CARE HOMES FOR OLDER PEOPLE
The Seaton The Old Manor Fore Street Seaton Devon EX12 2AN Lead Inspector
Michelle Oliver Unannounced Inspection 11th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Seaton DS0000061080.V256908.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 Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Seaton Address The Old Manor Fore Street Seaton Devon EX12 2AN 01297 20882 01297 625175 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) Southern Healthcare (Wessex) Ltd Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A person meeting the criteria for registration as a manager under the Care Standards Act 2000, as described in Standard 31 of the National Minimum Standards for care homes for older people, must be appointed and an application made for their registration within three months of the date of registration of Southern Healthcare (Wessex) Ltd as owners. 7th June 2005 Date of last inspection Brief Description of the Service: The Seaton is a detached Georgian building standing in it’s own grounds, situated in a residential area close to Seaton town centre. The Home is accessible to the local community and provides car-parking facilities to the front of the property. Accommodation is provided on two floors with lift access to the first floor. There are two platform lifts which provides level access within the home. The home provides a lounge and separate dining room. There is an extension, which provides a lounge, with dining area, which looks out onto a decked area and well maintained garden. The Seaton provides nursing and personal care to up to 31 older people. The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Tuesday 11th October 2005 over a period of six and a half hours. A manager has recently been employed at The Seaton and was present throughout the inspection. The provider visited the home during the visit and discussed plans for continued improvement at The Seaton. Four members of staff and fifteen were observed or spoken with. A number of records were inspected including residents plans of care, fire log book and staff files. What the service does well: What has improved since the last inspection? What they could do better:
Risk assessments must undertaken before bed rails are used to ensure that there use is appropriate, and whenever possible the resident should be consulted before they are used. Recording, handling, safekeeping, safe administration and disposal of medicines into the care home are not managed well. All handwritten entries should be signed and dated by the person making them and then checked and signed by a second person [this is the 3rd time this recommendation has been made]. Medication is being used for a person other than the person it was
The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 6 originally prescribed for. Medicine is not consistently being disposed of when it is no longer required by a resident. This lack of attention to proper management of medicines has significant potential to harm residents. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the dignity of service users. Not all residents’ dignity is being respected at all times. A bathroom door is not lockable, putting residents at risk of having their privacy compromised. The recruitment procedures at the home are not robust and do not properly protect residents from the risk that inappropriate staff are recruited. Individual plans of care do not provide staff with the information they need to ensure that all aspects of health, personal and social care needs are met. Fire equipment and emergency lighting is not being tested at the recommended time intervals. Two doors were wedged open at the time of the visit putting residents, staff and visitors at risk in the event of a fire at the home. The home needs to complete the almost finished project to cover all radiators so that residents are properly protected from the risk of burns. 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 Seaton DS0000061080.V256908.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 Seaton DS0000061080.V256908.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 1 Residents are provided with sufficient information about the home before making a decision to live there. EVIDENCE: A recommendation was made at the time of the last visit that the statement of purpose should include details of areas of the home which would be unsuitable for residents with limited mobility. This is now clearly explained in the statement of purpose. The Seaton DS0000061080.V256908.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): OP 7, 8, 9 & 10. Not all aspects of residents’ health social and personal care needs are identified and planned for. Medication receipt and administration at the home is not well managed. EVIDENCE: All residents at the home have individual plans of care. The format for the recording of information has been redesigned since the last visit. Four care plans were looked at in detail during this visit. None included any past social history or activities or hobbies that residents may have enjoyed before living at the home and would wish to pursue. Personal goals were vague and there was no record of monitoring as to how these could be met and whether they had been met. It had been assessed that some residents needed help with personal care but no guidance as to how these would be met had been included in the plans. Bed rails had been attached to a residents bed, the son and GP had been involved in this decision but there was no evidence of the resident having been consulted. There was no evidence of an assessment of the risks which bed rails present being undertaken before this decision was reached. Information about individual relevant medical conditions was not comprehensive.
