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Inspection on 05/05/05 for The Squirrels Care Centre

Also see our care home review for The Squirrels Care Centre for more information

This inspection was carried out on 5th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff team have a very good understanding of individual residents needs. The relationship between residents and staff working at the care home was seen to be good and staff working at the home were seen to respect residents and enable them to make choices about their daily lives. Food provided to residents was good. Visitors to the home are encouraged and those spoken with have a good relationship with the manager and her staff. Residents stated that they liked living at The Squirrels Care Centre with all its facilities and felt that the staff team were kind, caring and supportive. The manager and organisation are keen to provide suitable training for care staff. The current staff team seemed interested and eager to promote and provide good care.

What has improved since the last inspection?

Since the last inspection the manager and senior care staff have spent a lot of time improving the home`s care records and assessment procedures. The manager has made positive steps to improve dining arrangements for residents and to ensure that sufficient numbers of staff are available so that residents are appropriately supported. Particular training for staff to deal with the special needs of residents is now clearly evident.

CARE HOMES FOR OLDER PEOPLE The Squirrels Care Centre Warley Road Great Warley Brentwood Essex CM13 3HX Lead Inspector Michelle Love Carolyn Delaney Unannounced Inspection 5th May 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 Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Squirrels Care Centre Address Warley Road, Great Warley, Brentwood, Essex, CM13 3HX 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) 01277 224308 01277 261353 info@ashbourne.co.uk Ashbourne (Eton) Limited Mrs Jackalynn Gray CRH 58 Category(ies) of Old Age (OP) 58 registration, with number of places The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Personal care to be provided to no more than fifty eight service users over 65 years. Total number of service users for whom personal care is to be provided shall not exceed 58. Date of last inspection 13th December 2004 Brief Description of the Service: The Squirrels Care Centre provides personal care and accommodation for up to fifty eight older people. The home is a very large listed building, set within beautiful grounds, which are located some distance from shops and public transport. The home provides transport to both staff and visitors. There is sufficient car parking facilities to the front of the property. The home provides single and double bedrooms with en-suite facilities for all service users. In addition to service users individual bedrooms, there are three large lounges with disignated dining areas. The home provides a passenger lift so that all floors can be accessed. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out by two inspectors, Michelle Love and Carolyn Delaney. The inspection took place over eight hours. At this visit a tour of the premises took place and some care records and staff employment files were inspected. At the time of the visit the registered manager, four members of staff, six residents and one visitor were spoken with. An additional three visitors/relatives were contacted for their views following the inspection. What the service does well: What has improved since the last inspection? What they could do better: The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 6 The home must ensure that all residents have things available to keep them occupied, both within the care home and within the local community. Medication for residents is well managed, however safe and secure ways must be available for those residents who are able to look after their own medication. The home must ensure that staff working at the care home have an up-to-date work permit and do not overdo their specified contracted work hours if employed as a student. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 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 Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 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 and 5 Progress has been made to ensure that prospective residents are given information and have the opportunity to visit the home prior to admission so as to make an informed choice as to whether or not The Squirrels Care Centre is a care home they wish to live in. Arrangements have been made to ensure that residents are assessed prior to admission and information from placing authorities sought and included. EVIDENCE: Pre Admission Assessments were completed for the newest residents to be admitted. Assessments and information from residents placing authorities were completed in advance of the resident being admitted to the care home. No formal `dependency tool` to determine whether or not the home was able to meet the residents needs was completed however the format was readily available. One resident confirmed that they were invited to visit The Squirrels Care Centre prior to admittance. Upon admission the resident recalled that she had received a copy of the home’s Service Users Guide. Residents were noted to have a signed and dated Statement of Terms and Conditions. Throughout the day of the inspection many visitors were observed at the care home. