CARE HOMES FOR OLDER PEOPLE
York House Care Home York House Care Home York Road Kennington Ashford Kent TN24 9QQ Lead Inspector
Mrs Sue Gaskell Announced Inspection 23rd January 2006 09:30 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 York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 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. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service York House Care Home Address York House Care Home York Road Kennington Ashford Kent TN24 9QQ 01233 613931 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) Mrs Patricia Mary Ireland Mrs Patricia Mary Ireland Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th June 2005 Brief Description of the Service: York House Residential Care Home is registered to provide accommodation and personal care for up to 3 older people. The registered owner and manager Mrs Patricia Ireland lives in a separate flat above the home. York House stands within the grounds of St Valery Care Home, also owned by Mrs Patricia Ireland. All policies and procedures and the overall running of the home is identical to St Valery. The residents at York House are more independent than those in the neighbouring home, however full support is provided to all residents. York House is located within three miles of Ashford Town Centre and is close to local amenities. Public transport links are close by, to the front of the property there is adequate parking for many cars. The home consists of two separate living units, each unit has a living/kitchen area, bedroom and ensuite bathroom. Residents of the home have full use of the secure landscaped gardens and the communal areas within St Valerys. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out over a period of approximately 6 hours and in conjunction with the inspection of St Valery. The inspector looked around the building and inspected a number of the records. At the time of the inspection there were 3 residents in the home and staffing for the two adjoining units of St Valery and York House comprised the registered owner, 3 carers and a housekeeper. The inspector met the residents and spoke with the registered person and 4 members of staff. What the service does well: What has improved since the last inspection?
Pre-admission assessments have been reviewed and are now being retained. Residents’ care plans now include a reference to the condition that the medication has been prescribed for and the medication administration record file now contains a list of the names of staff together with their signatures and initials. Any activities that residents participate in are now recorded. A staff training matrix has been prepared. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 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. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 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 York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 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): 1,3 and 6 Whilst the information provided to prospective residents gives an account of what they can expect of the home the Statement of Purpose does not refer to the current registration situation at York House and the adjoining home. Prospective residents have their needs assessed and are assured that these needs can be met. EVIDENCE: Since the residents of York House spend much of their time in the adjoining home run by the same registered person, the two homes are to be amalgamated. The owner was advised that the home must submit an application for a variation to the current registration details to ensure that it is accurate and the Statement of Purpose must be revised to reflect any changes. There was evidence to show that the registered person assesses prospective residents prior to admission and that this assessment forms the basis of a care plan. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 and 11 Whilst the physical and health care needs of residents are identified and met the care plans would still benefit from more detail. Medication procedures are generally sound but care must be taken to ensure compliance with current guidelines. Residents and treated with dignity and their families are assured of care, support, sensitivity and respect at the end of residents’ lives. EVIDENCE: Whilst there have been improvements to the care plans they would still benefit from more detail and clear guidelines on how to address individual needs. The medication file contains a laminated photograph of each resident, a record of the names, signatures and initials of staff administering medication, and there are details in the care plans of what the medication has been prescribed for. However the home does not have a copy of up to date guidelines medication guidelines for residential homes and the Inspector is to query the method of taking the medication to the residents with the Pharmacy Inspector. Residents’ families spoke highly of the home and referred to the good care and respect for residents’ dignity. Special attention is paid to spending time with residents at the end of their lives and assisting families in coping with bereavement and loss.
York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 10 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): 12,13,14, and 15 Social activities provide some stimulation and interest for people living in the home. Residents are assisted and encouraged in maintaining contact with families, friends and their former way of life. Meals are nutritious and balanced but there was no evidence that alternative main meals are provided. EVIDENCE: The Home has now reverted to the previous practice of keeping a record of residents’ activities, mainly based around music and old films. The home maintains good links and relationships with families and friends, who are encouraged to visit and made welcome. The food served at the time of the inspection appeared nourishing and appetising, and the menu record contained references to a variety of foodstuffs, but there was no record of any alternative main meals provided to residents. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 11 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): 16 and 18 There is a sound complaints system in place and but lack of training for staff may compromise their awareness of how to protect residents from abuse or harm. The lack of a CRB check for one person who worked in the home had the potential to put residents at risk. EVIDENCE: The home has a detailed complaints and an adult abuse procedure. The Inspector was informed that arrangements have been made for staff to attend training in adult protection awareness in March 06. One staff file showed that there was a member of staff who commenced in November 2004 and left a year later without having received her CRB check returned. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 12 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): 19,24 and 26 The home is generally well decorated and maintained and residents live in comfortable surroundings. Residents in shared rooms lack a permanent form of privacy and residents do not have access to some specialist equipment. EVIDENCE: The home is maintained and decorated to a good standard and the bedrooms are homely and comfortable. There are currently no hoists in the home and although they may not be necessary at present, this should be constantly reviewed and discussed with the care managers. The only form of screening in shared rooms is by portable bamboo folding screens. Whilst risk assessments have been carried out for these screens they are not stable and may fall over easily if knocked. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 13 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): 27,28,29 and 30 Staffing levels are adequate and staff morale is high with a low turnover of staff. The procedures for the recruitment of staff are generally sound and offer protection for people living in the home but there has been inadequate monitoring of a CRB application. Whilst staff appeared competent they would benefit from specific training. EVIDENCE: Although there is no separate cook, there seems to be sufficient staff to ensure that residents did not have to wait for attention. Whilst staff files generally included references, CRB checks and evidence if identity there was one file of a member of staff who commenced in November 2004 and left a year later without having received her CRB check returned. Although there is a good proportion of staff who have completed NVQ training, some have not received training in conditions specific to this client group. York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 14 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): 31,33,35,36 and 38 Whilst the registered person is experienced, she lacks the qualifications necessary to meet the current standard. The record keeping and health and safety systems are generally sufficient to safeguard residents’ welfare, rights and best interests. Staff do not benefit from regular formal supervision. EVIDENCE: The registered person said that does not intend to become qualified at this stage as she will be retiring and appointing a registered manager. Whilst staff referred to regular handover periods and said that the registered person is also available to discuss any issues, there is no evidence of regular supervision for staff. The records showed that fire alarm systems are tested regularly and all maintenance certificates were up to date.
York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 15 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 2 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 2 X 3 York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 16 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 2. 3 Standard OP1 OP7 OP9 Regulation 39 15 13 Requirement Submit application to cover amalgamation of York House with St Valery Ensure care plans are reviewed as and when necessary and at least on a monthly basis. Ensure Home has copy of up to date guidelines on the administering and storage of medication. Ensure that an accurate record is kept of all food provided. There should be an on-going review of the need to provide hoists in the home .Some form of fixed screens should be provided in shared rooms. Ensure that all staff are CRB checked and ensure that there is a system to monitor outstanding applications Provide training for staff in adult abuse awareness and conditions specific to the client group, eg dementia awareness Ensure that all staff have regular and evidenced supervision Timescale for action 06/02/06 20/02/06 06/02/06 4 5 OP15 OP24 17 16 26/01/06 20/02/06 6 OP29 19 20/02/06 7 OP30 18 31/03/06 8 OP36 18 31/03/06 York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations York House Care Home DS0000023132.V266082.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Kent and Medway Area Office 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
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