Inspection on 04/05/05 for The Worthies

This inspection was carried out on 4th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

The Worthies 01/04/09

The Worthies 02/04/08

The Worthies 03/05/07

The Worthies 27/06/06

The Worthies 25/11/05

The Worthies 11/01/05

The Worthies 28/06/04

The Worthies 11/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Worthies 79 Park Road Stapleton Bristol BS16 1DT Lead Inspector Sandra Jones Draft - Unannounced 4 & 12th May 2005 9:30 th 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 Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Worthies Address 79 Park Road Stapleton Bristol BS16 1DT 0117 9390088 0117 9655881 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) The Worthies Residential Care Home Ltd Ms Shenaz Seehootoorah DE(E) Dementia - over 65 OP Old age 24 Category(ies) of 5 DE(E) and 19 OP registration, with number of places The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 24 persons aged 65 years or over Date of last inspection 11th January 2005 Brief Description of the Service: The Worthies is a 24-bedded home registered to accommodate 19 people who are elderly and 5 older people who have been diagnosed with dementia.The home is situated on a bus route, and is fairly close to shops, libraries and health centres. All but two rooms are single. These two rooms have en suite facilities. There is a lift to the first and second floor and a security system is in place to alert staff if service users with dementia wander from the home. A call bell system has been installed in each individual bedroom. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection is the first inspection for the year and was conducted on an unannounced basis over two days in May. With the service provider, deputy manager and residents. The inspection process included examination of the records held at the home and seeking residents and staff’s views on the standards of care at the home. What the service does well: What has improved since the last inspection? What they could do better: The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 6 The range of documentation for Local Authority must be developed to the level of information available for self funded placements. Care planning systems must be further developed to offer an action plan, which guide staff to consistently meet residents changing needs. 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 Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3&5 Information that enables potential residents, their representatives and placing agencies to make choices about the home is available. Policies and procedures to be appended must be developed to describe the steps taken to maintain the standards of care at the home. EVIDENCE: The prepared Statement of Purpose provides an overview of the services and facilities to be offered at the home. While it is evident that previous requirements to develop the document were actioned, more clarity is needed. A standard contract is included in the Statement of Purpose, defining the arrangements for payment of fees and termination procedure. With the rules and expectations of both parties. It is accepted that Social Services Purchase Agreements are in place for Local Authority placements but Terms and Conditions between the service provider and residents must be provided. Since the last inspection four residents were admitted to the home and case records examined contained core assessments. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 9 The Statement of Purpose refers to trial periods offered and contracts inform residents of the arrangements for admission at the home. The criteria for admission and procedure must be developed. As it is evident form the records that emergency admission are accepted, the procedure must incorporate the guidelines followed for emergency placements. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 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&11 Case records indicate that residents physical, emotional and social care needs are assessed. Assessments are conducted to identify potential risks and action taken to minimise the level of risk. Input from outside professionals is sought where appropriate. To consistently guide the staff action plans must be developed. Safe practices for the administration and recording of medications exist at the home. Training records must demonstrate the quality of the training provided to staff and profiles must be developed to ensure staff have adequate information about safehandling of medicines. EVIDENCE: An initial assessment is completed during the trial period at the home. Residents abilities and assistance needed with all area of daily living are assessed. Enabling the staff to develop a home’s care plan from the assessment and social workers care plan. An action plan must be developed from the information drawn together from the assessments and care plan. To consistently guide staff on meeting the individuals needs. Consideration The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 11 should be given to incorporating the person’s likes, dislikes and preferred routines, to present a person centred approach to meeting needs. Care plans describe the individual’s personal care needs and waterlow assessments are completed, for residents with scores over 10. From the assessment, a plan to minimise the risk is devised. For example, equipment and monitoring checks. For residents with dementia, care plan must detail communication and safety needs. Risk assessments are completed for manual handling, pressure sores and level of dependency. For residents that are at risk of fall a separate assessment is completed to ensure a plan of action that minimises the risk is developed. The service provider should consider using the dependency tool as the trigger for completing other risk assessments. For example, the dependency tool should trigger that manual handling risk assessments must be completed for mobility impairments and waterlow assessments for pressure sores. Documentation included in case records evidenced that residents access other health care professionals. Community NHS facilities such as the chiropodists and opticians visit the home regularly and dental visits are arranged as required. With district nurses, visiting the home to administer injections and dress wounds. The Palliative Care policy indicates that terminal care is offered to existing residents. The Statement of Purpose must therefore inform potential residents, their representatives and placing agencies that where possible palliative care is offered with the support of the health care professionals. It was reported by the deputy manager that administration of medicines is included in their roles and responsibilities. In-house and the pharmacists provide training to the staff. The induction programme evidenced that training is provided. Evidence of the quality of the training must be provided to ensure staff have the necessary competencies to administer medication. Individual profiles that include the purpose of the medication, side effects and compatibility with homely remedies must be produced. Information leaflets must be appended onto the profile enabling staff to update their awareness of the medications being administered. Medication are administered through a monitored dosage system and the records indicated staff sign the medications sheets immediately after administration. Homely remedies are administered from a stock supply when required and the records reflected the balances held. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 12 The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 13 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 Social and recreational needs are acknowledged at the home. The number of residents attending group activities is not proportionate with the number of people accommodated. EVIDENCE: A company that provides Specialist Therapeutic Activities for Older People will be providing programmes of activities. Members of staff will be expected deliver the programme. A record of activities is kept and lists the activities undertaken and participants with the staff signature. Indicating that small group activities take place each day. For example, bingo and board games. Outside entertainers visits are generally arranged to coincide with celebrations. While it is acknowledged that activities take place at the home, only a quarter of the group participate in activities. Care plans must specify the individuals preferred activities, with evidence of monitoring. Residents confirmed that their visitors are welcome by the staff and the staff make time to discuss issues with their family members. Residents agreed that for additional privacy, visits can be conducted in their bedrooms. Feedback regarding the quality of the meals served was sought from the residents during The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 14 the inspection. It was reported that at each mealtime there is a choice and the meals served are varied, sufficient in quantity and good in quality. The Data Protection and Financial Policies indicate the home’s approach towards empowering residents to exercise control over their lives. It was understood from the service provider that residents files can be accessed by their relatives. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 15 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) 16,17 & 18 Policies and procedures in place indicate a commitment to safeguarding residents from abuse, including seeking residents feedback on the standards of care. To fully evidence the commitment staff must attend POVA training. EVIDENCE: A simple format is used for the home’s Complaint procedure to ensure that the people who use the service can understand. There were no complaints received at the home or CSCI for investigation since the last inspection. The residents giving feedback during the inspection describe the steps that will be taken for making complaints. It was reported that the service provider and deputy would be approached with complaints. Comments received indicated their confidence that complaints would be taken seriously and acted upon. The Bristol and South Glos. Local Authorities “No Secrets” policies are available at the home. Along with the Whistleblowing policy, evidencing a commitment towards safeguarding residents from abuse. In terms of the Whistleblowing policy, the procedure must inform staff that they may be subject to disciplinary action, for not reporting poor practice. The service provider and deputy manager recently attended POVA workshop training and members of staff will have access to the awareness training. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 16 The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 17 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) EVIDENCE: These standards were not examined at this inspection. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 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 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&29 Staffing levels meet the current needs of the residents accommodated. For recruitment procedures to be robust, the process must be further developed. EVIDENCE: The personnel files of the three most recently employed staff and completed application forms and references are held in their files. While written references are sought, the names of the referees must relate to the name of last employer. Through examination of the staff’s personal records, CRB’s were obtained for seventeen staff. It was reported that as a result of staff’s delays with nine staff, their CRB’s are outstanding. The service provider must consider informing staff through the application form that delays in submitting documentation may lead to suspension without pay. The rota in place indicated that three staff are rostered throughout the day with two waking staff at night. Ancillary and catering staff are employed at the home. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 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) 32,35&37 Records are up to date and accurately maintained. Comments made by residents and staff indicated that an open culture exits at the home. EVIDENCE: Individual schedules of fees are in place for Local Authority placements, with contracts for self funded placements. £339.00 -£400.00 is the range of weekly fees charged at the home. It was understood that with the exception of one person, fees are generally paid by cheque or direct debit to the home’s account. Facilities for the safekeeping of cash and valuables at the home and the records examined indicated accurate accounting. Records were consistent with the balances held in safekeeping and receipts further evidenced the purchases made on residents behalf. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 20 Records that relate to fire safety policies, procedures, checks and practices were examined. Indicating that checks and practices are conducted at the stipulated frequencies. Feedback on the conduct of the home was sought from the members of staff on duty during the inspection. It was reported that more choices, in terms of accessibility to training and personal development exists at the home. Regarding consistency of care, members of staff’s comments indicated that handovers, staff meetings and individual supervision are the systems used to enable the standards to be maintained. Residents consulted made positive comments about the provision of care at the home. It was stated that the staff had the competencies necessary to meet their identified needs. In relation to making choices, residents confirmed that opportunities exist for residents to make choices. Residents are enable to make choices about meals, leisure interests and routines for daily living. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 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. 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 2 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 2 x x 3 x 3 x The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 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 1 Regulation Regulation 4 (1)(c) Schedule 1 Requirement The Statement of Purpose must be further developed to enable potential residents to make choices about the home. Including the criteria for admission and procedure for emergency admissions. Information about Palliative care offered to exisiting residents must be included. Terms and Conditions of residency must be prepared for Local Authority placements. An action plan must be developed to guide the staff to meet the identified needs. For residents with dementia, care plans must detail communication and safety needs. Preferred recreational activities must be included within the care plans, with evidence of monitoring. Individual medication profiles that describe the purpose of the medication prescribed, side effects and compatibility with homely remedies must be developed. Along with information leaflets appended onto the profiles. Members of staff must attend Version 1.30 Timescale for action 30/10/05 2. 3. Standard 2 Standard 7 Regulation 5 Regulation 15 30/7/05 30/10/05 4. Standard 9 Regulation 13 (2) 30/7/05 5. Standard Regulation 30/12/05 Page 23 The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc 18 6. Standard 29 13 (6) POVA training. 30/5/05 Regulation The refences must be accepted 19 from the names of the referees given in the application form, to establish the authenticity of the reference. 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. 3. Refer to Standard Standard 7 Standard 7 Standard 29 Good Practice Recommendations The care planning process should be developed into a person centered approach. Incorporating their likes, dislikes and preferred routines into the action plan. The dependency assessment should be the trigger for completing other risk assessments. Application forms should inform staff that delays in providing documentation may result in suspension without pay. The Worthies D56_S26524_Theworthies_V225189_040505Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG 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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