CARE HOMES FOR OLDER PEOPLE
York House 8-10 Cauldon Avenue Swanage Dorset BH19 1PQ Lead Inspector
Gill Kennedy Unannounced 04 July 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. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service York House Address 8-10 Cauldon Avenue, Swanage, Dorset, BH19 1PQ 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) 01929 425588 01929 426572 Mr Richard Graham Wylie Mrs Maxine Valerie Toni Jacqueline Wylie Mrs Margaret Street CRH 34 Category(ies) of OP - 34 registration, with number of places York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 01 February 2005 Brief Description of the Service: York House is a large, older style, detached property that overlooks a recreational/garden area and is close to the seafront. The home is about one mile from Swanage town centre and the amenities therein, which include a G.P surgery, community hospital, High Street shops and banks, a post office and places of worship. Accommodation is provided over three floors, all of which are serviced by a passenger lift. All communal lounges and dining areas are on the ground floor, along with the kitchen and manager’s office. There are 30 bedrooms in the home, two of which are currently registered for use as shared rooms. A maximum of 34 service users can be accommodated in the category OP (older persons). Mr and Mrs Wylie, registered persons in control, have owned York House since 1988. The home has a registered manager, Mrs Street, who is supported by the Deputy Manager, Mrs Dyke and Assistant Manager, Mrs Parham. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. During the inspection Mrs Street, the registered manager, was available until 15.00 hours and Mrs Janet Dyke, the Deputy Manager, took over. Both were helpful and co-operative and provided written information as requested. The files of two residents were read during this inspection. Three residents were seen privately to discuss their views about life in the home and the services provided. Three relatives were also spoken to, one in the presence of a resident. Completed quality control questionnaires that the home had distributed to residents, relatives and staff were also seen during the inspection. The time taken on this inspection was 6.75 hours and 12 standards were assessed and two were partially assessed. CSCI comment cards were left at the home for residents and relatives to complete to ascertain their views about the services provided at the home. At the time of writing this report 7 replies had been received from residents and one from a relative. The terms resident and service user used in this report are interchangeable What the service does well:
The home is seen as part of the local community, being used to provide respite care to local residents and people feel it is a welcoming place where relatives report they are able to make visits at times suited to them. Residents and visitors expressed confidence in the management of the home who they find approachable and feel any complaints they had would be listened to and addressed. One resident said on the CSCI comment card ‘I have lived here for x (no. given) years and have enjoyed my time very much. Everyone is so helpful and I am very grateful for all that is done.’ The home was found to be clean and comfortable providing pleasant surroundings for service users. The passenger lift was out of order at the beginning of the inspection and had not been operational for two days. Whilst the home had found a rather unorthodox solution to the temporary problem the management had done their best to accommodate residents with as little disruption as possible.
York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
A pro forma Service User Guide has been purchased which is being personalised to suit the needs of the home. However, the manager is still not able to demonstrate that they are providing the written information as required in Standard 1 to enable prospective residents to make an informed choice. Residents have been admitted to the home without a comprehensive assessment that should form the basis of a care plan, which can be easily accessed by staff to see how care should be given to residents. Failure to have this written information means that staff are reliant upon verbal communication which could lead to mistakes being made particularly when agency staff are used. Care plans need to be updated to reflect residents changing needs and the home should make more effort to involve residents and their relatives in the care planning and review process. The home needs to seek more information from residents about their views of the food provided, as three out of seven residents said on the CSCI comment cards that they only liked the food ‘sometimes’ and one resident said in discussion that whilst the breakfast and lunches were very good the evening meal was ‘not always attractive or adequate.’ However, two residents seen during the inspection expressed satisfaction with the food and the quantity provided, one person having put on weight since coming into York House. Risk assessments need to be regularly updated including those for residents who are self medicating and where radiators are uncovered in bedrooms and new residents move in.
