CARE HOMES FOR OLDER PEOPLE
Yews, The 2 Church Street Alvaston Derby Derbyshire DE24 0PR Lead Inspector
Janet Morrow Unannounced Inspection 1st February 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Yews, The Address 2 Church Street Alvaston Derby Derbyshire DE24 0PR 01332 756688 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Rakesh Bhalla Mrs Pushpa Bhalla Mrs Brenda Towell Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th July 2005 Brief Description of the Service: The Yews is a residential home for twenty-one older people situated in a suburb of Derby city. It is within its own grounds and on a corner location. There are nineteen single rooms and one shared double room. Access to the first floor is via a passenger shaft lift. There are two steps at one end of the first floor. The front and side of the property is lawned and accessible. There are two lounges adjoining each other and a dining room, all of which are well decorated with good quality furnishings and fittings. Support services are in place with a choice of General Practitioners, district nurses, chiropodist, dentist and optician. Community psychiatric nurses, occupational therapists, physiotherapists and dietician are accessed as required. Staff training takes place to inform and enable staff to care for residents appropriately. Regular entertainment is organised and those residents who wish to go out do so. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over 5 hours. Care records and staff records were examined. Two members of staff, one relative and five of twenty-one residents were spoken with. Two visiting professionals were contacted by telephone following the inspection. Written information provided by the home prior to the inspection informed the inspection process. What the service does well: What has improved since the last inspection?
Aspects of medication administration had improved which meant that there was less chance of errors occurring. The home was in the process of building an extension to provide a further six en suite bedrooms and additional communal space, toilets, laundry and sluice. This will enhance the facilities for residents when completed. Specific areas of care records had been more regularly updated, such as moving and handling assessments. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 There was sufficient information available to enable prospective residents to make an informed choice about the home. The admission information available established that the home could meet individual needs. EVIDENCE: The home had developed a statement of purpose and residents’ guide that provided useful information about the facilities available. The information in the statement of purpose included all the information required by Schedule 1 of the Care Homes Regulations 2001, although it would be useful to be more specific about the number of places provided. The residents’ guide had most of the information required by this standard, although there were no residents’ views of the home, the number of places provided was not specified and there was no information on any specialist interests catered for. The terms and conditions of residents were not included in the guide although these were available separately. The information provided was in written format only. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 9 A sample terms and conditions of residence was examined and specified all the information required by the Care Homes Regulations 2001. However, more specific information about additional charges would be useful. Two residents’ care files were examined. Both contained an assessment conducted by the home as well as documentation from the assessment and care management process. The information available was holistic and covered all essential care needs. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11 Health care needs were generally met but additional interventions would ensure better consistency of care. Bereavement issues were dealt with sensitively. EVIDENCE: Two residents’ care files were examined and both contained care plans. There were risk assessments for tissue viability, nutrition and moving and handling. However, there were no specific risk assessments for falls and one file did not have a care plan for pressure sore prevention where a risk was indicated. There was evidence that care had been discussed with residents and their families as the plans were signed and there was space in the file for comments from relatives. One comment seen stated that the relative was ‘happy with the way my mother is being looked after. Staff are wonderful’. A relative spoken with also stated that the care provided was ‘marvellous’ and praised the staff highly for the level of care and comfort offered during illness. Residents spoken with also praised the staff and said that requests for help were responded to quickly and cheerfully. One resident described staff as ‘caring and kind’. Visits by chiropodist, optician and General Practitioner were recorded.
Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 11 The medication administration record (MAR) charts were examined. These were found to be in order and accurately signed. Controlled drugs were stored securely and the records examined corresponded with the amount of medicine held. The medication refrigerator temperatures were recorded on a daily basis and were within safe limits. A medication policy was in place and the Royal Pharmaceutical Society Guidelines were available. Care of the dying and bereavement was discussed with the manager. She was able to demonstrate that care was given sensitively and that relatives were encouraged to be involved. Advice was sought appropriately from General Practitioners and district nurses. A relative interviewed confirmed that they had been able to stay at the home during illness and thought the care offered was of a high standard. A policy on care of the dying was available and covered essential areas although additional information on how to deal with a body after death and more information on how to contact specialist services would be helpful. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): There were no standards assessed in this section on this occasion. EVIDENCE: Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 and 18 Residents’ legal rights were protected and the systems in place also protected residents from abuse. EVIDENCE: The manager stated that postal votes were arranged for those residents wishing to vote and verification of this was seen on the two residents’ files examined. The manager was aware of how to contact advocacy services and had used an external agency such as Age Concern for a specific resident. The written information provided by the home stated that there had been no allegations of abuse in the last twelve months and that staff had undertaken training in adult protection. There was an adult protection policy in place and this included the Derby and Derbyshire Local Authority Social Services procedures. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home was well-maintained and provided safe, comfortable and homely accommodation for residents. EVIDENCE: The home was well maintained and suitable for the needs of residents. Routine maintenance and refurbishing were undertaken as required. Furniture and fittings were of good quality. Building work was taking place to provide an extension to accommodate a further six residents in en-suite bedrooms, additional toilets, an extra bathroom, laundry and sluice and increase the communal lounge space available. When complete, this should further enhance the facilities available. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 Robust recruitment procedures and access to training and qualifications ensured that residents were in safe and competent hands. EVIDENCE: Written information provided by the home and certificates on display showed that staff had undertaken National Vocational Qualifications (NVQ) training and twelve of seventeen care staff were qualified to NVQ level 2 or above. A further three were enrolled on the course. This meant that the home had exceeded the target of 50 of care staff being qualified to NVQ level 2. Staff spoken with stated that the training was useful and they had found it beneficial. The home is therefore commended for its commitment to providing and achieving qualification training. Three staff files were examined and these showed that most of the recruitment information required by Schedule 2 of the Care Homes Regulations 2001 was in place. This included Criminal Record Bureau checks, identity information, health information and two written references. However, two files for staff employed for several years had only one written reference. Application forms had been revised and now accounted for any gaps in employment. The written information supplied by the home stated that mandatory health and safety training had taken place over the last twelve months as well as courses in IT skills, medication and nutritional screening. It also stated that training in tissue viability, hearing loss and adult protection was planned.
Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 16 Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 37 and 38 The home was well managed and ensured that the safety and welfare of residents was addressed. EVIDENCE: The home had a plan for quality assurance that included monthly audits of the building and monthly discussions by the proprietor with residents and staff group. Questionnaires were also available for relatives and visiting professionals. However, with the exception of the proprietor’s report, none of these had been undertaken recently and feedback received was informal through thank you cards and by comments written on care files by relatives. The feedback seen was positive, with comments such as ‘special thanks for your kindness’ and another stated it was a ‘lovely place’. Two residents financial records were examined and were found to be in order with the record corresponding with the cash held. Receipts were available for
Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 18 individual purchases made. The manager stated that the home did not act as appointee for any residents. Staff supervision was discussed with the manager. She stated that this did not occur on a formal basis although informal supervision occurred on a day to day basis and group discussions were held with staff regarding care plans. Records were clear and legible and were stored securely. Information required by Schedules 1- 4 of the Care Homes Regulations 2001 was in place in staff and residents’ files and the statement of purpose. The written information supplied by the home showed that regular maintenance checks were undertaken and that these were up to date. For example, gas safety, emergency lighting, water safety and fire equipment were checked in September 2005. Staff had also undertaken training in the last twelve months in health and safety issues such as fire safety, moving and handling, first aid, infection control and food hygiene. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 3 3 Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement There must be a written plan as to how a resident’s needs in respect of his health and welfare are to be met. There must be a system to maintain and review at appropriate intervals the quality of care provided at the home. Staff must be appropriately supervised. Timescale for action 01/05/06 2. OP33 24 (1) 01/05/06 3. OP36 18(2) 01/05/06 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.
Yews, The Refer to Standard OP1 OP1 OP2 Good Practice Recommendations The residents’ guide should include residents’ views of the home, number of places provided and any specialist interests catered for. The statement of purpose and residents’ guide should be available in a variety of formats such as on tape, with symbols and in large print. Specific information about additional charges, such as
DS0000002011.V281623.R01.S.doc Version 5.1 Page 21 4. 5. 6. 7. 8. 9. OP7 OP7 OP11 OP29 OP33 OP36 hairdressing, should be included in the terms and conditions of residence. There should be a care plan to identify the action required where a risk has been identified. A falls risk assessment should be included in care plans for all residents. The policy on death and dying should include how to deal with a body after death and how to access specialist services. Two written references should be in place for those staff who have been employed at the home for a long time. Questionnaires for relatives and visiting professionals and quality audits should be undertaken regularly. Staff supervision should take place 6 times per year, should be recorded and cover care practice, philosophy of the home and career development. Yews, The DS0000002011.V281623.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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