Inspection on 08/06/06 for The Seymour

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Seymour 29/08/07

The Seymour 09/03/06

The Seymour 04/08/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Seymour The Seymour 327 North Road Clayton Manchester M11 4NY Lead Inspector John Oliver Key Unannounced Inspection 8th June 2006 10:00 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 Seymour DS0000063622.V298914.R01.S.doc Version 5.2 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 Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Seymour Address The Seymour 327 North Road Clayton Manchester M11 4NY 0121 308 4180 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) The Seymour Home Limited Mrs Susan Jones Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 26 older people (OP) may be accommodated. The staffing arrangements at the home at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum,`Care Staffing in Care Homes for Older People`. The home must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 9th March 2006 3. Date of last inspection Brief Description of the Service: The Seymour is a privately owned residential home providing personal care for up to 26 older people. The home is located in Clayton, north of Manchester City Centre and is close to public transport links into Manchester, Oldham, Droylsden and Ashton. Bedroom accommodation is provided on the ground and first floors accessed via a passenger lift. Sufficient toilet and bathing facilities were provided within close proximity to bedrooms and communal areas. Accommodation is provided in 18 single rooms and 4 double rooms. Three of the single rooms were fitted with en-suite facilities. Wheelchair access is provided and there is parking space to the front of the building. There is a large rear garden that is pleasant for residents who are able to sit out in the warmer weather. The current range of accommodation fees charged is between £358. 09 and £373. 54. Those items not included in the fees are: Newspapers, hairdressing, private treatments, some transport costs and some entertainment costs (such as trips to theatres etc). A full range of ‘extras’ charged for are included in the ‘Terms and Conditions of Residence’ provided to all residents on admission. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was conducted on 8 June 2006. Conversations were held with a number of residents, care staff, the manager, the owner and relatives of one resident who were visiting the home at the time. Various records were examined, including care plans and personnel files. Information about the home was also provided in a written questionnaire that had been completed by the manager and a number of questionnaires that residents had completed about the service they receive in the home. This information helped to provide a ‘picture’ of the services available and offered by the home. What the service does well: The management and staff of the home work hard to promote equality by treating people as individuals with individual choices and needs whilst ensuring that diversity issues such as mobility are appropriately met. Residents and relatives confirmed that care staff are kind and are always responsive to meeting individual’s needs. The manager sees training as a priority and all staff have been supported to maintain regular and updated training in various courses that are appropriate to the work they carry out. It is commendable that the home is working towards obtaining the ‘Investors in People’ (IIP) award and has to date, completed 16 of the 18 workshops that have to be done before an assessment can be carried out to see if the home has achieved ‘IIP’ status. The assessment is due to take place in September 2006. Residents’ relatives said that they are always made to feel welcome when visiting the home and confirmed that staff let them know if they have any concerns or worries about their relative. Staff were seen to talk with residents’ in a respectful manner and relationships between residents and staff appeared relaxed and friendly. Some of the comments made by residents spoken with during the visit included: * * * * “Staff are good” “We have a good time here” “Food is very good” “Staff look after me well” DS0000063622.V298914.R01.S.doc Version 5.2 Page 6 The Seymour * * “Staff are really good” “Sue (manager) and Mr Patel (owner) are friendly and treat you like a person”. 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 Seymour DS0000063622.V298914.R01.S.doc Version 5.2 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 Seymour DS0000063622.V298914.R01.S.doc Version 5.2 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): 1,2,3,4,5, and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Information is available to inform prospective residents and their relatives about the services offered by the home and to help make an informed choice about where to live. Systems are in place to ensure needs can be identified and appropriately met. EVIDENCE: Since the last inspection the Statement of Purpose and Service User Guide had been updated to ensure information was current and related to the service(s) offered by the home. This gave the prospective resident and their family an opportunity to make some informed judgements about the home prior to any admission taking place. Files of three residents were examined and these included two residents who had recently been admitted to the home and one resident who had lived at the home since 1998. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 9 Care manager assessments of needs were in place and the home conducted an in-house assessment of needs and these were found to be in place on the two files of the most recently admitted residents. Risk assessments were in place for a number of identified risks. Although both the assessment and risk assessments were good, not all information had been fully completed on both documents. This could lead to some needs not being fully met. Trial visits continue to be offered by the home and on the day of the visit one prospective resident was spending the day to see if the home was appropriate to meet their needs and to see if they liked it. The home did not offer an intermediate care service. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents and their families were confident that the home would meet the individual healthcare and personal needs of the people living in the home. However, some further work was needed to care plans and medication procedures used. EVIDENCE: Two care plans were case-tracked during the visit. Care plans had been developed from the information provided and contained within the care management assessment of needs and the home’s own pre-admission assessment of needs. However, plans were inconsistent in their content and did not always clearly explain how staff should meet identified needs. Daily records kept on each resident did not clearly link the care support given to the individual needs identified in the care plan(s). The relative of one resident who had lived in the home for a number of years praised the high standard of care that the home provided and said, “Mum is very well looked after, we couldn’t ask for more. She is always clean and tidy The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 11 and the staff keep us informed of how she is when we visit or by ‘phone. The staff are kind and considerate, they know each resident in the home and what they need”. Residents and relatives spoken to confirmed that people living in the home were always treated with dignity and respect. The management and staff have developed good relationships with other healthcare providers such as the Elderly Dementia Intervention Team (EDIT), who monitor and assess residents who may be referred to them by the home. This is an area of good practice that demonstrates the importance the home places on the personal welfare and comfort of the residents. The home’s system of medication was examined. Since the last inspection the home had changed the supplying pharmacy. The system used is a Monitored Dosage System (MDS) and staff with the responsibility for administering medication had received training in the new system from the pharmacy. Staff were also undergoing more in-depth training on medication/practices from a training consultant. Medication Administration Records (MAR) were examined and a number of signature errors were noted. Discussion with the member of staff administering medication explained that the new MAR’s were not very clear and this was causing some confusion as to where staff should sign. Examination of the MAR’s did indicate that some errors had occurred from the supplying pharmacy regarding some of the details stated. The manager said that she would contact the pharmacy and ‘work through’ each MAR to ensure details were correct and that residents were not placed at risk of errors occurring because details are incorrect. Some medication that is to be given ‘as and when required’ such as Paracetamol could not easily be checked as no ‘audit trail’ was kept. This could lead to errors occurring and place residents at risk. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. People living in the home are treated as individuals and their likes, dislikes and preferences respected. EVIDENCE: There was evidence that some activities were being provided for residents both individually and as a ‘group’. On the day of the visit and as the inspector arrived at the home a number of residents were going to the local church to attend a ‘bring and buy’ sale. One resident asked a member of staff “Can you please water my plants whilst I’m out – it’s very warm”. This demonstrated that staff supported residents to maintain a lifestyle that meets their individual choices/preferences. Various other activities were available throughout the week although these seem to be limited to the availability of the staff. However, discussion with the manager confirmed that she was hoping to employ an ‘activities organiser’ who would work at least 18 hours per week to support staff and development the programme of activities available in/out of the home. A further area for development is the recording of residents’ daily living activities and their The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 13 outcomes. Daily records lacked information and detail to provide evidence that residents lead fulfilling lives according to their assessments of need. The home supported and encouraged residents to maintain contact with their relatives and friends and those relatives spoken with during the visit confirmed that they always felt welcome in the home and that staff “always make sure that our mum has everything that she needs”. Residents told the inspector that the standard of the food provided in the home was very good and that choice was always available. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 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 the following standard(s): 16,17 and 18 Quality in the outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure that concerns would be addressed in an appropriate manner and that residents would be protected from harm. EVIDENCE: The home maintained appropriate systems for dealing with complaints although no complaints had been received since the last inspection. As previously mentioned in this report residents and relatives, who were spoken to, confirm that staff are always available to listen to any concerns and to keep relatives informed where necessary. Discussion with the manager confirmed most residents used postal votes during the recent Local Government Elections and this was confirmed by a number of residents spoken to. One resident said that two representatives from local parties visited the home canvassing for votes. This demonstrated that the home helped to maintained the individual rights of the person. Robust procedures were in place to ensure that the people living in the home were protected from harm. Since the last inspection the policy had been updated and staff had received training in the protection of vulnerable adults and further training sessions were planned. Staff spoken with clearly understood what the protection of vulnerable adults means and knew how to follow the homes policies and procedures relating to The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 15 this matter. One member of staff confirmed they would have no hesitation in using the whistle blowing procedure if needed. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 16 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): 19,20,21,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a suitable and well-maintained environment in which to live. EVIDENCE: Since the inspection conducted in March 2006 one bathroom in the home has been fully refurbished and a new ‘medi-bath’ and shower have been installed. This should make it easier for those residents with limited mobility that may find using a conventional bath difficult. There had been a water leak through the ceiling in the bathroom opposite room 9. The manager said that arrangements had been made for tradesmen to provide quotes for carrying out the repairs. This must be done to ensure the safety of residents who may use that bathroom. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 17 A number of recommendations were made to the manager during the tour of the premises regarding the renewal of some fixtures and fittings. The pathway around the rear garden was uneven in places where the paving stones had ‘sunk’. As this area is used a lot by residents during the nicer weather these paving stones must be re-laid to ensure that the potential tripping hazard is minimised for the residents. Equipment used in the home had been maintained on a regular basis and the home was found to be clean and hygienic. However, there was evidence that the small wash hand basin provided in the laundry room for staff to wash their hands after dealing with soiled linen was not used. Staff not adhering to procedures relating to control of potential infections could place themselves and residents at risk. Discussion with the manager confirmed that all staff had received training in the control of infection. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 18 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): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and knowledgeable team of care staff meets residents’ personal care needs. EVIDENCE: The home’s staffing rota provided evidence that sufficient staff were being deployed to meet the assessed needs of residents. The rotas also identified the hours worked by the registered manager and it is commendable that the ‘First Aider’ and ‘Health & Safety officer’ are identified for each ‘shift’. Staff training is seen as a priority by the proprietor and the registered manager and evidence in the pre-site visit questionnaire provided to CSCI confirms that 19 care staff have attained the National Vocational Qualification (NVQ) at Level 2 and four care staff have also attained NVQ Level 3. One personnel file was examined and found to contain the required information relating to pre-employment checks and evidence of training undertaken by individual members of staff. It is commendable that the home is working towards the Investors In People (IPP) Award and has completed 16 of the 18 workshops required before the The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 19 final inspection of the service is carried out in September 2006 by the IPP assessment board. Staff had completed mandatory health and safety updates in Manual Handling, Food Hygiene and First Aid. In conversation with staff it was evident that they possessed the knowledge, skills and experience to meet the assessed needs of people living in the home. Residents and relatives’ spoken with during the visit also confirmed that staff were skilled and knowledgeable. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 and 38 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff were benefiting from the ethos of the home, which was further developing in ensuring a positive and inclusive management style was adopted and maintained. EVIDENCE: Since the last inspection was carried out in March 2006 there have been positive improvements in the way in which the home is managed. The registered manager was able to demonstrate that she was providing leadership and guidance to the care staff on a daily basis. This had not only created learning opportunities for staff but has also created a noticeably improved positive and open atmosphere within the home. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 21 It is commendable that the provider of the home is currently working towards obtaining the Registered Managers Award and other training specific to the management and care practices carried out in the home. Additionally, the manager had enrolled on numerous courses of study to support her in the management of the home. Evidence was on file that the proprietor carries out regular unannounced visits to the home and produces a report of one of these visits. Residents, visitors and staff confirmed that the proprietor was in the home on a regular basis and was always available to talk to. Satisfaction surveys (questionnaires) had been carried out in 2005 of residents/relatives and other healthcare professionals to gain an indication of the quality of the service being provided by the home. Of those seen during the visit all were very positive about the service offered by the home. Discussion with the manager during the visit confirmed that the proprietor intended to use some ‘extra’ budget to purchase the services of a professional company to carry out a ‘quality survey’ and produce a report that would be available to all. The manager confirmed that the home does not manage the residents’ personal finances. These are handled either by residents’ relatives or their advocates such as solicitors. Staff spoken to during the visit confirmed that one to one supervision took place on a regular basis. The pre-site visit questionnaire completed by the proprietor confirmed that all service records relating to equipment and aids used throughout the home have been regularly serviced. During the visit a member of care staff carried out an ‘unannounced’ fire alarm test. This was carried out proficiently and was responded to well by staff and visitors in the home. This confirmed that the staff and regular visitors to the home had been told about procedures relating to fire protection. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must set out 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 residents are met. The registered person must ensure that arrangements are made for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. A structured programme of activities must be available to residents and the outcomes of residents’ activities of daily living must be detailed in the daily records. The ceiling in the bathroom opposite room 9 must be repaired where the water leak has taken place. Hand washing facilities in the laundry area must be readily available for use by staff after dealing with soiled linen. DS0000063622.V298914.R01.S.doc Timescale for action 14/07/06 2. OP9 13 14/07/06 3 OP12 16 28/07/08 4 OP19 23 25/08/06 6 OP26 13 & 16 14/07/06 The Seymour Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP19 Good Practice Recommendations All sections of the pre-admission assessment document and risk assessment document should be fully completed to ensure all needs are fully identified. It is recommended that the carpet and light fitting in the bedrooms identified to the manager are replaced sooner rather than later as part of the maintenance programme. The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 The Seymour DS0000063622.V298914.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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