Care Home: Threeways

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What the care home does well Residents are encouraged to regard Threeways as their home and choose how they spend their time, in their own rooms or in the lounges. Residents meetings and the quality assurance system give residents an opportunity to put forward their opinions about the services, and staff confirmed that changes can be made to ensure the home offers the support and care the residents want. The home is decorated and furnished to a very good standard, which ensures service users live in a pleasant safe home. The activity programme is wide ranging including one to one sessions giving service users a choice of things to do. What has improved since the last inspection? There is a full time in house training coordinator who has carried out an analysis of training needs. This ensures that staff have the skills they need to meet peoples needs. The requirement made at the last inspection has been met. The medication policy has been updated improving medication practices. New manual handling equipment has been purchased to assist service users There are some new carpets, a new shower room and some redecoration has been carried out enhancing the environment. . Care plans are now reviewed more often to ensure that any changing needs are identified. CARE HOMES FOR OLDER PEOPLE Threeways 40 Beacon Road Seaford East Sussex BN25 2LT Lead Inspector Kim Rogers Unannounced Inspection 5th March 2008 12:30p 05/03/08 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 Threeways DS0000014068.V359507.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. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Threeways Address 40 Beacon Road Seaford East Sussex BN25 2LT 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) 01323-896196 01323 896196 Mr Bernard Edward Clarke Mrs Caroline Mills, Mrs Barbara Ann Clarke Mrs Shirley Eyles Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (45) of places Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the rooms in Firle are available for four (4) service users who require personal care. A maximum number of forty-one (41) service users in receipt of nursing care and four (4) service users in receipt of personal care. Service users must be older people aged sixty-five (65) years or over on admission. Service users with physical disabilities under sixty-five (65) years may be admitted. 15/03/07 Date of last inspection Brief Description of the Service: Threeways is registered to provide care for 45 residents in total with, nursing care for 41 residents within the categories of older people and physical disabilities and personal support for 4 residents. The home is part of a family business and the owners play an active role in managing and developing the services provided. It is situated in a residential area, close to local amenities and public transport and within walking distance of the seafront and an attractive park. Threeways is on two floors and has been extended to include attractive new rooms with en suite facilities. All resident’s rooms are single and the 4 residents who require personal support have rooms in the older part of the building, Firle House, which is accessed by three steps. A shaft lift enables residents to have access to the rest of the building and the staff use hoists, assisted baths and toilets when providing support for the residents. There are three lounges one in Firle, as well as one on the ground and first floor of the main building, that are used by residents for recreational and social activities. Each of the lounges has a dining area and there is a smaller dining room near the kitchen at the rear of the home. There are attractive gardens to the front and rear of the home that are accessible to wheelchair users and individuals who use walking aids. The current fee for the home ranges from £714 to £864 per week. For more information about the fees and what is included please contact the Provider. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. One inspector carried out this unannounced key inspection. The site visit took about four hours. Work was carried out before the site visit including surveying service users, staff and relatives. 6 Service users, 3 staff and 1 relative returned a survey form. Information received about the home and from the home was looked at. This inspection included a tour of the home, a review of care plans, preadmission assessments, medication records, training, menus and the activity programme. The inspector also made observations. The inspector spoke with the nurse in charge, the Registered Provider, staff, the cook and service users. The requirement made at the last inspection has been met. Service users said ‘The staff are very friendly and caring’ A relative said ‘ My relative is cared for in a very understanding and gentle manner’ ‘Staff do their utmost to maintain my relatives dignity’ What the service does well: Residents are encouraged to regard Threeways as their home and choose how they spend their time, in their own rooms or in the lounges. Residents meetings and the quality assurance system give residents an opportunity to put forward their opinions about the services, and staff confirmed that changes can be made to ensure the home offers the support and care the residents want. The home is decorated and furnished to a very good standard, which ensures service users live in a pleasant safe home. The activity programme is wide ranging including one to one sessions giving service users a choice of things to do. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 6 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. Threeways DS0000014068.V359507.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 Threeways DS0000014068.V359507.