Care Home: Raplea

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Communication between people who use the service and staff was observed to be positive and open. There is a recruitment procedure in place that ensures service users are protected from harm. There is a range of policies and procedures, providing care staff with relevant information about all aspects of care and the home/organisation. What has improved since the last inspection? Medicines are now stored securely and safely at all times. Staff have completed up to date mandatory training to ensure that they are provided with updated knowledge and skills and up to date with current good practice. Insurance is in place and evidence of this has been forwarded to the Commission. What the care home could do better: The information provided to both prospective and current service users, in the service users guide and statement of purpose, needs updating to provide people with up to date information about the home. Gas appliances must be serviced every year and the home must keep the certificate for this. CARE HOMES FOR OLDER PEOPLE Raplea Farthing Green Lane Stoke Poges Bucks SL2 4JQ Lead Inspector Barbara Mulligan Unannounced Inspection 13th January 2009 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Raplea DS0000023013.V373743.R01.S.doc Version 5.2 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. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Raplea Address Farthing Green Lane Stoke Poges Bucks SL2 4JQ 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) 01753 644459 Mrs Lila Paterson Mrs Lila Paterson Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2008 Brief Description of the Service: Raplea is a care home for older people, which provides personal care for service users who are elderly. The home has three single rooms, two on the ground floor and one on the first floor. The home is annexed to the family home of the owners/manager, Mr and Mrs Paterson. It has a large garden. The home is situated half a mile from Stoke Poges village and three miles from Slough in a rural setting. Public transport is not easily accessible. The home was fully occupied at the time of this inspection. The home charges a basic fee of £380 per week. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. The home is located in an annexe attached to the owners’ own residence, providing residents with their own single bedrooms, two of which are on the ground floor and one on the first. One the day of the visit there was one person using this service. Due to the size of the home it is run and managed by the proprietor who is on hand at all times to provide for the needs of the residents and she is supported by her husband and a carer. The registered manager Lila Paterson was away on leave on the day of the inspection and her husband assisted with the inspection. The inspector looked at how well the service was meeting the standards set by the government and has, in this report ,made judgements about the standard of the service. What the service does well: Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Communication between people who use the service and staff was observed to be positive and open. There is a recruitment procedure in place that ensures service users are protected from harm. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 6 There is a range of policies and procedures, providing care staff with relevant information about all aspects of care and the home/organisation. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 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 Raplea DS0000023013.V373743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. The Statement of Purpose needs to revised and amended to provide potential service users with up to date information about the service. Service users needs are assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the previous inspection a requirement was issued for the homes statement of purpose and service users guide to be reviewed and amended. On the day of the visit the registered providers husband amended a copy by hand by updating the present address of t he Commission. However the statement of purpose still needs to contain the qualifications and experience of both the staff and registered manager as detailed at the previous inspection. This requirement will be repeated in this inspection report. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 9 At the time of the inspection there was one service user residing in the home. The inspector examined this care plans and the initial needs assessment. This assessment forms the basis of the care planning process. The organisation uses an assessment tool called the Barthel assessment. This covers eating and drinking, sleeping, elimination, communication, vision, hearing, personal care, dressing, skin care, mobilising and moving and handling. This was fully completed in the file examined. This information is readily available to staff who are expected to refer to the documentation to meet service users care needs. From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9and 10 Quality in this outcome area is good. The health and personal care needs of people using the service are generally well met, with personal care delivered in a way that promotes respect and dignity. However, more detail is required in care plans for people who are assessed as at risk of pressure sores. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there was one person using this service. The inspector examined their care plan and risk assessment documentation. This was in the form of pre-printed sheets with the service users name inserted. These provided adequate information for staff to follow in the provision of personal care. However, some entries lacked specific detail. For example, one entry records” assist with shower”. This is a vague statement and should contain specific details for staff to follow. This is a recommendation of the report. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 11 At the previous inspection it was identified that the daily records of the care provided did not give a full picture of the actual care given and a recommended was made for daily entries be fuller in description to reflect the care being delivered. The daily notes for the individual using this service were examined. These are not completed on a daily basis but are completed on average every three days. Some entries are detailed although many were difficult to read. Some entries contained limited information and did not give a full picture of the care provided. For example, one recent entry records “ enjoyed lunch, did some knitting” and another recent entry read, “daughter phoned”. It is strongly recommended that the daily notes are fully completed on a daily basis, and these should be fuller in description to reflect the care being delivered. The health care needs of the person using this service were evident in their personal file. There was evidence of optical screening, records of visits to the individual’s GP and the Chiropodist visits the home. The inspector was told that a domiciliary dental service would visit the home on a needs only basis. A tissue viability assessment is in place for the person using this service, which is reviewed on average three monthly. This person has been assessed at low risk of pressure sores. Following the previous inspection it was identified peoples medication was found to be stored insecurely, in an unlocked drawer of a bureau and a requirement was issued for residents’ medicines to be kept safely stored at all times. Likewise it was found that the procedures around the recording of controlled drugs was confusing and difficult to ascertain an audit trial. A requirement was issued for a system to be put in place to ensure a clear audit trial for the use of controlled drugs. At the time of the inspection there were no service users who were able to self-administer their medication. The storage of medicines was examined and a lockable metal cabinet has now been installed. The inspector was informed that there were no controlled drugs in use at the time of the visit and if they were to be used they would be stored in a metal tin within the lockable metal cabinet. The medication records are handwritten and are not signed or dated. The inspector was informed that on the day they were expecting the pharmacy to deliver the medicines in Blister Packs and the Medication Administration Records (MAR) would be pre-printed. It is strongly recommended that where medicines are written by hand on the MAR charts that these are signed by two staff and dated. Training records show that the two care staff have received medication training and plan to undertake refresher training in 2009. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 12 The inspector observed staff interacting with the service user and did so in a kindly and respectful manner. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. People living in the home are provided with a pleasant and relaxed environment. Meals are home-cooked, nutritious and nicely presented offering choice in both what they wish to eat and at a time and place to suit them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home encourages people who use the service to maintain links with family, friends and the local community and support is given to maintain contact where required. They can receive visitors in private and choose who they do/do not see. The person using this service is regularly visited by two friends and this is encouraged. On the day of the visit there was one person using this service. They enjoy a one-to-one with the staff. On the day of the visit they were completing a puzzle. This persons care plan however still contains information about activities that were enjoyed regularly but due to a change in her circumstances she is no Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 14 longer able to take part in these. This information must be updated to reflect her present situation and is strongly recommended. The inspector observed the menu’s which show that varied and wholesome meals are offered. Al meals are prepared freshly on the premises. Service users likes and dislikes are respected with a choice being offered where the need arises. There is a limited range of activities on offer, determined in part by the abilities of service users and the small size and resources of the home. Daily newspapers, weekly magazines, television, radio and a selection of books and jigsaws are provided for residents’ entertainment. A visiting hairdresser and chiropodist is available for those who require. Regular trips out shopping, trips to local restaurants, local shows held in the community are provided for those using the service and when the weather prevails, residents are able to help in the maintenance of the garden according to their abilities, if they wish. Contact with friends, families is encouraged and they are invited to events held in the home such as birthday celebrations, public holidays such as that held in December, where a Christmas dinner was put on for families, friends and visitors to enjoy with their friends/family members living in the home. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. The home is able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is accessible to service users and their representatives. There is a complaints form available with the procedure. At the previous inspection it was identified that since the Commission has changed its address it was recommended that the complaints procedure be updated to provide people with the new up to date contact details. This was completed by hand on the day of the visit. The inspector was informed that the home has not received any complaints since the last inspection. The Commission has not received any complaints about this service. There are policies and procedures in place for dealing with any allegations or incidences of this nature. The two care staff working within the home have completed Safeguarding training in October 2008. There have been no safeguarding referrals since the last inspection and the Commission has not received and safeguarding issues about this home. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 24 Quality in this outcome area is good. People living in the home are provided with a safe well maintained environment which is homely, clean, comfortable and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in an annexe to the owners’ own residence, providing residents with their own single bedrooms, two of which are on the ground floor and one on the first. One the day of the visit there was one person using this service. There is a small communal lounge/dining area that is homely and has many personal touches such as pictures, plants and books. A combined toilet and bathroom is located adjacent to the lounge for use during the day. There is also a separate toilet on the first floor, adjacent to the third service user bedroom. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 17 There is a conservatory attached to the main part of the building which service users, friends and relatives are able to readily access as are the patio and gardens during the warmer months. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. People living in the home are looked after by appropriate numbers and skill mix of staff, who are trained to carry out their duties. Recruitment policy and practices are in place to support and protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the size of the home it is run and managed by the proprietor who is on hand at all times to provide for the needs of the residents and she is supported by a carer and her husband. On the day of the visit the registered manager was on leave and her husband assisted with the inspection. One carer was on duty throughout the day of the visit. The home has a robust recruitment procedure in place to ensure only suitable people are employed to work with those using the service. New staff will complete induction training to ensure they are provided with the skills and knowledge to undertake their roles competently. The procedure is good although not tested, as there have been no newly recruited staff since 2006. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 19 Whilst staff have had the relevant CRB checks (criminal record bureau), it is strongly recommended that those undertaken in 2004 be repeated to ensure that users of the service are in safe hands at all times. During the previous inspection it was identified that staff training was out of date and a requirement was issued for staff mandatory training to be reviewed and updated where necessary. The training records were examined during this visit and staff have recently completed training in Infection Control, Fire Awareness, Safeguarding Vulnerable Adults, First Aid, Basic Food Hygiene and Moving and Handling. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. The home provides a consistent service to people using the service and there are systems in place to protect the health and safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the size of the home it is run and managed by the proprietor who is on hand at all times to provide for the needs of the residents and she is supported by a carer and her husband. At the time of the inspection there was one person using the service. The registered manager was away on leave on the day of the visit. The inspector was told that the registered manager is usually available in the home on a daily basis to deal with issues as they arise and has an ‘open-door’ Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 21 policy that encourages people to see her without the need to make an appointment. The registered manager has many years experience caring for older people and has recently completed the Registered Manager Award. Residents provide feedback about the home during everyday conversations with the registered manager and proprietor. They also have an opportunity to give written feedback on feedback forms that are provided to them and their relatives on an annual basis. The person using the service has a representative who manages their finances, the home does not have any involvement. People are enabled to hold monies within the home and are provided with lockable storage facilities for this purpose. Records were seen for fire safety. These show that the fire alarm is tested weekly and recorded. There is a fire based risk assessment and this was up to date. Health and safety training demonstrates that staff are up to date with all mandatory training. Service reports are in place for PAT testing dated 5/8/2008, Electrical Installation dated March 2004 and Gas appliances dated 2007. This must be completed on an annual basis and a requirement is issued to this effect. The Commission requires confirmation to be sent when this has been completed. During the previous inspection it was noted that the certificate of insurance in relation to the care home was out of date. An immediate requirement was made to ensure that this evidence be provided to the Commission for Social Care Inspection within 24 hours to confirm appropriate insurance is in place. The Commission received the evidence as was agreed. Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 22 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 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(c) Schedule 1 Requirement The homes statement of purpose must be reviewed and amended to meet with the care home regulations 2001. A copy is required to be sent to the Commission for Social Care Inspection. The registered person is required to ensure that GAS appliances are serviced annually and a copy is sent to the Commission for Social Care Inspection. Timescale for action 30/04/09 2 OP38 23 30/04/09 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. Refer to Standard OP7 OP7 Good Practice Recommendations It is recommended that all entries in the care plans contain specific details about the provision of personal care. It is strongly recommended that the daily notes are fully completed legibly, on a daily basis, and should be fuller in description to reflect the care being delivered. DS0000023013.V373743.R01.S.doc Version 5.2 Page 24 Raplea 3. OP9 It is strongly recommended that where medicines are written by hand on the MAR charts that these are signed by two staff and dated. It is strongly recommended that the care plan of the person using this service should be updated to record their present situation and how their social care needs are to be met. 4 OP12 Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Raplea DS0000023013.V373743.R01.S.doc Version 5.2 Page 26 - 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. 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