CARE HOMES FOR OLDER PEOPLE
The Salisbury 20 Marine Crescent Great Yarmouth Norfolk NR30 4ET Lead Inspector
Hilary Shephard Unannounced Inspection 6th October 2005 10:20 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 Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Salisbury Address 20 Marine Crescent Great Yarmouth Norfolk NR30 4ET 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) 01493 843414 Dr Suman Nagpal Dr Sunita Nagpal, Dr Surrinder Batra, Mrs Indira Batra Christine Horner Care Home 26 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (26), of places Physical disability (1) The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Twenty six (26) older people of either sex may be accommodated, to include: One (1) Service User with a physical disability, who is under 65 years of age and is named on the records held by CSCI, may also be admitted at any time provided care needs have been assessed and these can be met at The Salisbury. No other person under the age of 65 years is to be admitted. One (1) Service User with dementia, who is named on the records held by CSCI,may be accommodated provided care needs have been assessed and these can be met at The Salisbury. No other person with a diagnosis of dementia is to be admitted. To accommodate no more than twenty-six (26) people in total. 2. Date of last inspection 23rd June 2005 Brief Description of the Service: The Salisbury is a care home providing care and accommodation for up to 26 older people and is situated approximately one mile from the centre of Great Yarmouth. Accommodation is provided on two floors and there are 16 single bedrooms, four with en-suite facilities, and five shared rooms. There are two lounges and a dining room and a pleasant secure garden to the rear of the building. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over 6 ¼ hours during which time the inspector spoke with 5 residents and 2 staff. Five comment cards were received from relatives and these along with the views of residents and staff, where appropriate, are reflected in the findings in the report. A tour was made of the building including some of the bedrooms, and the inspector also looked at samples of care plans, staff files, records of residents’ finances, staff training and safety. At the end of the inspection feedback was given to the member of staff in charge. A total of 5 requirements and 1 recommendation were made as a result of this inspection. The proprietors wish to register the home to accommodate an agreed number of people with dementia and the inspector has been involved in providing advice and guidance regarding the homes suitability to provide such a specialist service. An unannounced visit regarding this was made to the home on 8th September 2005 and the proprietors now intend to apply to vary the conditions of the homes registration. The home is currently without a registered manager as the manager recently resigned. The home is being managed by the deputy manager who is overseen by one of the proprietors. What the service does well: What has improved since the last inspection?
Care plans have improved significantly since the previous inspection and recent unannounced visit. They are more detailed and contain lots of very good information about the residents’ family history. The care plans have also been organised better, recorded information is clearer and they are easily available to staff. Basic care plans are also completed for residents staying on a temporary basis. Staff are also using the care plans at handover time indicating that these are being used to inform staff of residents needs.
The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 6 Doors that residents like to be kept open have been fitted with proper safe closures to prevent them from being wedged open, improving residents’ safety. Six care staff have undertaken a half days dementia care training covering the very basics of dementia care and some, but not all, demonstrated a good understanding of caring for people with dementia. Staff have also completed training in the protection of vulnerable adults and expressed their views very clearly about protecting the residents from harm. 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 Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 the following standard(s): Standard 6 Residents admitted for intermediate care have their needs identified and guidelines are put in place for staff to follow. EVIDENCE: There were two recently admitted residents receiving respite care, and staff were putting together a plan of care for both of them. The care plans were basic and contained brief assessments, but had guidelines for staff enabling them to meet their needs. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 the following standard(s): Standards 7, 9 and 10 Care plans have improved significantly, but do not contain enough detail about residents need for occupation. Medication Administration Records (MAR) were still not being completed correctly indicating that medication may not be administered properly. Residents felt their privacy and dignity is respected. EVIDENCE: Care plans were inspected and have improved a great deal since the previous inspection. Staff have worked with the residents and their families to complete really good, informative life stories for each person. Information from this is being used in the guidelines for staff enabling the care provided to be more individualised. Guidelines for staff were clearer, more detailed and up to date, however information regarding the residents needs for meaningful occupation was omitted although staff were very aware of residents’ individual needs and were helping them to become occupied and feel valued. Staff were also using the care plans to handover information to the staff on the afternoon shift indicating proper continuity of care was taking place. Assessments of nutritional needs have been completed but these have not been dated making them difficult to use as a baseline observational tool.
