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Inspection on 04/08/05 for Whitby Road (5) - North Yorkshire County Council

Also see our care home review for Whitby Road (5) - North Yorkshire County Council for more information

This inspection was carried out on 4th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

During the inspection it was clear that the home benefits from the strong community links it has. The service users often know each other prior to their admission and they also know of or about the staff. This means that the relationships between the staff and service users are very relaxed and friendly. Several service users said that the staff could not do enough for them and were always there to help. The staff can access training through North Yorkshire Social Services and this allows them to develop their skill base in dealing with the different needs of the service users.

What has improved since the last inspection?

The management team now keep a written record of any pre-admission assessments they carry out. They visit all prospective service users and only admit those people whose needs they know they can meet.

What the care home could do better:

The management team need to tighten up their administration procedures. The medication records were unclear and an audit trail of medicines given was not available. They also need to ensure that staff have their proper checks before they are deployed to work directly with the service users. Several areas of the environment require attention and the manager should ensure that regular checks of the building are carried out.

CARE HOMES FOR OLDER PEOPLE North Yorkshire County Council 5 Whitby Road 5 Whitby Road Pickering North Yorkshire YO18 7HD Lead Inspector Pauline ORourke 4 August 2005 th Unannounced 10:10 - 15:45 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. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service North Yorkshire County Council 5 Whitby Road 5 Whitby Road Pickering North Yorkshire YO18 7HD 01751 473369 01751 473889 Address 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) North Yorkshire County Council Mrs Marion Greenbank Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17th November 2004 Brief Description of the Service: 5 Whitby Road is a care home providing personal care and accommodation for up to 50 older people. There is a separate day centre within the complex. North Yorkshire County Council owns it and Marion Greenbank is the registered manager. The home is located on the outskirts of Pickering and is within walking distance of the shops, bank, post office and cafes. The home is purpose built. There are 44 single bedrooms and 3 double bedrooms that are available for two people wishing to share. The home has pleasant grounds that are available for use by service users in appropriate weather North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, including preparation time took place over 13 hours. A tour of some areas of the building was conducted. A number of the service users records, staff records and records about the management of the home were inspected. 15 of the 43 service users, six of the nine staff on duty, four visitors and a district nurse were spoken with. What the service does well: What has improved since the last inspection? What they could do better: The management team need to tighten up their administration procedures. The medication records were unclear and an audit trail of medicines given was not available. They also need to ensure that staff have their proper checks before they are deployed to work directly with the service users. Several areas of the environment require attention and the manager should ensure that regular checks of the building are carried out. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 6 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. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.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 North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.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) 3 The service users can be assured that their care needs will be met EVIDENCE: The service user files seen contained copies of an assessment by a care manager. The registered manager confirmed that they visit all prospective service uses before their admission and a copy of the assessment carried out is maintained. Service users spoken with confirmed they had seen someone from the home prior to their admission North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 9 The health, social care and personal needs of the service users are met. EVIDENCE: The service user files seen contained a Promotion of Independence Plan. This document was pertinent to the individual concerned and those service users spoken with were aware of their plans. The staff are responsible for reviewing the plans at monthly intervals. Contact sheets are maintained but a daily record is not kept unless it is about bathing. The service users files contained information about their health needs and details of GP visits and district nurses are recorded. A district nurse spoken with said that the staff work closely with them in regard to the health needs of the service users. The service users spoken with said that they could see their GP on request and that any visits made either to the home or the surgery were in private. There is a medication policy in place and all staff that administer the medication have received appropriate training. The medication records were incorrect and it appeared that medication had been signed for but not given. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 10 All other areas regarding the handling of medication were managed appropriately. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 The service users are able to keep their own routine within the home and join in with social activities. EVIDENCE: The service users spoken with during the inspection said that they could maintain their own routine to the day. The service users also said that they discuss with their key worker what activities they would like to do. The service users said that they enjoy the activities provided but said that there were also times they felt bored. Visitors spoken with said that they are always made welcome and there are no restrictions as to when they visit. The service users confirmed this was the case. One visitor said that the managers were good at keeping them informed about events affecting their relative or generally what’s going on in the home. A visitors’ policy is in place and all visitors sign a visitor’s book on entering the home. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 12 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 Service Users were confident that any complaints or concerns they had could be raised and acted upon.. EVIDENCE: North Yorkshire Social Services has a detailed complaints policy. This policy is provided to all the service users and is displayed around the home. There have been no complaints made to the CSCI or the home in the last 12 months. Service users and their relatives said that if they had any problems they would go to the manager. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 13 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, 23 and 26. The service users live in a home that is clean and with the exception of a few areas well maintained. EVIDENCE: The home is located close to shops and is suitable for its stated purpose. The grounds are well maintained and accessible to the residents. The residents have access to a patio area and a summerhouse to the front of the building. Several items of bedroom furniture were in a state of disrepair, several commode chairs required re-staining, several divan bases were stained and require replacing and there were carpets that required stretching or replacing. These have been identified in a letter to the home. All areas of the home visited were clean and free from odour. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 14 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) 29 The service users have not been protected from possible abuse as the procedures for the recruitment of staff have not been followed correctly. EVIDENCE: The staff files were seen and those of the established staff contained the documentation as required by the Care Homes Regulations 2001. However the files of two newer members of staff had no evidence of a current Criminal Records Disclosure. Another file showed a Criminal Records Bureau Disclosure dated 8/12/03 and the staff member commenced her employment on 1/8/04. new staff must not commence their duties as a resource worker until they have received clearance from the Criminal Records Bureau either through a POVAFIRST check or the standard Criminal Records Bureau Disclosure. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 15 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) 35 and 38 Policies and procedures are in place to ensure the service users financial interests are safeguarded. The health and safety of the service users and staff is promoted. EVIDENCE: The service users financial interests are safeguarded. Staff handle the personal allowance for several service users and the appropriate records were accurate and up to date. The staff spoken with confirmed that they had received training in health and safety, first aid, back care, food hygiene, COSHH, and fire training. Evidence of this was seen in the staff files and the office diary. The equipment used in the home is serviced at the prescribed intervals with the exception of the portable hoists and bath hoists. Health and safety notices were displayed around the building. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 16 Accidents are properly recorded and where necessary reported to the Commission for Social Care Inspection. Information from the accident records is used in the care planning process. All staff can access Induction and Foundation training, this provides them with basic skills required to undertake the role of resource worker. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 17 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x 1 x x 3 STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x 3 North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 18 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 9 Regulation 13(2) Requirement Staff handling medication must ensure that the records are kept upto date in line with the medicines held. The carpets identified to the manager must be stretched or replaced. The commodes and divan bases identified to the manager as neeeding attention must be made good or replaced. All new staff must have a current Criminal Records Disclosure prior to deployment as a resource worker. Timescale for action with effect from 4/8/05 30.09.05 2. 23 13(4)a 23(2)c 3. 29 19(1)b with effect form 4/8/05 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. Refer to Standard 7 Good Practice Recommendations Staff should maintain daily records for the service users reflecting what they have done throughout the day. North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO18 7HD 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 North Yorkshire County Council 5 Whitby Road J53_J04_S34278_5 Whitby Road_V237868_280705_stage 4.doc Version 1.40 Page 20 - 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. 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