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 9 The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11 The care planning process has improved since the last inspection. Medication at the home is well managed and storage and records were seen to be appropriate. EVIDENCE: Since the last inspection individual care plans and risk assessments sampled contained more detailed evidence of residents health, personal, emotional and social care needs. Key worker details were not recorded within individual care plans and some residents were not aware of who their key worker was. Information related to healthcare issues, visits and professionals involved were clearly documented. One resident stated that he received personal care from care staff and healthcare visits by professionals in privacy and care staff were sensitive and respectful of his care needs. Information pertaining to funeral arrangements for residents were clearly detailed within the care plan. Some residents had participated within the care planning process. Staff demonstrated a good understanding of residents care needs and their individual care plans. Medication procedures were generally satisfactory, however medication for one resident who `self medicates` was not placed in a lockable facility within the The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 11 resident’s bedroom. The residents `self medication` risk assessment had not been reviewed monthly. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Until recently there has been little in the way of planned or other activities within the care home to provide residents with stimulation and meaningful occupation. Activities within the local community are fairly limited. The meals are good offering both choice and variety and catering for dietary needs when required. EVIDENCE: Since the last inspection the home has recruited one activities co-ordinator, however they have not remained at The Squirrels Care Centre. A new activities co-ordinator has been newly employed and on the day of inspection had been in post for one week. Resident’s records indicated that prior to her appointment, activities provided for residents were limited. An activities list for May 2005 was displayed however, this was not displayed in a format that enabled residents to make a choice. Activity lists were evident within some resident’s bedrooms. Information relating to advocacy services was displayed within the main entrance hall of the care home. On the day of inspection residents were making bird rings/feeders. Resident’s comments were mixed in relation to activities provided at the care home i.e. three residents stated that they did not wish to participate in activities and two residents felt that activities were not appropriate for their specific needs. From talking with the activities co-ordinator it was evident that she was committed and enthusiastic The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 13 to her new role and welcomed the opportunity for further training. Activities had not been provided for residents with dementia/complex needs. The home has an `open visiting policy` whereby residents are free to receive their visitors at any reasonable time in the privacy of their own room or within the newly created visitors area. The relative of one resident commented that staff are always welcoming, friendly and approachable. It was positive to note that residents are actively encouraged to maintain contact with family members i.e. one resident has a computer in their bedroom, whilst another resident is helped by dictating their response to staff and them emailing the residents family. Since the last inspection the home’s dining arrangements have been altered to ensure that staff are readily available to offer assistance to residents and dining is a `social event`. The home operates a four week rotational menu, which was varied, nutritious and offered a range of choices. Food provided to residents looked appealing and plentiful, and residents commented that the day’s main meal was lovely. Not all residents were aware of the day’s menu. Care staff provided appropriate care, support and sensitivity to residents during the lunchtime meal. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home’s Complaint and Adult Protection policies and procedures were appropriate so as to ensure that residents are protected from harm or abuse. EVIDENCE: Of those residents and relatives spoken with, all felt that they could raise issues and concerns with the registered manager or care staff at the home, and that their concerns would be listened to. Since the last inspection the home has received four complaints, two of which the Commission for Social Care Inspection have been made aware. One of the complaints was formally investigated by the Commission and the outcome was that the complaint was partially upheld. One complaint is still in progress and remains outstanding. In general terms records detailing the nature of the complaint, the investigation, action taken and outcomes were available. No record of a response to one complainant was available. As part of staff’s induction, records confirm that staff receive Residents Welfare training. Since the last inspection some members of staff have received training to deal with residents aggression and inappropriate behaviours. