Care Home: The Terrace

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What the care home does well People live in a clean comfortable home. Staff are kind and helpful and make every effort to provide the service in the way that people want. Staff also support people to maintain their independence. Comments were made such as "They are welcoming and cheerful", " The staff have always been most helpful and kind". And "All the staff are pleasant and helpful. Nothing is too much trouble for them, they are my family". A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. One person spoken to said "The food is excellent." The relationships witnessed between staff and the people who live at the home appeared relaxed, warm and genuine. One person said " the staff are lovely, they can`t do enough for us". How people spend their day is given a lot of consideration. Staff and the activity organiser spend time helping people to maintain their interests and to try something new. This encourages peoples` decision-making and helps retain independence.The staff are provided with comprehensive training to improve their knowledge and skills. This promotes best practice and ensures people receive a good quality service What has improved since the last inspection? This is the first inspection since the new providers have been registered. What the care home could do better: Admissions to the home must only take place after a full assessment of the persons needs. This will assist the home in deciding whether they have the skills and expertise to meet the person`s needs before they move. CARE HOMES FOR OLDER PEOPLE The Terrace Maison Dieu Richmond North Yorkshire DL10 7AX Lead Inspector Chris Taylor Key Unannounced Inspection 20th November 2007 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 Terrace DS0000070557.V351990.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 Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Terrace Address Maison Dieu Richmond North Yorkshire DL10 7AX 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) 01748 822 342 01748 822 599 Southern Cross OPCO Ltd Position Vacant Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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: 2. Old Age, not falling within any other category, Code OP The maximum number of service users who can be accommodated is: 44 First inspection Date of last inspection Brief Description of the Service: The Terrace is a substantial detached building that was previously a hotel. It is west facing with beautiful views. An additional 21-bedded building is situated at the rear of the site. It stands in its own grounds with gardens to the rear and ample car parking facilities. The home is close to the centre of Richmond and the amenities and facilities available in the town. The accommodation comprises of both single and double bedrooms some of which have en suite facilities. There is a passenger lift in each of the two buildings enabling level access to all floors. The home provides personal and social care for up to forty-four older people. Prospective service users receive an information pack that gives details of the services provided at the home. The scale of fees at 20/11/07 ranged from £375 to £500 per week. Additional charges are made for personal newspapers, magazines, toiletries, hairdressing and private chiropody visits. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called an Annual Quality Assurance Assessment. A visit to the home that was unannounced. This lasted six hours and included talking to staff about their jobs and the training they have completed. Also spending time with people and checking some of the records polices and procedures the home has to keep. Three surveys received from relatives, nine surveys from people who live at The Terrace, one from a health care professional and one from a member of staff. Looking at four peoples’ care files in detail. • • What the service does well: People live in a clean comfortable home. Staff are kind and helpful and make every effort to provide the service in the way that people want. Staff also support people to maintain their independence. Comments were made such as “They are welcoming and cheerful”, “ The staff have always been most helpful and kind”. And “All the staff are pleasant and helpful. Nothing is too much trouble for them, they are my family”. A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. One person spoken to said “The food is excellent.” The relationships witnessed between staff and the people who live at the home appeared relaxed, warm and genuine. One person said “ the staff are lovely, they can’t do enough for us”. How people spend their day is given a lot of consideration. Staff and the activity organiser spend time helping people to maintain their interests and to try something new. This encourages peoples’ decision-making and helps retain independence. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 6 The staff are provided with comprehensive training to improve their knowledge and skills. This promotes best practice and ensures people receive a good quality service 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 Terrace DS0000070557.V351990.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 Terrace DS0000070557.V351990.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): Standard 3. People who use this service experience good quality outcomes in this area. Where peoples’ needs have not been assessed prior to admission it is less likely that their needs will not be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear referral system. This happens in one of two ways. Care managers from the local authority contact the home with an assessment of the persons needs. The second way is when members of the public contact the home directly. Regardless of where the referral comes from the manager would visit the people either at their own home or in hospital and complete the home’s assessment to make sure that the home would be suitable. A return visit by The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 9 the person in order for them to get a feel for the home is encouraged but can’t always be possible. Sometimes relatives visit instead. Two people said that they had been provided with information about the home before they moved in and this had been useful. All of the surveys received agreed that sufficient information about the home had been provided before admission. The format for the pre admission assessment is good and has appropriate headings to determine what support people need. Four people’s files were looked at to establish whether this process had been followed. Two people had lived at the home for quite a while and both local authority and the home’s own assessment had been completed thoroughly. This provides staff with the right kind of information to support people safely and in a way that they want. The other two files looked at were for people spending a short respite stay at the home. Neither had a pre admission assessment completed. If this information is not completed then the home can’t determine whether they have the skills and expertise to meet the person’s need safely. The Terrace DS0000070557.V351990.