The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 10 A monitored dose medication system is used at the home. A record is kept of all medication received at the home. Hand written instructions on medication administration charts had not been witnessed and in one case had not been signed at all. Codes had not been entered on medication administration charts to indicate why a medicine had not been given. The procedure for recording controlled drugs was incorrect and inaccurate. A medicine prescribed for a resident who no longer lives at the home had not been returned to the pharmacy and was being used for another resident. A medicine that was prescribed to be given on alternate days had been given daily. Medication for one resident had not been stored securely. Throughout the inspection staff were seen to address service users in a respectful and friendly manner. A resident in the lounge was distressed at not being able to call staff to assist her to the toilet. She said that she always has to call for help and that she is not given a call bell. Another resident in the lounge has a bell and usually rings when she asks. She said, “It isn’t right, you always have to ask. I get worried that I will have an accident, it’s not dignified”. A bathroom door on the first floor has not been fitted with a lock which could compromise residents’ right to privacy and dignity being respected. The Seaton DS0000061080.V256908.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): OP 12, 13, 14 & 15. Social activities are well managed, providing daily variation and interest for residents. Residents are encouraged to maintain contact with their families or friends as they wish. A varied balanced diet is provided served in a pleasant atmosphere. EVIDENCE: Residents said that they were able to choose their own clothes. None of the residents spoken to were involved in local social and community activities. The daily routine, including mealtimes, appeared to be flexible however residents’ interests and preferences had not been consistently recorded. A programme of activities is posted on a notice board at the home. Residents care plans include a record of activities undertaken by residents. Residents are given the choice of whether they take part or not. A resident said they are encouraged and supported to pursue their religious observances and that members of the church are always made welcome when they visit the home. The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 12 All residents said that they enjoyed the meals at The Seaton. The food on the day of the visit looked appetising and was well presented in friendly comfortable dining rooms. Dining tables have been laid with co-ordinating tablecloths and attractive cutlery and crockery. Residents were told what was on the menu and they were able to make a choice. The mealtime was unhurried, residents were assisted discreetly and all enjoyed the meal. The home caters for all dietary needs including vegetarian and diabetics. Fresh vegetables are used as often as possible. The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 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): Op18. Service users are properly protected from the risk of abuse by well-informed staff. EVIDENCE: Staff could identify forms of adult abuse and all said that they would challenge and report any poor practice. Two recently recruited carers spoke about the training they had received. There was no evidence to suggest that residents were anything but well cared for at the home. The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 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): Op19 A comfortable standard of accommodation is provided for the residents. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The home offers two lounges and a dining room. Residents’ rooms were personalised with sentimental items, photographs and small pieces of furniture and all expressed their satisfaction with the accommodation provided. The home has an accessible garden which is well maintained. The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 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): OP27, 29 & 30. The numbers and skill mix of competent staff are sufficient to meet residents’ needs. The procedures for the recruitment of staff do not provide safeguards for the protection of people living in the home. EVIDENCE: Staffing levels were satisfactory on the day of the inspection and consisted of the manager, a registered general nurse, 5 carers (2 of which were “shadowing” the experienced carers as they had been recently employed at the home), a cook, housekeeper and a maintenance person. Residents confirmed that staff were kind and helpful. Domestic and other ancillary staff are employed in sufficient numbers to ensure that standards relating to food, meals and cleanliness are maintained. The manager said that the home is currently seeking to employ two additional members of care staff. Three staff recruitment files were looked at including two of the most recently employed staff. None of them were complete. None of them included a current up to date police check or POVA check, one did not include a copy of the employee’s birth certificate, and only one reference had been obtained for one staff member. This was discussed with the administrator. Two recently employed staff spoke about their induction training since being recruited. A record is kept of all induction training and is signed by trainer and trainee. In house training has been provided including a video on the protection of vulnerable adults, fire training and a fire drill. During the visit both staff were seen familiarising themselves with the homes’ policies and individual residents’ care plans. Both said they wanted to undertake NVQ
The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 16 training. One is considering undertaking nurse training. They said “ to see an elderly lady smiling makes me warm inside, if I’ve made someone smile then I’ve made a difference” The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 38. Some management duties are not being properly attended to, putting staff and others at potential risk. EVIDENCE: The Registered provider visits the home regularly but has not submitted monthly reports of his inspections to the CSCI. Records indicated that regular safety and fire checks are not being carried out. The most recent weekly fire alarm check was carried out on 20.07.05. Emergency lighting, which should be checked monthly, had not been tested since 08.06.05. All staff have attended fire training the most recent being held on 27.09.05. Two bedroom doors were wedged open at the time of the visit. Work is continuing to cover all radiators in the home. The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 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 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 1 The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 13[4][c] Requirement Timescale for action 2 OP9 13[2] The registered person shall ensure that unnecessary risks to 11/11/05 the health and safety of service users are identified and as far as possible eliminated. [This relates to no assessment being undertaken before bed rails were used] The registered person shall make arrangements for the recording, 11/11/05 handling, safekeeping, safe administration and disposal of medicines into the care home. The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the 01/11/05 dignity of service users. [this relates to a resident in the lounge being distressed at not being able to call staff and a bathroom door not being lockable] The registered shall not employ a person to work at the care home unless he has obtained the 01/11/05 information and documents specified in Schedule 2
DS0000061080.V256908.R01.S.doc Version 5.0 Page 20 3 OP10 12[4][a] 4 OP29 19[1][b][ 1] The Seaton 5 OP38 6 OP38 23[4][c][v The registered person shall make adequate arrangements for reviewing fire precautions and 11/01/05 testing fire equipment at suitable intervals. [This relates to fire alarms and emergency lighting regular tests not being maintained] 23[4][c][ The registered person shall make 1] adequate arrangements for containing fires. 11/10/05 [This relates to doors being wedged open at the home] 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 service user plan should include in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service users are met. To protect the individual making the entry, and the service user, all handwritten entries should be signed and dated by the person making them and then checked and signed by a second person.[ this is the 3rd time this recommendation has been made] Medications should only be used for the person they were prescribed for. Medications should be disposed of when no longer required. Work undertaken to cover all radiators at the home should be continued until work complete. 2 OP9 3 4 5 OP9 OP9 OP38 The Seaton DS0000061080.V256908.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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