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. The time span is too long between checks by the maintenance person. EVIDENCE: The home is well maintained and decorated for residents needs. All resident’s bedrooms are single and have en-suite private facilities. All bedrooms were personalised and individualised, and resident’s comments pertaining to their private space were positive e.g. one resident’s bedroom was observed to contain a fridge, tea and coffee making facilities and microwave. One resident stated “I love my bedroom, look at the view”. The home has a designated smoking area for residents and a newly created area has been provided for residents to receive visitors. Sufficient communal space is provided to residents (lounge/dining areas). The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 16 Service users have sufficient toilet, washing and bathing facilities. Not all bedrooms have hand towels available for residents. A random sample of hot water temperatures were tested from residents wash hand basins and baths and these were seen to be appropriate, however hot water emitted for a brief moment before returning to the recommended temperature of 43 degrees centigrade. Residents have access to a range of specialist equipment such as walking frames, wheelchairs, bedrails and protective covers, hoists and slings. The home has a maintenance programme to ensure that equipment is serviced and maintained to a safe standard. The registered provider has altered some of the timescales and this in some instances is inappropriate and requires rethinking i.e. bedrails were serviced/checked bi monthly and now it is proposed that this will be undertaken six monthly. Call alarms were available and accessible for residents. One residents bedrail had a substantial gap between the bedrail and the mattress, which could pose a health and safety risk. All areas of the home were cleaned to an appropriate standard and smelled pleasant and odour free. The homes laundry area was well organised. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 17 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, 29 and 30 Since the last inspection the standard of recruitment practices within the home has improved so as to offer protection to those people living at The Squirrels Care Centre, however some minor gaps were noted. The home’s induction process is considered inadequate and inappropriate. EVIDENCE: Staff rotas showed that agreed staffing levels are being maintained. Although some members of staff are working up to 53 hours per week, they had appropriate time off duty. Two members of staff worked above 20 hours per week, which is not in line with their contractual agreement or immigration. Recruitment practices were much improved with few gaps i.e. no National Insurance number recorded on all occasions, specific details of one member of staff’s `spent convictions` not recorded, one member of staff’s residence permit had expired and references not always taken from their last place of employment/care establishment. Staff training records evidenced that staff have received mandatory training/updates and some specialist training which meet the specific needs of residents. The majority of the induction training was provided on one or two days i.e. Fire Awareness, Basic Food and Hygiene, Health and Safety, Moving and Handling and Residents Welfare. It is positive to note that care planning training will be provided to all staff in the near future. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 18 Out of twenty six members of staff six have NVQ Level 2. The registered manager completed NVQ Level 4 in Management and Care in February 2005. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 19 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, 32, 36 and 37 The management arrangements at The Squirrels Care Centre, ensure that the home is managed appropriately and efficiently and that residents needs are met wherever possible and they are kept safe from potential harm. EVIDENCE: Since the last inspection no management changes have been made at the care home. Residents, relatives and staff made positive comments about the management of the home. One relative stated that he felt that the registered manager was “very honest and approachable”. Staff stated that the registered manager was approachable, was `hands on` and would deal with issues if brought to her attention. Residents stated that they liked the registered manager and thought she was lovely. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 20 Staff supervision records were available for staff. Two members of staff advised that they receive regular supervision. Supervision of care staff is provided by all senior members of staff. A random sample of records as required by regulation were inspected and all but one was seen to be satisfactory. Since the last inspection the home has reduced the number of beds available from 58 to 55. An application to vary the homes registration has been sent to Ashbourne Ltd, however the Commission has to date not received the completed application. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 2 x The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 22 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 OP9 Regulation 13(2) Requirement Ensure that appropriate measures are undertaken for the safe and secure storage of medication. This refers to those residents who self medicate. Ensure that all residents receive a suitable range of activities which meets their needs. This is a repeat requirement Ensure that robust recruitment procedures are implemented at the care home. This is a repeat requirement Ensure that the Commission receives an application to vary the homes registration and includes the details of changes. Timescale for action 01.06.05 2. OP12 16(m) and (n) 01.06.05 3. OP29 4. OP1 17(2), Schedule 4 and 19, Schedule 2 12(3)(c) and (4) of the Registrati on Regulations 01.06.05 07.06.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 23 The Squirrels Care Centre 1. OP28 50 of care staff should achieve NVQ Level 2 or equivalent. The Squirrels Care Centre I56-I06 S18113 Squirrels V225197 050505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend On Sea Essex SS2 6BG 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. 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