The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 10 Medication was checked which was not always being booked in correctly, the MAR sheets contained some gaps, with some medicines remaining in the blister packs. Administration codes were not being used correctly making it difficult to see if the resident had received the medication, or the reason why the medication had been omitted. Requirements and recommendations have been made regarding care plans and medication. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 the following standard(s): Standards not assessed at this inspection. EVIDENCE: The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 the following standard(s): Standards 16 and 18 The home has a satisfactory complaints procedure, residents feel that their concerns are acted upon and they feel safe. Staff have a good understanding about reporting issues and make every effort to protect residents from harm. EVIDENCE: The home displays its complaints procedure in the front hall, however two comment cards out of the five received from relatives indicated that they were not aware of this procedure. Staff advised that they have had training in the protection of vulnerable adults and were able to explain the correct reporting procedure. Residents said they felt safe and well cared for and would speak to a member of staff if they had any concerns. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 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 the following standard(s): Standards not assessed at this inspection. EVIDENCE: The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 14 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): Standards 28, 29 and 30 Staffs knowledge of basic care practice has improved and NVQ qualified staff are available on most shifts. Recruitment practices have not improved, and are not thorough enough to completely protect residents from harm. EVIDENCE: Two staff are qualified to NVQ level 2 and the deputy manager has NVQ level3 and where possible staff cover different shifts. Two staff are due to commence NVQ level 2 shortly. Most staff have completed updates in basic care practices and other mandatory training in safe working practices. Staff have also undergone a short training session about dementia care. A requirement has been made regarding NVQ training. Files of new staff were inspected and were not satisfactory. One file contained a “to whom it may concern” reference, which is unacceptable. Another indicated that a member of staff had commenced without the home receiving a satisfactory check on the Protection of Vulnerable Adult (POVA) register or two written references. The home must improve its recruitment practices, as residents are not being properly protected. A requirement has been made. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 15 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): Standards 31, 33, 35, 36 and 38 Although the managers position is vacant, the deputy manager is managing the home well. The safety of the environment has improved and residents’ benefit from the home monitoring and measuring the quality of service provided. Residents’ finances are being managed safely. Staff have not been receiving formal supervision, and this is impacting on their knowledge and understanding of the care to be provided. EVIDENCE: The home undertakes a yearly quality survey involving residents and relatives, and the report following the one in March 2005 indicated that residents and relatives’ views are listened to. Five comment cards have been received by the Commission from relatives, which indicated that all except one person was satisfied with the care provided. The homes records of money kept for residents were inspected and were satisfactory.
The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 16 From observation of the interaction between staff and residents, it was clear that some staff work well with the residents and others need more support and guidance. As the manager has recently left the home, formal staff supervision has not been taking place. A requirement has been made regarding supervision. A brief tour of the premises was undertaken, and the work required to be undertaken on wedging open doors in two previous inspections had not been carried out. However, staff advised that this was due to take place the following day, and one of the proprietors contacted the Commission to advise that the fitting of special door closures has now been carried out. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 17 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? One STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The Registered person must ensure that care plans contain assessments of the residents need for activity and meaningful occupation and guidelines detailing how these are to be met. Timescale for action 30/11/05 2 OP9 13 The Registered person must 30/11/05 ensure that the correct codes are used on the MAR sheets, that gaps do not occur and that all medication is booked in properly. (Deadline of 23.6.05 not met) 3 OP28 18 4 OP29 17, 19 The Registered person must 31/12/05 ensure that a minimum of 50 of care staff have, or are working towards NVQ level 2 (minimum) by the end of December 2005. The Registered person must 06/10/05 ensure that staff do not commence unless: • Two satisfactory written references are received, none of these are “to whom it may concern” references, and at least one must be from their previous employer.
DS0000027419.V249307.R01.S.doc Version 5.0 Page 19 The Salisbury 5 OP36 18 A satisfactory check has been made on the POVA register and the staff is supervised until a satisfactory CRB is received. The Registered person must ensure that staff receive formal supervision at least 6 times per year commencing 1st December 2005. • 01/12/05 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 OP7 Good Practice Recommendations The Registered person should ensure that all nutritional assessments are dated. Repeated recommendation. The Salisbury DS0000027419.V249307.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Norfolk Area Office 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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