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Inspection on 18/07/05 for Yoakley House (Michael Yoakley`s Charity)

Also see our care home review for Yoakley House (Michael Yoakley`s Charity) for more information

This inspection was carried out on 18th July 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.

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

What the care home does well

The home provides a well-maintained environment with a welcoming atmosphere. Service users personal space is respected and are encouraged to bring in personal possessions. Service users are supported to maintain independence and are encouraged to pursue interests and activities outside the home.

What has improved since the last inspection?

The registered manager and the whole of the team at the home have worked very hard to meet the requirements made at the last inspection, which was just six months prior to this inspection. There were 22 previous requirements made, 20 of these have been met. The care staff have undergone intensive training, including both the NVQ course and the mandatory training. Many of those doing the NVQ training have completed the course in 6 months. Staff have benefited from the training provided. Medication practices and procedures have greatly improved. Nursing practices being undertaken by staff have been stopped. All of the radiators have been guarded and the glass walls have been frosted to ensure privacy and dignity is maintained. Policies and procedures have been reviewed and updated, additional copies have been produced and made available to all staff.

What the care home could do better:

Two service users were found to have needs outside of the homes registration. An application for a variation needs be made. Procedures for the handling of homely remedies needs to be produced and implemented. New care plan formats and assessment tools have been introduced, however some of thesehave been developed by the registered manager and will need to be closely monitored to ensure they are an accurate and effective tool. A system is needed for recording and storing the records of meals provided. Concerns are raised about the temperature testing of hot food, the registered manager is required to liaise with the environmental health regarding this matter. Written records need to be kept of the interviews of prospective staff.