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): Standards 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. People receive a care service that meets their needs. Care is delivered in a manner that respects peoples’ wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four peoples’ case records were looked at in order to check that a plan had been formulated which helps staff provide support to people according to their needs and wishes. The home is currently in the process of transferring information onto new care planning formats. For each person forms were completed which contained information about the person such as date of birth, GP and next of kin. Information recorded not only covers where people need help and assistance but also contains information about social interests and personal preferences The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 11 about how individuals wish to spend their day; times for getting up, going to bed, what newspaper and TV programmes are preferred. The care plan also records information about areas of risk. In particular moving and handling and falls and nutritional assessments, where a person may need a specific diet due to weight gain or loss. There is a monthly review sheet and daily record. Daily records provided a good picture of how people spend their day and would provide essential information to track any changes people may experience, with ill health or involvement in social activities. People are registered with a GP of their choice. The manager and staff said that the working relationships with GP and district nurses are good. They said the support from other health care professionals such as occupational therapists and the psycho geriatrician is good. The delivery of personal care is individual and flexible. Discussions with people confirmed this. They said that staff always treat them with respect and ensure their privacy and dignity. Comments heard include “anything you ask them to do they do it” and “ The staff have always been most helpful and kind” Staff were observed delivering care in a kind and helpful manner. People looked clean and well cared for. Medication is stored in a locked trolley. A monitored dosage system is in use with proper procedures in place for the receipt, storage, administration, recording and return of medicines. It is usual that only senior members of staff administer medication and staff receive accredited medication training before they are permitted to so. Lunchtime medication administration was observed and this was carried out safely and in a way that ensured peoples’ dignity was maintained. One person spoken to takes responsibility for administering their own medication. An appropriate risk assessment had not been completed but the manager rectified this before the end of the visit. The Terrace DS0000070557.V351990.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): Standards 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. People can choose how they spend their day and have the opportunity to pursue their own interests. Meals provided are nutritious, are of good quality and freshly prepared. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People choose their own daily routines and are encouraged to remain independent and have as much control over their lives as is possible. People can sit in communal lounges or spend time in their rooms and can rise and retire as they wish. There is an activities organiser employed and people said that they enjoyed the activities on offer but there was no pressure to join in. All of the surveys received indicated satisfaction with the activities provided one said “ there is always something happening if you want to attend”. All surveys commented on the disappointment that the weekly bus trips had stopped. The manager The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 13 explained that the new providers of the care home had not retained the post of driver. This role has been added to the maintenance man’s responsibilities but he is unable to drive. The manager is trying to look at ways to reinstate the weekly bus trips. There is a hairdressing room and the hairdresser was visiting on the day of the inspection. There is a monthly Christian service and communion in the home. Arrangements can be made for people to attend church. The atmosphere at the home was very relaxed. Warm and genuine relationships were witnessed between staff and service users and there was a lot of good-hearted banter. There are three main meals per day and a choice is provided at each. Special dietary needs such as low sugar diets are catered for and special requests can usually be met. Where appropriate nutritional assessments are carried out and these were seen in case records. People spoke positively about the quality of meals provided and people clearly enjoyed their lunch. Staff supported those people who needed assistance respectfully and discreetly. Menus were looked at and these were varied. Hot and cold drinks are available throughout the day with a hot drink and snack provided prior to bed. The Terrace DS0000070557.V351990.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): Standards 16 and 18. People who use this service experience good quality outcomes in this area. People can be confident that concerns are listened to and appropriate action is taken. There are sufficient effective systems in place to safe guard people from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is provided to people and is included in the Statement of Purpose. People said that they felt able to talk to staff and the manager of the home if they had complaints and that these would be dealt with properly. One person said the manager always listens to and acts upon grumbles aired in the residents meetings. The manager views complaints positively and believes that bringing any concerns to the attention of the manager and staff can only improve the service provided. There is a comprehensive policy and procedure with regard to adult protection and staff have a good awareness of this. The manager reported that there was good support with regard to adult protection issues from partner agencies; that they were always available to listen to any concerns and offer advice. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 15 Staff receive training in adult protection issues during induction and foundation training and as part of NVQ level 2 and 3 in care. Appropriate recruitment procedures are followed, with references and Criminal Records Bureau (CRB) checks made to reduce the risk of undesirable people working in the home. The Terrace DS0000070557.V351990.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): Standards 19 and 26. People who use this service experience good outcomes in this area. People live in a clean, comfortable and safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is going through a refurbishment programme and those areas completed provide a bright, attractive and pleasant environment. Samples of bedrooms were looked at and these were comfortable and personalised. The home has a variety of equipment available to assist with maintaining people’s independence. This is serviced at the required intervals to ensure the safety of people who use this equipment. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 17 Information from surveys confirmed that people always find the home ‘clean and tidy’ and ‘fresh and clean’. The home is kept clean so that the risk of people becoming ill from poor hygiene is unlikely. The home was free from offensive odours for the duration of the visit and made the environment pleasant. Hand wash scrub, gloves and aprons are available throughout the home so as to minimise the risk of cross infection from one person to another. The laundry facilities are adequate and peoples’ clothing looked to be clean and in a good condition. The Terrace DS0000070557.V351990.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): Standards 27, 28, 29 and 30. People who use this service experience good outcomes in this area. Staff are properly vetted and trained to ensure people receive the care and support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recruitment records of the three most recent staff employed were checked. All had a completed application form and had attended formal interview where any gaps in employment had been explored. Written references and POVA (Protection of Vulnerable adults) first checks had been obtained and staff had not started to work in the home until they have a CRB (Criminal Records Bureau) check. Staff complete a competence based induction programme which includes health and safety training such as moving and handling, first aid and infection control. Staff are encouraged to complete NVQ level 2 (National Vocational Qualifications) and other training which provides them with essential skills and knowledge to support people competently. Staff spoken to said the training was good and helped them with their role. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 19 During the inspection there appeared to be enough staff on duty to meet people’s needs. One person said “ there’s always a member of staff around when I need them” and another said, “ the staff are wonderful, kind and attentive, always enough staff around”. Other comments were that there was sometimes a shortage of staff particularly during the late afternoon. The manager confirmed that there had been difficulties in staffing this shift but a number of staff have recently been recruited to fill this gap. They will commence work once CRB checks are returned. The manager and senior staff work alongside staff and as such monitors their practice. At every shift change there is a handover where specific issues relating to service users are discussed. Polices and procedure are discussed at regular staff meetings. Staff receive formal recorded supervision and an annual appraisal. The Terrace DS0000070557.V351990.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): Standards 31, 33, 35 and 38. People who use this service experience good outcomes in this area. The home is managed in such a way that promotes the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is organised, competent and runs the home to meet the needs of the people who live there. Service users, staff and families know who to go to if there is a problem and are very happy with the way in which the home is run. The manager keeps up to date with her own training and is knowledgeable about current ways of working. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 21 There is always a senior carer on duty to take responsibility for the smooth, safe running of the shift. Tasks are appropriately delegated so that the safety of people, and the safe running of the home is shared out among the more senior members of staff. The organisation has a formal quality assurance system and is planning to survey people for their views once people had had time to experience the new oraginisation in practice. Residents and relatives meetings are held regularly and evidence from talking to people and looking at the minutes indicates they are very lively, proactive meetings which are well attended. Regular, internal audits make sure that all the necessary health and safety checks are being carried out. The home’s line manager visits monthly and allows time for people to talk about their satisfaction with the service. The fire procedure is prominently displayed throughout the home and fire detection and fire-fighting equipment is tested and maintained regularly. Records were seen which confirmed that other equipment in the home is maintained and serviced appropriately. Staff are trained and able to administer first aid should a service user get injured or require immediate treatment for a minor injury. The Terrace DS0000070557.V351990.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 x x 2 x x x 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 The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14 Requirement Service users shall not be admitted to the home unless a preadmission assessment has been carried out to determine what the service users needs are and that the home has the capacity to meet those needs. Timescale for action 31/12/07 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 Refer to Standard OP12 Good Practice Recommendations A means to re instate the weekly bus trips should be explored. The Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Terrace DS0000070557.V351990.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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