CARE HOMES FOR OLDER PEOPLE
York House Care Home York Road Kennington Ashford Kent TN24 9QQ Lead Inspector
Sue Gaskell Unannounced 27 June 05 10:00 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 Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service York House Care Home Address York Road, Kennington, Ashford, Kent. TN24 9QQ 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) 01233 613931 Mrs Patricia Ireland Mrs Patricia Ireland Registered Care Home 3 Category(ies) of Older People aged 65 or over registration, with number of places York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31/03/05 Brief Description of the Service: York House Residential Care Home is registered to provide accommodation and personal care for up to 3 people with dementia. 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 en-suite bathroom. Residents of the home have full use of the secure landscaped gardens and the communal areas within St Valery’s. York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of hours 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 spoke with the registered person, 2 members of staff, and met the 2 residents. What the service does well: What has improved since the last inspection? What they could do better:
Written pre-admission assessments should be prepared and retained. Individual care plans require more detail, evidence of having been reviewed as and when necessary and at least on a monthly basis. Manual handling assessments and other risk assessments must identify the actual risk itself, or and/or include clear guidelines on how to minimise the risk. Medication Administration Records must include a record of the names, signatures and initials of staff administering medication and the care plans must include what the medication has been prescribed for. A record should be kept where residents have received an alternative meal to that written on the menu record. There should be an on-going review of the need to provide hoists. Some form of fixed screens should be provided in shared rooms. A record should be kept of any of the activities provided. Staff would benefit from training in adult protection awareness and conditions specific to this client group. Risk assessments must be prepared around the use of portable folding York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 Page 6 bamboo screens and action must be taken so that the water from the hot taps does not present risk. 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 H56-H05 S23132 York House V232868 270605 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 York House Care Home H56-H05 S23132 York House V232868 270605 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) 3,6 It was not possible to establish whether there is a proper assessment of prospective residents prior to them moving into the home. Without such an assessment there is no assurance that care needs can be met. EVIDENCE: Whilst there is a format for recording pre-admission assessments and the registered person said that these had been completed on recently admitted residents, the completed forms have not been retained. There is also no confirmation to prospective residents and/or their families or care managers confirming that their needs can be met. York House Care Home H56-H05 S23132 York House V232868 270605 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 Some progress has been made on improving arrangements to ensure that the physical and health care needs of residents are identified and met. The shortfalls have a potential to place residents at risk. Residents and their families are assured of care, support, sensitivity and respect at the end of residents’ lives. EVIDENCE: Individual care plans have been prepared but not all needs, eg a resident who had difficulty holding a cup, have been identified. The plans are basic, not up to date, and some have not been reviewed since November 2004. Manual handling assessments and other risk assessments have been prepared but do not necessarily identify the actual risk itself, or and/or include clear guidelines on how to minimise the risk. Although the medication storage was satisfactory and the Medication Administration Records were dated and signed, there is no record of the names, signatures and initials of staff administering medication or what the medication has been prescribed for. 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 H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 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 standard(s) 14,15 Social activities provide a limited degree of 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 it was difficult to establish whether alternative main meals are provided. EVIDENCE: The registered person said that there are a variety of activities for residents, mainly based around music and old films, but there was no recent record of any of the activities provided. The home maintains good links and relationships with families and friends, who are encouraged to visit and made welcome. Whilst the main meal of chicken, chopped fried potatoes and baked beans appeared nourishing and appetising, and the menu record contained references to a variety of foodstuffs, there was no evidence of any alternative main meals provided to residents. York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 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 standard(s) 16,18 There is a sound complaints system in place and but lack of training for staff may compromise their ability to protect residents from abuse or harm. EVIDENCE: The home has a detailed complaints procedure and the registered person explained how this has needed to be used recently where a complaint was found to be without substance. Although the home has an adult abuse procedure, staff have not had training in adult protection awareness. York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 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 standard(s) 19,26 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: Maintenance and decoration was being carried out at the time of the inspection. There are currently no hoists in the home. The registered person said that the use of a hoist is not necessary at present, but this should be constantly reviewed and discussed with the care manager. The only form of screening in shared rooms is by portable bamboo folding screens. No risk assessments have been carried out for these screens. York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 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 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) 27,29,30 Staffing levels are adequate and staff morale is high with a low turnover of staff. The procedures for the recruitment of staff are sound and offer protection for people living in the home. Whilst staff appeared competent, there is inadequate recording of staff training and they would benefit from specific training. EVIDENCE: Although there was no separate cook, there seemed to be sufficient staff to ensure that residents did not have to wait for attention. Staff files included references, CRB checks and evidence if identity. 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. There was no training matrix available. York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 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 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) 33,35,38 Whilst the registered person is experienced, she lacks the qualifications necessary to meet this Standard. The record keeping and health and safety systems are generally sufficient to safeguard residents’ welfare, rights and best interests, but there are some health and safety issues requiring attention. 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. The records showed that fire alarm systems are tested regularly and all maintenance certificates were up to date. However, there was no risk assessments around the use of portable folding bamboo screens, and the water from the hot taps was uncomfortably hot to touch and could present risk. York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 3 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 x 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 2 x 3 x 3 x x 2 York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 Page 16 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 OP3 Regulation 14 Requirement Timescale for action 30.06.05 2. OP7 15 3. OP9 13 4. OP24 16 Retain pre-admission assessments. There must also be evidence of confirmation to prospective residents and/or their families or care managers confirming that their needs can be met. Individual care plans require 31.07.05 more detail, evidence of having been reviewed as and when necessary and at least on a monthly basis. Manual handling assessments and other risk assessments must identify the actual risk itself, or and/or include clear guidelines on how to minimise the risk. Medication Administration 30.09.05 Records must include a record of the names, signatures and initials of staff administering medication and the care plans must include what the medication has been prescribed for. There should be an on-going 31.12.05 review of the need to provide hoists in the home and some form of lift from the ground to first floor. Some form of fixed screens should be provided in
H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 York House Care Home Page 17 shared rooms. 5. OP30 18 Provide training for staff in adult 31.12.05 abuse awareness and conditions specific to the client group, eg dementia awareness Risk assessments must be 30.06.05 prepared around the use of portable folding bamboo screens, and action must be taken so that the water from the hot taps does not present risk. 6. OP38 13 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 OP8 OP15 OP30 Good Practice Recommendations Record activities undertaken by each resident on an individual basis. Record alternative meals provided to residents. Prepare on-going training matrix York House Care Home H56-H05 S23132 York House V232868 270605 Stage 4.doc Version 1.30 Page 18 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
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