Care Home: The Old School House

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What the care home does well People are assessed before they move into the home to make sure that their needs are known and can be met by the staff in the home. Good support is offered in the meeting of people`s health needs. The staff work well with health professionals and follow instructions to make sure that needs can be met. People are able to exercise choices in their lives and are offered a variety of leisure activities. This enables them to decide what to participate in and when to spend time alone. The home is very modern and clean and has been purpose built to meet people`s needs. People are supported by staff who have been employed through good recruitment systems and who receive training to be able to meet needs. There is good support with the managing of people`s monies; computer systems assisting the staff to make sure that finances are kept safe. What has improved since the last inspection? This is not applicable as this is the first inspection of this service. CARE HOMES FOR OLDER PEOPLE The Old School House New Walkergate Beverley East Yorkshire HU17 9BP Lead Inspector Sarah Rodmell Key Unannounced Inspection 15th May 2008 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 The Old School House DS0000071358.V364660.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. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old School House Address New Walkergate Beverley East Yorkshire HU17 9BP 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) 01482 868118 jan.newman@eastriding.gov.uk East Riding of Yorkshire Council Mr John David Duncan Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40) of places The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE and Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 40 2. Date of last inspection Brief Description of the Service: The Old School House is situated in the town of Beverley; it is close to the main shopping area and the bus station. The home provides accommodation and care for up to forty people over the age of sixty-five, and who suffer with dementia. The district nurses provide any element of nursing care that may be required. There are two floors with two passenger lifts and stair access. There are three lounge areas and a dining room. There are good views of the external areas of the home, which include a courtyard and a raised pond with room for tables and chairs. All of the rooms are single and all have en-suite facilities. The home has two bathrooms with bath hoists and overhead tracking. The home has single toilets throughout, near the lounge and dining areas. There is a small car park at the front of the building. The environment is modern, homely, clean and well presented. Information about the home and its service can be found in the statement of purpose and service user guide. Both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The senior staff member told us on the 15th May 2008 that the weekly fees are £478 per week, with additional charges for toiletries, chiropody and Sky TV. The Old School House DS0000071358.V364660.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 two star. This means the people who use this service experience good quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last visit to the home, including information gathered during a visit to the home. Since the registration of the home, the CSCI has not received any information about the home from the registered provider; there have been no letters or complaints to us from other people. The site visit took place on 15 May 2008, beginning at 09.30 am and ending at 4.00 pm. The provider was not told in advance of the date or time we planned to visit. The manager was not available for this visit and during the visit we spoke to the senior staff on duty alongside the care staff, some of the people living in the home that were able to participate, their representatives, and a health professional during the visit. We looked around the home including people’s rooms and the shared areas of the home, and we inspected records of people’s care, staff files, and health and safety documents. There was one relative available at the time of the visit and only limited numbers of people who live in the home who were available to speak to us. We did not have any written surveys to use as part of this inspection report and we did not have an Annual Quality Assurance Assessment (AQAA) from the home. The AQAA is an audit tool which provides us with information on the home, how it has developed over the last year and how it plans to develop in the coming year. Following the visit the home gained permission from relatives for the CSCI to contact them, although people were not available when we telephoned. What the service does well: People are assessed before they move into the home to make sure that their needs are known and can be met by the staff in the home. Good support is offered in the meeting of people’s health needs. The staff work well with health professionals and follow instructions to make sure that needs can be met. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 6 People are able to exercise choices in their lives and are offered a variety of leisure activities. This enables them to decide what to participate in and when to spend time alone. The home is very modern and clean and has been purpose built to meet people’s needs. People are supported by staff who have been employed through good recruitment systems and who receive training to be able to meet needs. There is good support with the managing of people’s monies; computer systems assisting the staff to make sure that finances are kept safe. 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. The Old School House DS0000071358.V364660.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 The Old School House DS0000071358.V364660.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&6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed before they move into the home to make sure that the home will be able to meet these. EVIDENCE: We examined three care files of people who live in the home. Two of these included an assessment of need that had been completed by the Local Authority. The third included the Local Authority plan of care. The assessment included people’s self care needs, health care needs and their religious or cultural needs. These assessments had then been used by the home to complete a plan of care for each individual. The senior person on duty at the time of the visit told us that the home does not provide intermediate care. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported through a care planning process, to have their health and personal care needs met. EVIDENCE: We examined the care plans for three people. All of these included details of people’s needs in relation to self-care, diet, mobility, mental health and physical health, medication, social care, relationships, religion and culture. They also included the likes and dislikes of people such as what foods people like and for example, that someone likes to wander around the home. The files also include a person’s life story and combined with the admission information assist the staff to develop a picture of the individual. Staff told us that they keep up to date with people’s changing needs by reading their personal files. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 10 The files include key worker monthly notes and reviews of the care that people receive. These reviews help to keep staff up to date with the latest needs of the person and how they are to be met within the home. Daily charts are kept for each individual which reflect whether the person has eaten or drank well, taken a bath or received assistance with personal care. In addition occasional notes are made by the care staff regarding the person and what has occurred during their day. As these notes are not consistently made they do not allow a picture to form of the individual and although many positive interactions were seen on the day between staff and people living in the home these are also not recorded. People’s individual files contain risk assessments and health assessments. These include, nutritional screening, weight monitoring, a Mental Health Assessment, an assessment for the risk of malnutrition, the risks regarding the self administration of medicines, the risk of falling out of bed and the risk of using steradent. The risk assessments also include a management plan that clearly identified how any risk is to be managed and reduced. People’s health needs are clearly recorded and there are letters relating to specialist health checks that include, for example, appointments with the optician. Records are also kept of all visits by the GP or district nurse and include the reason for the visit and any outcome or treatment following the visit. One health professional told us that they are very happy with the care and support offered by the home and that the staff work well with the district nursing team, referring people as necessary and following the nurses instructions. The medication file held a faxed letter from a local GP who wished to thank the home for their excellent communication with the practice. In discussion staff reflected a good knowledge of how they support people to meet their health needs, this includes getting to know people and contacting the GP as necessary. Individual risk assessments for medication have been undertaken for people who access the home on a daily basis. There is a medication policy to guide staff and this is signed and dated by staff when they have read it. There is a list of staff signatures of those staff who can administer medication and this allows people to clearly recognise who has administered which medicine. Medication is stored in a locked room away from the main residential areas of the home. When needed it is transported into the main living area in two locked trolleys. Medicine was seen to be administered correctly with staff asking people if they required additional prescribed tablets, for example painkillers. Records were up to date and appeared correct. Staff sign to check that the correct medication is received into the home and sign when medication has been administered. Medicines described as ‘controlled’ were kept in a separate locked cupboard with accurate records being kept in a separate hardback book. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 11 All of the rooms are single, offering privacy for individuals. Staff told us that they try to respect people’s wishes and privacy. An example was that when people required support to use the bathroom staff would when possible stay outside rather than going in with people, offering more privacy. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live their lives as they choose and have their dietary needs met by the home. EVIDENCE: People’s assessments and care plans include the details of the different activities that people like to participate in. These include knitting, flower arranging, day trips, and visiting family. Since the opening of the home the Local Authority have employed activities staff that assist people to participate in a variety of leisure activities. These activities are continuing to be developed but have included aromatherapy, reminiscing, a sing a long and music and movement group. Each month there is a different theme within the home that has included Scotland, Wales and musicals. There has been a variety of entertainment brought into the home that included a school choir, a clothes party and a pianist. People have participated in trips out to a coffee morning, a garden centre and Easter lunches. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 13 The activities person keeps detailed records of which activities someone decides to participate in and which activities they decline. The records include whether the person enjoyed the activity. This helps to build up the current picture of what leisure activities the person enjoys and helps the home to plan to meet these needs. The records reflect that activities vary and that there are choices for people in the home. Throughout the day people were supported to receive visitors. People were able to visit for any length of time and some enjoyed a meal with their relative. Staff told us that there are no restrictions on the time that people may visit. One relative commented that it would have been nice to have a private room separate to the person’s own room for when they visit, and that a room for them to stay over night in would also have been of benefit. Staff also told us that people were able to have visitors at any time and that people could stay for tea if they wished. People’s likes and choices are recorded within their individual files. These include whether people practise a religion, their daily routine and for example, that one person enjoys a glass of beer after a meal, although there was not record of whether this had occurred. Peoples’ preference to what they were known as was also recorded. Where peoples’ choices were restricted this was clearly recorded, for example, one person was too unwell to hold a key to their room, and others had the opportunity to vote but were unable to do this due to their illness. Staff told us that people’s choices are supported and that people may choose when to get up, what to wear, where to sit and who to sit with. There are good kitchen facilities to support the catering staff to meet the dietary needs of the people living in the home. Four weekly menus offer people a variety of meals and records are kept of the foods they do and don’t eat. Breakfast was observed to be a relaxed experience with people arriving at different times for their meal and receiving individual support with their meal. At lunchtime people also received good individual support to eat their meal. However, as the dining room was full the mealtime was extremely busy and at times noisy. One staff member told us that there are plans to alter the dining arrangements so that there is a smaller group of people in the dining room and this would benefit people to have a more relaxed mealtime. The meals provided were well presented. There are condiments such as salt and pepper available to people should they ask for it, although they are not placed on dining tables. Due to the high level of need it is recommended that the home attempt other methods of making sure people receive them rather than waiting for a person to ask. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to raise concerns and are protected from harm. EVIDENCE: There is a complaints policy held within the home. Staff we spoke to were aware of the complaints policy and were happy to approach people with a concern or complaint. We spoke to people who live in the home, one person knew who to speak to if they had a concern but two people did not. Staff were confident when asked of the actions they would take to deal with a complaint and that the complaint would be dealt with appropriately. One person we spoke to felt that information sharing and the handling of complaints could be improved upon. When we spoke to staff about protecting vulnerable people, we found that although people had not all received formal training and were not clear on the policy in the home; they were able to give good answers on how to protect people and the actions they would take should they suspect abuse. One safeguarding notification had been forwarded to the appropriate person and this has been dealt with. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a clean, warm and comfortable home that has been purpose built to meet their needs. EVIDENCE: The home has recently been built to replace an existing Local Authority care home for older people. It offers single accommodation to a good standard. Despite the home being almost in the town centre the space has been well used and offers several outside areas for people, including a raised pond area. A risk assessment for the use of the pond was discussed with the staff on duty and it was agreed that it would be good practice to complete one. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 16 Some of the old trees remain in grassed areas offering a relaxing place for people to sit. The home is built to a good standard and is very clean and well maintained. Access to the grounds of the home is via a main gate that includes CCTV. All access to the home is via coded locked doors, and doors to the garden areas are all alarmed. This is linked in to the main call system within the home and alerts staff that the alarm has been triggered and the location of this within the home. This includes when people in the home use the call system within their own rooms. There are adequate bathroom and toilet facilities with overhead tracking being provided to assist people with mobility needs. All rooms have adjustable beds that help people with their mobility and safety. Rooms offer people good en-suite space and people told us that they are happy with their rooms. There have fitted wardrobes and each person has a flat screen TV. Outside of each room there is a display cabinet were people can place photos or memorabilia to help them remember that this is their room. People are also able to bring items in from home to personalise their rooms. Records are kept of the weekly fire alarm, emergency lights and monthly fire drill checks. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported by correctly recruited staff who are adequately trained. EVIDENCE: The duty rota showed that there is a senior care officer (SCO) on duty 24 hours a day with an additional SCO on call throughout the night. There are usually 6 carers on duty in a morning and 5 in an afternoon, reflecting the different needs of people at different times of the day. Staff records included that all staff have completed an application form before they start to work for the Local Authority. Some staff have transferred from other services to work within the home. All staff have had two written references undertaken on them prior to their employment. Evidence that a Criminal Records Bureau (CRB) check has been undertaken was available for two of the three staff. This check would show if the person has a criminal conviction that may prevent them from working with vulnerable people. Staff told us that they had undertaken a CRB check and references before they started to work in the home. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 18 Staff records also included details of the training that people had undertaken. This included training on Fire safety, Dementia, Moving and Handling and emergency first aid. One person had no records for any training and it is recommended that these records are completed and kept up to date. Staff told us that they have attended a variety of training that included bereavement and dealing with challenging behaviour. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive adequate management support, with good systems in place to keep them safe and meet their needs. EVIDENCE: The manager of the home does not have their office base at the home. The staff told us that a senior member of staff manages the day-to-day running of the home, and that the registered manager telephones or calls into the home on a daily basis to support the staff team. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 20 There are two areas for the person in charge of the shift to be based. One is a designated office area, which is located away from the staff team and people living in the home. The second is a station within the main area of the home, this allows the person in charge to be near to the people in the home and the staff during their shift. There is a quality assurance system within the home, which includes the views of staff, managers, people living in the home, advocates and relatives. In addition, quality meetings are held with carers to give them the opportunity to express their views. This information is gathered into a report that identifies conclusions and aims, including actions to be taken. There are good systems for the recording and handling of people’s personal monies. These are computerised with staff being able to access these records as needed. As an additional precaution, only identified people are able to alter these records through a password system. Records and monies held were checked and were found to be accurate. Maintenance records are kept in the home; these include the gas and electrical safety certificates. The hot water temperatures are checked weekly and records are kept of any accidents in the home. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X 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 2 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 The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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 OP18 Regulation 13 Requirement The registered person must make sure that staff receive training on safeguarding people so that they are aware of and competent with the policies and procedures in place, to make sure that people are protected and supported. Timescale for action 15/11/08 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 OP26 Good Practice Recommendations Individual daily records should be recorded to reflect events in people’s lives. An assessment for the safe use of the garden pond including risks of legionella should be undertaken and reviewed. The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 The Old School House DS0000071358.V364660.R01.S.doc Version 5.2 Page 24 - 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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