Mrs K Janes, service manager and a senior care assistant. The inspection took account of the care records for two service users, a review of sundry other documents, discussions with three service users, a member of staff, a visiting healthcare specialist and both Mrs Janes. A partial tour of the building was carried out. What the service does well: What has improved since the last inspection?
The records to identify service users’ needs and how these will be met had been completed in more detail recently. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 6 Records indicted that staff training had improved but also that there were some gaps to essential training. It was explained however that further training was scheduled. 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 I51 S14943 Paddocks V223176 070605 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 I51 S14943 Paddocks V223176 070605 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) 1,2,3,4, Satisfactory arrangements were in place to enable prospective service users to make an informed choice about moving into the home and to ensure that the home could meet the needs of those admitted to the home. EVIDENCE: There had been no changes to the written guidance to the home that had been previously assessed as satisfactory. Random case files were reviewed and showed that individual contracts were in place to identify the terms and conditions of residency. Records of pre-admission assessments of need showed that the home had obtained sufficient information to determine that the home had the capacity to meet needs. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10. Written guidance provided a detailed assessment of need for each individual and the arrangements to meet those needs. EVIDENCE: Care planning documentation had continued to improve. Whilst some records were a little brief they had taken account of the details specified by the National Minimum Standards for inclusion in care planning processes. Those completed more recently were more detailed. It was explained that all plans would be reviewed against this standard in the near future. This review should ensure that limitations to personal autonomy and freedoms such as the inability to manage money and hold keys to bedrooms are recorded. Documents should include signed consent for the use of bedrails. The records assessed showed that the home had made referrals as appropriate to meet service users’ routine healthcare needs and to specialist services as required. An assessment of skin care was in place for the less mobile. A service user confirmed that she had been able to consult with her General Practitioner when she was unwell. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 10 Service users were observed to receive chiropody services in the conservatory. The practitioner stated that he treated service users in the privacy of their rooms if this was their preferred choice. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 11 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) 12,13,14 A flexible approach to daily routines had enabled service users to have a lifestyle that suited their preference. EVIDENCE: Two service users preferred to remain in their rooms, and took some of their meals in their rooms. These preferences had been accommodated but care also had been taken to ensure that these people had not become isolated. Members of staff were observed to go into one person frequently to engage her in friendly conversation. One service user was reluctant to take his meals with the other service users but still wished to eat in the dining room. It was noted that the service user was served his meal at a different time to others to respect his wishes. Service users were engaged in personal hobbies such as reading and knitting but were also provided with sufficient divisional activities for stimulation. It was noted that the television did not dominate the lounge as can be usual in residential homes. It was not switched on until the late afternoon. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 12 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 was conducted in an open and inclusive manner so that service users could readily voice their concerns. EVIDENCE: The complaint procedure was advertised in a prominent position in the hallway that service users passed by each day on entry to the dining room. There had been one complaint that was had been speedily investigated and found to be a mistake on the part of the service user. The proprietors lived on the premises and were very involved in the day-to-day running of the home. In her dual role Mrs Janes had adopted a hands on approach that enabled service users to talk to her each day. Key personnel had been provided with training in procedures for the protection of vulnerable adults. The member of staff spoken to at the inspection showed an understanding of these procedures. The sequence for reporting of allegations of abuse and who was responsible for investigating these was not completely known. Staff left in charge of the home must be made aware that serious allegations are notified to the Local Authority and that the home must not initiate any investigations. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,23,22,23,24,25. The home, with some omissions, provided suitable accommodation to meet service users assessed needs. EVIDENCE: The premises had not been assessed by an occupational therapist but appeared to have been suitably adapted to meet the needs of its frail occupants. The building had retained much of the appearance of its former use as a family home. The areas of the main building seen at this inspection were clean, orderly, well decorated and furnished. Service users evidently derived a great deal of pleasure from the countryside views and the welltended garden. Three remaining uncovered radiators had been covered to prevent the risk of accidental burn since the previous inspection. Hot water supplies continued to be a little problematic. At the previous inspection the delivery of hot water supplies to one bedroom had been too
The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 14 cool. At this inspection that issue had been solved but the hot water supply to a toilet facility was cold. It had been noted at the previous inspection that the laundry and other facilities housed in outbuildings had been linked to the home by a corridor that had been constructed since the preceding inspection. The requirement from the last report to agree safety arrangements in these areas with The Fire Service and the Environmental Health Services had not been met The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 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 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) 27,28,30 Whilst the staff presented as caring and skilled there were gaps in their knowledge that could result in a lack of awareness about service users’ needs and how these could be best met. EVIDENCE: Records indicated that sufficient personnel were rostered to meet service users’ needs. However, although there had been an improvement in the provision of training there had been none in relation to understanding and meeting the needs of those with dementia. This gap in the training provision had been somewhat offset by the culture of kindness within the home that was sensitive to the needs of the more vulnerable service users. Future training plans were discussed and included plans for two members of staff to enrol on NVQ courses in care at level three and three to enrol at level two. One member of the team had already achieved an NVQ at level two and another had also achieved this award and an NVQ in management at level four. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 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 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) 31,33,36. The collective approach of the proprietors and the service manager had ensured that the home had been operated in the best interests of service users. EVIDENCE: As indicated by the judgement above there had been a united approach by Mr and Mrs Janes and their daughter–in- law to the management of the Paddocks. Both Mrs Janes were qualified in the care and management of residential care services. When assessed for the outcomes for service users this approach had resulted in positive results. When assessed against the manager’s responsibility it was evident that Mrs L Janes had been gradually relinquishing her manager’s role to others. She had stated her intention of retiring at a previous inspection. This situation must be regularised. The manager is legally accountable for the day-to day operation of the home. The proprietors are therefore urged to
The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 17 ensure that the person managing the home is fully aware about the development of care plans, the development of staff and the implementation of quality assurance programmes. All of these were in hand but had been instigated or overseen by others. Record keeping was of a good standard but there were some omissions to confidentiality with regard to accident records and the district nursing notes that had been left by nurses in service users’ rooms. The manager agreed to take action on these. Records indicated the management of fire safety was satisfactory. Staff had received training from a retired Fire Officer. There had been a lapse however in the requirement to carry out bi-annual fire drills, the last record of such dated 14.02.04. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 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 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 3 3 2 3 3 2 x STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 2 x x x 2 2 The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 19 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 18 Regulation 13(6) Requirement Timescale for action 31.08.05. 2. 19 13(4)(a) 3. 25 23(2)(j) 4. 30 18(1)(a) The registered person must ensure that staff are briefed about the Local Authoritys procedures for reporting and investigation of allegations of serious abuse. 31.08.05 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 timescale of 31.01.05 had not been met). The registered person must 14.07.05. provide sufficient supplies of hot water to hot water outlets throughout the home at temperatjures that are not too cool but that do not exceed 43 degrees centigrade to service users facilities. Staff must be trained in 30.09.05 understading the needs of those with demenntia and how these
Version 1.30 Page 20 The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc can be met. 5. 31 10(1) The person managing the home must demonstatrate that they are aware of the day-to day operational issues. Each member of staff must attend a fire drill. These must be carried out twice each year thereafer 31.10.05. 6. 38 23(4)(e) 31.07.05 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 22 Good Practice Recommendations The registered person should arrange for the premises to be assessed by a qualified occupational therapist. The Paddocks I51 S14943 Paddocks V223176 070605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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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