CARE HOMES FOR OLDER PEOPLE Yoakley House Via Drapers Close St Peters Road Margate Kent. CT9 4AJ Lead Inspector Clair Brown Announced 18 & 19/07/05 at 10:20hrs 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. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Yoakley House Address Via Drapers Close, St Peters Rd, Margate, Kent. CT9 4AJ 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) 01843 223652 Michael Yoakleys Charity Mrs Gillian Lilley Registered Care Home 26 Category(ies) of Older People aged 65 or over registration, with number of places Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25.01.05 Brief Description of the Service: The Home was purpose built in the 1980s in a semi-rural location. It is a short journey to the local amenities and is situated on a bus route. The local general hospital is situated next to the Home. The Home is registered 26 male & female service users of both genders, aged 65 years plus. The Home is all on one level and all bedrooms are single with en-suite facilities. There are two waking night staff on duty every night and between 2 and 5 care staff on duty during the day. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s announced inspection, which was conducted by one inspector. The duration of the inspection was 11 hours over two days. The Home representative was the registered manager. Additional time was spent in planning the inspection and report writing. The inspection included assessing the progress being made to meet the 22 previously made requirements and 2 recommendations from the last inspection. The inspector spent time talking to 4 service users and 3 staff to gain their views. 16 service users and 3 relatives completed pre-inspection questionnaires. A full tour of the premises was conducted, documents and records were examined and service users files were case tracked. What the service does well: What has improved since the last inspection? What they could do better: Two service users were found to have needs outside of the homes registration. An application for a variation needs be made. Procedures for the handling of homely remedies needs to be produced and implemented. New care plan formats and assessment tools have been introduced, however some of these Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 6 have been developed by the registered manager and will need to be closely monitored to ensure they are an accurate and effective tool. A system is needed for recording and storing the records of meals provided. Concerns are raised about the temperature testing of hot food, the registered manager is required to liaise with the environmental health regarding this matter. Written records need to be kept of the interviews of prospective staff. 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. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.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 Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.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) 1,2,3,4,5 The statement of purpose provides up to date information to enable prospective service users to make an informed decision. EVIDENCE: A revised statement of purpose has been produced and now contains all of the required information. During the inspection two service users were identified as having mental health, which is outside of the homes registration. A recently admitted service user file was assessed, this showed that pre-admission assessment were being completed and recorded. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 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) 7,8,9,10,11 Medication procedures and practices have improved but there needs further improvements in practices. New care plans and health assessment tools being implemented need regular assessing and auditing to ensure their effectiveness. Improvements have been made in maintaining service users dignity. EVIDENCE: There has been a lot of work and effort made by staff to improve the medication practices in the Home. The room has been refurbished and the quantity of stock held has been greatly reduced. Through discussions with staff they have gained a greater understanding of their accountability when taking on the responsibility for administering medication. Thirteen staff have now completed the medication training. However there were some errors in administration identified, these include medication being signed for but not given, these incidents mainly occur when giving from the original packaging and not from the nomad trays. This is an improvement from the last inspection. Medication facilities for service users self-medicating remains inadequate, one lady was storing her medication in the wardrobe as the cupboard provided was too small. Some concerns were raised regarding a lack of procedure for the handling of homely remedies, this included the fact that Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 10 some service users and relatives purchase over the counter medication without informing the home. The registered manager has recently introduced a new care plan format and health assessment tools. This includes a dependency assessment tool. Some of the assessment tools have been designed by the registered manager and therefore have not been verified to their accuracy and effectiveness. The registered manager is to regularly assess the effectiveness of the tools. The care staff have recently started to write the care plans and not all elements of care are included. The quality of the daily records in the service users files varies, with some vague entries being made. Glass walls have been frosted in the service users bedrooms to ensure service users privacy and dignity. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 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) 12,13,14,15 The programme of activities satisfies the wishes of the service users. A balanced diet is provided however there are concerns regarding food safety measures and some service users are unhappy with the food. EVIDENCE: The home provides a range of activities that include gentle exercise, quizzes, sing-a-longs, outings, prayer meetings and activities in the gardens of the home. The person responsible for organizing and implementing the activities programme is member of the care team and has no formal training in providing activities and stimulation for the elderly. Many of the service users are quite independent and active. The four service users spoken to and the sixteen who completed the comment cards all expressed they were happy with the activities provided. Recently the registered manager has started resident meetings to enable them to have a voice in the home. The menus show a very traditional diet is provided with lots of fresh vegetables available every day. Six service users expressed they do not always like the food. The registered manager stated that at the last residents meeting she asked the service users to give suggestions on what they would like on the menu, the results are being collected at the next meeting. The hot food is only temperature probed before being placed in the hot cabinet, with no testing before it is served. Meals that are saved for service users and then reheated are not temperature probed Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 12 prior to serving. Records of meals provided have been kept but disposed of after a few months due to lack of storage facilities. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 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 standard(s) 16,17,18 Service users and relatives are confident that their opinions and concerns are taken seriously and responded to appropriately. EVIDENCE: Three relatives and sixteen service users completed comment card, they all stated that they were aware of who to speak to and believed any issues raised would be taken seriously. Four service users spoken to stated that the manager was approachable and that she would listen to and act upon their concerns. No new complaints have been received since the last inspection. The Home has an adult protection policy and procedure, which includes a whistle blowing policy. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,23,24,25,26 The building is well maintained providing a homely environment for service users. EVIDENCE: The home was seen to be well maintained and requirements made at the last inspection have been acted upon. The hot surfaces and radiators have been guarded throughout the home. Hot water temperatures are recorded and thermostatic valves have been serviced on the baths, these continue to run below 43’. Four service users spoken to like their bedrooms and have brought personal possessions in with them. The glass walls have had a frosted cover applied to maintain dignity. The home has a variety of assisted bathrooms and the manager stated that they are considering converting an unused bathroom into a wet room. The home was seen to be clean and hygienic. Pedal bins have been provided in the en-suite bathrooms as part of the infection control procedures. These bins should use yellow clinical waste bags, further advice should be sought from the infection control unit. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 15 Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Significant progress has been made with providing staff with training. Staff have gained knowledge and skills to meet the needs of the service users. Thorough recruitment procedures are used. EVIDENCE: The registered manager has recently employed additional care staff, increasing the total number of carers employed. The Home now employs 19 care staff and 5 flexi care staff, total 24. Ten of the care staff have just completed the NVQ level 2 & 3 in care training. The staff have worked hard and completed this training in six months. Staff said although they have found all of the training draining they do feel the benefit of it. One member of staff had a very positive view of the training and believed it had raised their awareness of their actions and provided them with the skills required for the job. All of the staff have embarked on an intensive training programme to bring staffs skills up to date. The registered manager has produced a training matrix and individual training programmes for staff. Staff files showed that staff are not employed without evidence of identity, POVA checks and CRB check being conducted. There is no format for recording the interview of prospective staff. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,36,37,38 The manager has the skills and knowledge to continue to bring the home forward. Excellent progress has been made to achieve the standards provided in the home. Health & safety practices have improved. EVIDENCE: The registered manager has worked hard over the last six months with the support of the registered person and all the staff employed at the home to successfully achieve the improvements noted since the last inspection. The registered manager has demonstrated leadership enabling the home to move forward. A selection of staff have been trained in first aid and health & safety. The health and safety documentation such as fire log-books, electrical certificates were up to date. Portable electrical appliances in have been tested, although the need to test office equipment as well was discussed. It was agreed to set a new timescale for the requirement for staff to receive formal supervision 6 times a year. The registered manager does operate an open Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 18 door policy and when staff were spoken to they expressed how easy the registered manager was to approach and to talk to. They said they found this very supportive, especially during the recent changes within the home. Policies and procedures have been reviewed and copies placed in the staff room. See text for standard 15. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x 3 x 2 2 2 Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 20 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 OP4 Regulation 4,12,14, 18 Requirement An application for a variaition to the homes registration must be made for those service users identified as outside of the homes registration. All service users admitted to the home must be within the registration of the home. The registered manager must keep under regular review the effectiveness of the new care plan system and assessment tools being implemented. Daily reports must clearly record care provided and the events of the day. The medication policy / procedure must include homely remedies. A system must be introduced for managing homely remedies purchased by relatives and service users, including those self administering medication. Service users self administering medication must be provided with adequate lockable storage facilities in their rooms. The registered manager must ensure that medication is not accepted with give as directed Timescale for action 31.10.05 2. OP7,8,37 10,12,13, 14,15,16, 17,18, schedules 3&4 31.10.05 3. OP9 12,13,14, 16,17,23 schedule 3 30.11.05 Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 21 instructions, including insulin. 4. OP15,37 10,12,13, 14,15,16, 17, schedule 4 Records of temperature probing of hot food must be kept. The registered manager is required to contact environmental health regarding temperature probing of reheated food. Records of meals provided must be kept and a system/facilty provided for storing the records in. A written record of interviews of prospective staff to be kept. For all staff to formal one to one supervision six times a year. 31.10.05 5. 6. OP29 OP36 7,8,9,19 schedule 2 18 31.10.05 31.01.06 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. Refer to Standard OP11 OP12 OP26 Good Practice Recommendations To expand the care of the dying policy to include, bereavment, personal wishes, and multi-cultural needs. To consider a trained activities person being employed. To contact the infection control unit regarding clinical waste procedures. Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU 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 Yoakley House H56-H05 S23632 Yoakley House V232810 180705 Stage 4.doc Version 1.30 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!