Care Home: Straven House

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What the care home does well Information about services provided by the home is good, it is available to those people who use the service and provides enough information for them to be able to decide if the home will be suitable for them. People live in a environment that gives them safety and security. They are treated with respect and staff show good awareness of their needs. Positive relationships were seen between them, and people reacted in a positive way. The people who use the service appeared to be at ease during meals and staff offered the support they required making sure that they could enjoy their food. People`s bedrooms have been furnished to meet their individual needs and tastes, and many areas in the home are tastefully furnished and well equipped. Visitors said that they could visit at anytime, were made welcome and offered refreshments by staff. The home has regular activities and entertainment and people can choose whether or not they wish to take part. What has improved since the last inspection? The manager has taken steps to ensure medications are dealt with safely. People are given their medications as prescribed by their doctors so that their health and general wellbeing is maintained. The manager makes sure that accidents and incidents that affect the safety or well being of people living in the home are reported to the Commission in writing. What the care home could do better: The care plans must monitor and record the weight of people at regular intervals. Any emerging patterns or variation in peoples weight loss/gain can be medically reviewed, and dietary needs can be more ably addressed. This will prevent serious consequences to peoples health. Everyone must have a pre-admission assessment done. Assessments needs to be more detailed and information about who was involved in the assessment process and who supplied the information is also needed. The plans should show how people needs are met and what action has been taken by staff to make sure that needs are met. Relatives should also be involved in the reviews. Because of the risks associated with the use of bed safety rails, the home should make sure that they are the best option for people before they are put into use. When in use, proper safety and maintenance checks must take place. The manager must make sure there are enough staff on duty to make sure all the peoples` needs can be met fully. Because of the layout of the building and psychological needs of people in the home the manager should review the night staff level in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Straven House Queens Road Ilkley West Yorkshire LS29 9QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Frederick Rawlins     Date: 0 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Straven House Queens Road Ilkley West Yorkshire LS29 9QL 01943607063 01943600708 welchfa@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (GL) Ltd Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The place for MD(E) is only for the use of the service user named in connection with the variation application of 13.1.05 Date of last inspection Brief description of the care home The home is an adapted detached property set in its own grounds on the outskirts of Ilkley. Accommodation is provided on the ground and first floors. There is a passenger lift, which can be used by people to access the first floor and the lower ground floor where the dining room, kitchen and laundry are located. There are large attractive gardens but not all areas are accessible to people; three patio areas have been Care Homes for Older People Page 4 of 26 Over 65 2 1 21 1 0 0 0 0 Brief description of the care home provided, one of which has raised flower beds and another which can be accessed via the dining room has views across the valley. Ramps are available in the gardens and provide level access for wheelchair users into the building. A local bus route is nearby and Ilkley town centre is within walking distance although this is a steep road. The home is registered to provide care to twenty-four people of either sex over the age of 65, care can be provided for up to two people with dementia and one person with a physical disability. Nursing care is not provided. Two shared rooms are used as singles therefore occupancy is limited operationally to twenty-two. Information about services provided by the home is kept in a file in the reception area as well as in people rooms. Information packs will be posted to people on request. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A visit was made on 6th September 2008 from 08:30 to 17:00. The home did not know that this was going to happen. The inspection was conducted in the company of the manager who had only worked at the home for 3 months and had never been involved in the inspection process as a manager. Feedback was given to her at the end of the visit. The purpose of the visit was to assess what progress the home had made in meeting the rquirements made in the last inspection report and the impact of any changes in the quality of life experienced by people living at the home. Before visiting the home the inspector asked for information from the manager (the Care Homes for Older People Page 6 of 26 Annual Quality Assurance Assessment - AQAA) which asks about what policies and procedures are in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. The methods used during the inspection included talking to people who live in the home, staff, manager and relatives visiting at the time. Care records were looked at and a tour of the home was carried out. At the time of writing this report, the fees charged for care provided were 307 pounds 75 pence to 604 pounds per week. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The care plans must monitor and record the weight of people at regular intervals. Any emerging patterns or variation in peoples weight loss/gain can be medically reviewed, and dietary needs can be more ably addressed. This will prevent serious consequences to peoples health. Everyone must have a pre-admission assessment done. Assessments needs to be more detailed and information about who was involved in the assessment process and who supplied the information is also needed. The plans should show how people needs are met and what action has been taken by staff to make sure that needs are met. Relatives should also be involved in the reviews. Because of the risks associated with the use of bed safety rails, the home should make sure that they are the best option for people before they are put into use. When in use, proper safety and maintenance checks must take place. The manager must make sure there are enough staff on duty to make sure all the peoples needs can be met fully. Because of the layout of the building and psychological needs of people in the home the manager should review the night staff level in the home. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make an informed choice about whether to move into the home and can be confident Straven House will be able to meet their individual needs. Evidence: Four people we spoke to said they felt well informed before they moved into the home. Positive comments made were the staff and management give us helpful support. I have settled very well and from a relative my mum has been at Straven House for over a year staff give me all the information I need and any questions I ask are always fully answered. The home has a statement of purpose and service user guide both are continually reviewed. Four people said they had all been given written information about the home before they moved in. They also said they had received a contract, records examined confirmed this. Care Homes for Older People Page 11 of 26 Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people are receiving health and personal care based on their individual needs this could be compromised by the inconsistency of the records. Evidence: There have been many positive comments made by people living in the home as well as their relatives about the care provided. Examples from two relatives spoken with include; the home keep me well informed and I cannot praise the staff enough for the care they provide for my relative. One person said I am very happy living here. Case tracking was done for five people living in the home. This involved looking at their care records and medication charts. The care plans provided useful information about how care needs were met and showed evidence of regular review. However there were some areas where improvements could be made in relation to health care needs. One care plan stated that there had been no change in the persons weight. However Care Homes for Older People Page 13 of 26 Evidence: on examination of the record there was no evidence that the person had been weighed. The care records must clearly show the weight of people who users the service and what action has been taken by staff to ensure dietary needs are addressed to prevent serious consequences to their health. Though most care plans indicated the medical diagnosis for each person, the plans did not specifically differentiate and/or highlight the symptoms/behaviour exhibited by each person and the ways in which staff managed these symptoms. For example one care plan stated; has made simple choices but did not state what these choices are and why they were made. Some care plans contained little detail about the actions staff would need to take in order to meet the needs of the person or their individual preferences. Risk assessments had been carried out for both mobility and bed rails but not all care plans contained the details of how to minimise risk. Although there was evidence of care plans being reviewed, one relative said she was not aware she could be involved in the review of her mothers care plan. Staff were observed to be treating people in the home with kindness and respect when speaking with them. People looked to be clean and well cared for. The home has a medication policy, and the manager has been monitoring the systems. Examination of the records evidenced the home is complying with their policy. Care plans showed people are assured that at the time of their death, staff will treat them and their family with care and respect. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff are working hard in developing a stimulating place for people to live and people in the home receive a nourishing diet. Evidence: The home has an activities organiser and the people who use the service are supported to take part in valued activities such as reminiscence, exercise, quiz, manicures, dominoes, craft and singers from outside are booked. Positive comments were made on the surveys about activities and the organiser. One person said she is very helpful and gets people involved. On the afternoon of the site visit, people were singing along with the entertainer the home had booked. There were also other elderly people from outside the home enjoying the entertainment. People said the food was good. One person said they make every effort to give me a choice the puddings are really good. People also said the meals are nicely presented. During the site visit staff were seen supporting people with their meal, by cutting up their food and helping those who needed it. Care Homes for Older People Page 15 of 26 Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are comfortable in raising concerns and complaints to the management, and the management will resolve the situation in the best interest of the person. Staff are aware of how to protect people from abuse. Evidence: Three people said they were aware of who to complain to and felt comfortable when raising concerns with the management. Two gave example of how their concerns and complaints had been resolved by the management. Also two relatives said they know who to speak to if they were not happy. The home has a complaints policy, which provides staff with the policy they should follow if a complaint is made. There has been two complaint made to the Commission which the management have investigated and responded back to the Commission. The organisation has adult protection policies and information in place and the home has got copies of the local authority adult protection procedures. Staff said that they would report suspected or actual abuse to the person in charge. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people to live in a safe, and comfortable environment, which encourages independence. Evidence: All areas of the home were visited. The home offers a very comfortable and safe place for people who live there. Staff have made sure that the peoples bedrooms reflect their needs and suit their choices and preferences. Radiator guards are in place to protect people from heat injury. With one exception rooms were clean and free from any unpleasant odours. A relative made positive comments about the cleanliness of the home and said it was always clean and fresh. The nurse call system was activated and the response was good, however the manager should ensure the call leads are within reach of people when in their rooms during the day. There is a range of communal space where people can meet with their families. The bathrooms have the appropriate aids and adaptations to support staff and people who users the service. Gloves and aprons were available throughout the home and the manager said in the Care Homes for Older People Page 18 of 26 Evidence: pre assessment questionnaire there is an infection policy and staff are trained in infection control. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Proper recruitment checks are made to make sure that people are safe and staff are suitable to work with older people. The manager needs to review the staffing levels to ensure peoples needs are met at all times. Evidence: In discusssion with all persons they generally confirmed that the staff are good. Comments from them were; good and helpful, they do what they can for you, they get you what you ask for. Relatives said there is a good up beat atmosphere with the care assistants and very friendly staff. The Annual Quality Assurance Assessment returned to the Commission said we maintain the correct number of staff agreed with the inspectorate and taking account of the individual needs of the people. In response to the inspection in November 2007 the management said because of some peoples psychological and emotional support needs the home will ensure that there are four staff on duty from 7am to 10pm; seven days a week. However the home has not been able to enforce the above because of sickness, holidays and staff turnover. Currently the home has advertised for a senior carer, a care assistant and a cook. The manager is trying to cover these posts with Care Homes for Older People Page 20 of 26 Evidence: staff overtime and agency workers. However until these vacancies are filled there is a risk that some peoples care needs might not be met. At present the home has two staff on duty at night. However because of the layout of the building it will be difficult to ensure that the physical, psychological and emotional needs of some of the people living in the home can always be met therefore it was recommended to the manager that a review of the risk within the home at night should be undertaken. Comments from the surveys returned by staff said;people appear to be increasingly more dependent which can put a strain on the staff. Taking this as well as the current difficult staffing situartion into account, this reinforces the recommendation that the manager needs to review staffing levels within the home. Two members of staff said the training was good. Records confirmed that staff had received training in areas such as infection control, health and safety, food hygiene and dementia training. Although staff said they had induction training at the start of employment there was no record of this on the files looked at. Four people spoken with said they felt safe and a relative commented I was assured that the staff received the relevant training to enable them to look after the people in this home. Another comment was;I think this is the case from the way I have observed staff dealing with my relative. Information provided by the manager said over 50 percent of staff have their National Vocational Qualification (NVQ) at level two or above in care. A sample of three staff employment records was examined and all had complete records with criminal record bureau checks having been carried out. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a manner that promotes good service delivery in the best interest of people using the service. Evidence: The manager is a registered nurse who has several years experience of caring for the elderly. She started work at the home June 2008 and has applied for registration with the Commission. During the site visit she discussed her commitment to making sure the home puts the interests of the people in the home first and provides the best possible quality service. People talked with during the site visit explained how the manager has responded to any concerns they had about the quality of the service. The finance administrator explained the home does not hold money for people, this is either carried out by the person themselves, their family or an advocate. Care Homes for Older People Page 22 of 26 Evidence: The pre inspection questionnaire states all of the recent health and safety visits have been carried out and the home works to a health and safety policy. This is to ensure people living in the home are safe. The manager ensures staff are supervised and supported to enable them to care for the people in the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 7 It is recommended Relatives should be informed and encouraged to take part in peoples care reviews. The care records should clearly show the weight of people who uses the service so dietary needs can be more ably addressed. It is recommended pre-assessment reports should be more detailed and information recorded should include who was involved in the assessment process as well as who had supplied the information. Because of the risks associated with the use of bed safety rails, the home should make sure that they are the best option for people before they are put into use. When in use, proper safety and maintenance checks must take place. It is recommended the manager review the staffing levels within the home so that potential risks can be minimized. 3 7 4 8 5 27 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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