York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 7 It was noted on the last inspection that the home had recorded on six of their risk assessments that six residents were at high risk if the radiators were not covered or changed to those with low temperature surfaces. To date only two of these radiator covers have been supplied which leaves four residents at risk of scalding. The home needs to monitor the dependency levels of residents as this will help them to decide how many care staff are needed to fully meet residents assessed needs. Staff recruitment procedures are poor and could place residents at risk. The home should aim to ensure all staff have a Criminal Records Bureau check before starting work at the home and as a minimum they must have a *POVA first check. * Protection of Vulnerable Adults. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 8 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 York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 9 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 The home still does not have a Service User Guide available for prospective residents to be clear about the services the home provides to enable them to make a fully informed decision. The home is not able to demonstrate that all residents have received a full assessment prior to admission. EVIDENCE: Whilst the home has written information for prospective residents they are still working on The Service User Guide and have purchased a detailed document, which they are tailoring to suit the individual needs of the home. Two relatives said they had not received written information prior to their relatives coming into the home. However, both residents were familiar with the home, either having respite previously or attending coffee mornings and they and their relatives had been confident York House would be able to meet their needs. Three residents who had recently been admitted did not have care plans. One person had been accepted into the home as an emergency and it was agreed a care plan would be drawn up as a matter of priority. Currently staff are reliant upon verbal instructions about how to meet these residents needs.
York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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) 7,9 Systems are not in place to update care plans and involve residents and their relatives in this process to ensure that care plans clearly indicate to staff how care needs should be met. Whilst some progress had been made regarding the delivery of medication in the home there was still some improvements to be made for this standard to be met. EVIDENCE: The files of two residents were read in detail. A lot of effort has been put into obtaining Care Planning and Assessment booklets. These can form a firm basis for good care planning, providing they are kept up to date and completed in more detail to indicate how any changes in a resident’s condition may effect the care delivered to them. One relative whose Mother had lived at the home for sometime was unaware that there was a plan of care for his/her relative and had also been concerned when there was a significant change in his/her mother’s care and this had not been discussed prior to a decision being made. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 11 It was noted on a care plan that one resident who sought attention at night was seen by staff as ‘buzzer happy’ and there was no clear information on the care plan how this resident’s needs at night should be addressed. There are five service users currently self-medicating. Four residents had a risk assessment, but the risk assessments seen were dated 2003 and had not been updated. A new resident without a care plan was self-medicating and did not have a risk assessment. It had been suggested at the last inspection that the risk assessment should include a commitment from residents to indicate that they would ensure their medication was securely locked away, but this had not been instigated. Evidence was seen to confirm that the home now records the medicines received for those self-medicating and the quantity supplied to them. There were still issues about storage of medication and developing audit trails for drugs not pre-packed to be resolved. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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) 13.15 There are links with the local community and visitors feel welcomed into the home. Whilst there is a wholesome and balanced diet there is a small group of residents who are sometimes dissatisfied with the meals supplied. EVIDENCE: Visitors felt they were made welcome and could call in at any time they wished. There are regular coffee mornings that help to raise funds for local charities. There is a four-week menu, copies of which have been supplied to CSCI. The home has a cook who is used to dealing with specialist diets and had information about one service user who has specialist needs. The views of service users about the food supplied was mixed, out of the seven CSCI comment cards returned four said they liked the food and three said they liked it sometimes. One person said on the comment card ‘I feel the food is not always attractive or adequate in the evenings’. This was followed up in discussion with this resident who said the breakfast and lunches were excellent and whilst he/she was aware there was a choice on offer for the evening meal
York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 13 he/she was not always able to access the menu board to make a choice. This resident also said he/she would not like to ask for a sandwich later in the evening as the staff were ‘too busy’. The two other residents seen expressed satisfaction with the food, one person having put on weight since coming into the home and the other resident said there was too much food. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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 Residents and their families expressed confidence that any complaints would be listened to and addressed by the management. EVIDENCE: Service users and their families could not recall receiving written information on how to access the home’s complaints procedures, but they find the management team accessible and would feel comfortable about airing their complaints and confident they would be dealt with appropriately. The complaints procedure is available on the notice board, but those spoken to were not aware of this. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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) 25,26 Work has been undertaken to improve the safety of residents but there is still some action needed to protect vulnerable people. There is a clean and comfortable environment for service users, making it a pleasant home for those living there. EVIDENCE: The manager confirmed that thermostatic valves had been fitted to all hot water outlets to ensure that water was delivered to service users around 43oC. In May 2004 the proprietor had agreed to fit radiator covers on six unguarded radiators where the home’s own risk assessments had indicated there was a high risk to these residents. This has been completed in two rooms and another two are said to be in the current programme but still not completed. Leaving four rooms where residents are defined at risk and action has not been taken. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 16 York House was found to be clean, hygienic and free from offensive odours. Laundry facilities are appropriately situated with washable walls and floor surfaces. Foul laundry can be washed at 65oC.The home had an infection control policy and procedure. A member of staff indicted that there was always plenty of gloves and aprons for staff to do their jobs safely. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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 The home does not use the information it collects to demonstrate that staffing levels are determined by the assessed needs of the residents. Recruitment practices at the home are not sufficiently robust to protect service users. EVIDENCE: Files indicate that the level of residents care needs are assessed and this information should be used as an indicator of the staffing levels required for care staff in the home. A number of ancillary staff are employed to underpin the care provided by the care staff. Six residents who replied to CSCI comment cards said they felt well cared for, and one person felt this sometimes. One resident said ‘Could do with more staffing – present staff excellent’ and another said staff were a little hurried and did not go at his/her pace when personal care was provided. Two relatives also expressed the view that there was not always sufficient staff on duty. One relative noted that staff had their breaks together and sometimes it was difficult to locate a staff member. It was noted during the inspection that in the residents lounge no member of staff on duty came into the lounge for over an hour until afternoon tea was served. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 18 The files of three staff newly employed at the home were seen. Only one had a CRB check, the manager said that the2 other two had been applied for. On two files there was only one reference. In the case of one staff member comments on one of her references had not been followed up prior to appointment. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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) 33,37 Quality control systems are being put in place that will give management information on how residents view the services that are provided. EVIDENCE: The home had purchased a detailed quality control document and is currently using a questionnaire for residents and their families to assess their satisfaction with the services provided. They are also seeking information from staff about their views on the induction and training they are receiving. How the home is developing this system and using it to shape services can be further assessed at the next inspection. Standard 37 was not fully assessed but the provider is now sending in Regulation 26 reports to CSCI on a monthly basis. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 20 Standard 38 was not fully assessed, but work still needs to continue on risk assessments where radiator covers are not provided particularly when a new person is admitted and current assessments must be reviewed on a regular basis and residents changing needs recorded. See Standard 25. York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 1 x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2
COMPLAINTS AND PROTECTION x x x x x x 2 3 STAFFING Standard No Score 27 2 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 3 x x x x x York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 5 Requirement A copy of the Service User’s Guide must be made available to the Commission and each service user. (timescale of 31.10.04 and 01.04.05 not met.) The needs of the service user must be assessed by a suitably qualified person prior to admission as far as it it practicable to do so. Where practicable consultation with the service user or a representative must take place when preparing and reviewing the care plan. The care plan must be reviewed on a regular basis and reflect the changing needs of the service user. Radiator covers or low temperature surface radiators must be fitted in the rooms of residents the home has defined as at high risk. No person must be employed at the home until the required checks have been done. CRB checks must be obtained and as a minimum the POVA first check must be in place. All staff must have two written Timescale for action 04.09.05 2. OP3 14 04.09.05 3. OP7 15 04.09.05 4. OP7 15 04.09.05 5. OP25 13 04.09.05 6. OP29 19 Schedule 2 04.09.05 7. OP29 19 04.09.05
Page 23 York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 8. 38 Schedule 2 4 references, one of which must be from their last employer. Where radiators are not covered 04.09.05 nor have low temperature surfaces, risk assessments must be in place to demonstrate that they reflect the needs and capabilities of current service users and that they are regularly reviewed. (timescale of 10.10.04 and 01.05.05 not met.) 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 OP9 OP9 OP9 Good Practice Recommendations The risk assessments for service users who self medicate should include a commitment from them that they will store medicines securely. The home should have a clear audit trail for medicines not MDS blister packs e.g. dating packs when they are started or entering a carry forward balance on the MAR chart. The registesred person should obtain a cupboard that complies with the Misuse of Drugs (Safe Custody) regulations 1973 for storing Controlled Drugs (CDs) and a CD record book. The home should seek more detailed information from residents about the quality of the food provided and change the menu or offer further choices if necessary. The home should be able to evidence that staffing levels are determined by the dependecy levels of residents. The residential forum calculation could be used for guidance. 4. 5. OP15 OP27 York House D55 S26895 York House V215072 040705 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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