Inspection on 11/08/05 for Todwick Care Home

This inspection was carried out on 11th August 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 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

Todwick Care Home 11/09/09

Todwick Care Home 08/05/08

Todwick Care Home 03/03/06

Todwick Care Home 09/11/04

Todwick Care Home 26/05/04

Todwick Care Home 02/12/02

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Snydale Care Home

Larchfield Manor

Hawkhills

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Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Todwick Nursing Home 160 Kiveton Lane Todwick Sheffield, South Yorkshire S26 1DL Lead Inspector Ramchand Samachetty Unannounced 11 August 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. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Todwick Nursing Home Address 160 Kiveton Lane, Todwick, Sheffield, South Yorkshire, S26 1DL 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) 01909 770248 01919 774956 e-mail: todwick@todwick.com Multi Counties Rest Homes Limited Mrs Susan Harrington Care home with nursing 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9-Nov-2004 Brief Description of the Service: Todwick Care Home is registered to provide care for up to 25 people in the category of older adults. It is owned by Mr & Mrs Marshall and managed by Mrs. susan Harrington.The home is situated in the village of Todwick, close to bus routes and the local railway station. It is a two- storey building which provides accommodation on both floors. There is a passenger lift to facilitate access between the floors. There are three lounges, one of which is on the first floor. The dining area, the kitchen and two lounges are located on the ground floor. One of the lounges is used by residents who smoke. There is a garden area which can be accessed either through the front or side of the building. There is a car parking facility at the front of the building. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on 11 August 2005, starting at 10.30 hours and finished at 17.00 hours. The inspection included a tour of the premises, conversations with five residents, three relatives and four members of staff. Some aspects of care provision were observed and care documentation and other records were checked. What the service does well: What has improved since the last inspection? What they could do better: The assessment of need of residents, on their admission to the Home, must be improved to ensure that all aspects of care needs are considered. Risks that Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 6 residents face in their activities of living must be appropriately assessed and managed. Care plans must be developed to include all identified needs. More importantly, care plans must be put in place as promptly after admission, as possible. Care plans are reviewed but the process used to carry out such review must be explained and recorded. Menus regarding all meals served at the Home should be appropriately developed and displayed for the benefit of residents. The Home’s adult protection policy and procedures must be improved to bring them in line with guidance issued by the Department of Health- ‘No Secrets’ document. Improvement is needed in the facilities, relating to residents private accommodation. This relate to the provision of bedside lighting, lockable storage space and double electric sockets, where they are missing. Information regarding recruitment and selection of staff, in particular, safety checks and references, must be kept at the Home at all times, and made available for inspection as necessary. A few health and safety issues were highlighted for immediate action. These relate to the need to ensure that fire doors are not obstructed, and to the need to review the overall risk assessment for the Home. 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. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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 Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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, 3 and 5. Residents including potential ones have adequate information about the Home and the services it provides. Prospective residents and their relatives are encouraged to visit the Home and check whether it is suitable, before making their choice of a care home. However, the information contained in the Home’s statement of purpose and service user guide, could be improved. The care needs of residents were assessed on admission to ensure that identified needs could be met. Such assessments were not always comprehensive and specific enough to address all important areas of needs. Sometimes, this has led to needs not being fully met. The process of assessing needs must be improved and staff should ensure that they are able to carry out assessments satisfactorily. EVIDENCE: Residents and relatives, who spoke to the inspector, stated that they had been encouraged to visit the Home and to look at its facilities and services before making their choice. One relative said ‘ I visited the Home before Mum came in. It was homely and I was happy with it and so was Mum’. Copies of the Home statement of purpose and of its service user guide were displayed in the entrance hall. Residents and relatives were aware of them. The statement of Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 9 purpose was well developed, but there were omissions in the information provided. These relate to arrangements for, fire precautions, meeting religious and cultural needs, consultation with residents and for care review. The service user guide must include a copy of the last inspection report. The care records of three residents were checked. They included copies of their needs assessments. These were very basic and failed to include important areas of needs. There were no assessments in areas of sensory and nutritional needs and risks. Social care needs were also inadequately assessed. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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 and 10. Individual care plans were not adequately developed and they were not always put in place in a timely fashion. This can lead to needs not being fully met. Overall improvement is required in the care planning and review process. Care staff were proactive in ensuring that the health care needs of residents were adequately addressed. The administration of medicines was appropriately undertaken. This helped the residents to maintain and improve their health. Staff attitude and approach to care was based on respect for the individual and this ensured the safeguard the rights and dignity of residents. The overall view of residents and relatives, about the Home, is positive. EVIDENCE: Residents and relatives, who spoke to the inspector, confirmed that staff were ‘ good and caring’. Interactions between staff and residents were noted to be friendly and courteous. One resident commented that ‘ the staff are very helpful. They are very caring and will do their utmost to see that I am comfortable.’ Residents were in good attire and this enhanced their confidence and dignity. Personal care was offered in the privacy of their own rooms or in bathrooms. A sample of care plans was checked. One resident who was admitted for respite care was not provided with a care plan. Although care plans were developed on the basis of needs assessment, they appear weak because they did not address all areas needs and risks. Care plans were reviewed on a Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 11 monthly basis, but the process used to conduct the review was not explained and was not clear. Care records of individual residents showed that they were appropriately referred to a range of health care professionals as and when needed. Residents who suffer from diabetes were appropriately referred to their GPs and to chiropodists. Storage of medicines and medication records were checked. Medicines administration records were also checked. They were found to be satisfactory. Oxygen therapy for one resident was well organised. All necessary precautions were taken with regards to the safe storage of oxygen cylinders. One resident who was self -administering her medication, was appropriately risk assessed to do so. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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 and 15. Although the Home organises indoor recreational activities and outings, residents’ social care needs are not always adequately assessed. This can potentially hinder the participation of individual residents in the programme of social activities. Daily life at the Home appeared to match residents’ preferences and capabilities. The Home was providing a good catering service, which met the nutritional needs of residents. It should, however, ensure that menus are appropriately displayed for the benefit of the resident group. EVIDENCE: Residents and relatives, who spoke to the inspector, stated that they were satisfied with the recreational activities that are organised at the Home. One resident commented on the valuable help she receives from staff, to enable her to have ‘communion’ every month’. Other residents spoke about a trip to seaside during the summer. However, on the day of this inspection, residents were observed to be spending most of the day sitting in lounges or in their own rooms. Some residents chose to watch television and others to listen to radio programmes. Care plans which were checked, did not fully address the social care needs of residents, particularly in relation to their ability to participate in recreational activities. Residents, who spoke to the inspector, expressed their satisfaction with the meals served at the Home. The inspector noted that a wide range of breakfast Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 13 items was offered to residents. There was a choice of the protein part of the main meal, served at lunchtime. Various drinks were also offered. Meals were well served. However, no menus were found displayed in the main areas used by residents. Nutritional needs of residents were not assessed and care plans made little reference to dietary needs. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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. Management and staff take complaints and concerns seriously. A good system of communication between staff, residents and their relatives, helps to address concerns promptly. This is felt to be reassuring. Care practices seemed to protect residents from abuse, thereby creating a safe environment for them. However, the Home’s policy and procedure on adult protection was not in line with current good practice, in particular the multiagency approach to the management of adult protection issues. This policy must be improved and all care staff must be appropriately trained on adult protection issues and on implementing the policy. EVIDENCE: The manager and other care staff commented that they seek feedback from residents and their relatives, in order to address any concerns promptly. Residents and relatives, who spoke to the inspector, confirmed this approach. They felt they could raise their concerns directly with the manager, with the knowledge that ‘ she would look into the matter and resolve it’. A complaint procedure is available and it is publicised. The Home has not received any complaints since the last inspection. The policy and procedures for adult protection were checked by the inspector. They were not in line with guidance contained in the ‘ No secrets’ document issued by the department of Health. The policy and procedures regarding adult protection must be improved and staff training provided, in order to ensure that a more robust protection system is put in place at the Home. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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 and 26. The building and its surroundings were generally well maintained, thereby enhancing its appearance and facilities. Although there is a refurbishment programme in place, some improvement is required in the private accommodation of service users. Good hygiene standards were maintained at the Home and this helped with the control of infection and with making the place more pleasant. EVIDENCE: The inspector, accompanied by a senior member of staff, undertook a tour of the Home. The communal areas and some residents’ private rooms, which were viewed (the latter with residents’ permission) appeared to be in good decorative state. Some residents stated that they were ‘very happy’ with their private accommodation. They were able to bring personal memorabilia and to personalise their rooms. A new shower room is being installed and this should increase residents’ choice of bathing facilities. However, not all bedrooms were fitted with a lockable item of furniture, to allow for the safe storage of personal items. Bedside lighting and double electric sockets were not available in some rooms. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 16 The Home was found to be clean and tidy and there were no malodours. The grounds were kept tidy and well maintained. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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, 29 and 30. The number of care staff appeared adequate to meet the needs of the resident group. There was a good staff team in place. Care staff were provided with training and their skill mix and knowledge allowed them to fulfil their tasks. Whilst new members of care staff had been recruited, the inspector was unable to access the relevant documents, in order to form a view as to how well recruitment and selection of staff is handled. All staff files, including information about safety checks and references must be kept at the Home and made available for inspection as necessary. EVIDENCE: There were three care assistants and a senior carer on duty, on the morning of this inspection. The support staff on duty included a cook, a laundry worker, a domestic, an administrator and a maintenance person. The afternoon shift consisted of two care assistants and the manager. Two care assistants were scheduled to work the night. There were twenty residents in occupancy. The level of care staffing was not based on the dependency of the resident group, but on current occupancy level, the number of care staff deployed, appeared to be able to meet the needs of residents. New care staff had been recruited since the last inspection. They have been provided with induction. Staff files were not available at the Home, during this inspection and so the inspector was unable to check the recruitment and selection procedures used at the Home. The Home has its own ‘training co-ordinator’ to ensure that its staff receives the required training in good time. Staff spoken to, confirmed that they had received training on ‘ moving and handling’, fire precautions, and on medicines Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 18 administration. Seven care workers had attained their NVQ level 2 in Care. Two others will be completing this NVQ during the following month. However, there are gaps in the provision of training. All care staff must be provided with training on ‘adult protection’. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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, 33 and 38. The Home is well managed and staff are motivated to provide a good standard of care for the resident group. Residents and relatives are satisfied with the management of the Home. However, some areas relating to health and safety issues require attention, in order to enhance the welfare of residents. EVIDENCE: In discussion with residents, relatives and staff, the inspector noted that the day- to- day management of the Home was well appreciated by all concerned. The registered manager has achieved the ‘ Registered Manager’s Award in Care’. Staff commented that they were satisfied with the support they were receiving from the manager, in their work. The manager has developed a residents and relatives’ satisfaction questionnaire and is using it to get feedback on the care provided at the Home. The Home has already received the ‘ Investor In People Award’ (2004). The overall welfare of residents is safeguarded by providing staff with training on a range of topics including for example, moving and handling, fire safety Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 20 and food hygiene. However, a couple of fire doors were kept open by the use of door wedges. This was pointed out to senior staff and the door wedges were immediately removed. The overall risk assessment for maintaining safe working practices and a safe environment (the hazard analysis) was not detailed enough and must be reviewed. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 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 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 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 x 2 3 x 3 x x x x 2 Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 22 No 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 4,5 Requirement The Homes statement of purpose and service user guide must be improved to meet the Regulation. Assessment of care needs must be improved to ensure that all health, personal (including risks) and social care needs are considered. Individual care plans must be improved to address all areas of need. Care plans must be put in place promptly. The process of reviewing individual care plans, must be appropriately explained and recorded. The social care needs of individual residents must be appropriately assessed, developed in care plans and catered for, to meet their preferences and capabilities. The Homes adult protection policy and procedures must be improved to reflect the guidance of the Department of Health- No Secrets document. All care staff must be provided with training on adult protection. All residents bedrooms must be provided with a lockable storage Timescale for action 19/12/05 2. 3 12,14 Immediate and ongoing. Immediate and ongoing. 3. 7 12, 15 4. 12 12, 16 19/12/05. 5. 18 12, 13 30/01/06 6. 19 12, 23 30/01/06. Page 23 Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 space. 7. 19 12, 23 All residents bedrooms must be provided with appropriate bedside lighting and two double electric sockets. All staff files, including information about safety checks and references, must be kept at the Home, at all times and made available for inspection as necessary. Fire doors must not be kept wedged open at any time. The overall risk assessment for the Home must be reviewed. 30/01/06. 8. 29 12,18, 19 Immediate and ongoing. 9. 10. 38 38 12, 13 12, 13 Immediate and ongoing. 19/12/05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 15 Good Practice Recommendations Menus regarding all meals served at the Home should be appropriately displayed for the benefit of residents. Todwick Nursing Home 20050811 Todwick X00015 UN Stage4 S3091 V205017 J55.doc Version 1.40 Page 24 Commission for Social Care Inspection First Floor Barclay Court Heavens walk Doncaster DN4 5HZ 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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