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): Standards 1 and 3. Standard 6 is not applicable. People who use the service experience good outcomes. Pre-admission assessments are carried out for prospective residents to ensure the home can meet their individual needs. People have the information they need about the home to make an informed choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two pre- admission assessments were viewed. They were noted to include information with regard to the medical, nursing and social needs of prospective residents, to enable staff to decide if the home can offer the support and care that they require. The nurse in charge confirmed that they are completed by senior staff at the home, with the involvement of the prospective resident and their relatives. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 9 Each person has a copy of the home’s Statement of Purpose and Service User Guide. This is given to people so they have the information they need to make a decision about moving in. The nurse in charge said this could be produced in different formats like large print if requested. Each resident is issued with a contract outlining terms and conditions of residency. All of the service users surveyed said they have a contract and information about the home and the services provided. People are able to have a look around the home with family, friends etc before they make a decision about moving in. Threeways DS0000014068.V359507.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 the service experience good outcomes. The care planning system is clear and consistent and provides staff with the information they need to meet the residents’ needs. The staff have a good understanding of peoples’ health and personal care needs ensuring that they are met. Staff protect residents by following the home policies for medication. People are supported to take control of their own medication if they wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care planning system provides staff with a complete picture of the residents’ individual needs, with relevant risk assessments including moving and handling, falls and nutritional assessments. Daily records are completed. Care plans are now reviewed on a monthly basis. The home involves service users in developing their plans. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 11 Residents are registered with GP’s and are referred to health professionals as required. Health and personal care needs as well as action needed by staff to meet these needs are detailed in individual plans. All of the service users surveyed said that their medical and health needs are met. Bathrooms and toilets are adapted to meet peoples’ needs. Aspects of the homes medication practice were inspected. This included the storage and safekeeping of medicines and administration records. Storage is safe and orderly and records are well recorded. If people wish they can take control of their own medication. This is supported by staff following an assessment with a G.P. All of the service users surveyed said that staff listen to them. Staff were observed talking to and interacting with service users in a positive and respectful manner. One relative said that staff do their utmost to maintain their relatives dignity. None of the bedrooms are fitted with any sort of lock. The Provider said that people are asked before they move in if they would like a lock. The Inspector recommended that suitable locking devices be fitted to rooms as they become vacant to ensure that people have the choice about locking their door. Threeways DS0000014068.V359507.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, 15 People who use the service experience excellent outcomes. Residents benefit from a varied programme of in-house activities. The routines of the home are flexible enabling residents to have control over their lives and encouraging them to make choices about aspects of their day to day living. The meals in this home are good offering both choice and variety and catering for special dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two activity staff at the home provide activities for residents from Monday to Friday, in the morning and afternoon. These range from group activities, including games and musical sessions, to taking individual residents out for a walk. One to one sessions are also facilitated. All of the service users surveyed said that they are happy with the range and amount of activities. Daily records show that people attend a range of activities including in house religious services. The home arranges transport for community based events and activities. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 13 Family and friends can visit at reasonable times. There were some visitors at the home on the day of the visit. One relative said that staff do their utmost to maintain their relative’s dignity. Service users are supported to take as much control over their lives as possible for example people are supported to manage their own medication. Staff spoken with said that the residents are encouraged to regard Threeways as their home. The staff and residents spoken with and surveyed said the meals at the home are good, they are able to choose what they want for breakfast and supper, and can have an alternative at lunch time if they do not like the main meal. The cook has been working at the home for 29 years and said they have fresh fruit and vegetables with freshly baked bread from a local bakers daily. The senior nurse told the inspector about working with a service user and a health professional to meet the person’s nutritional preferences and needs. Nutrition is monitored in service user plans to ensure people have the support they need. Threeways DS0000014068.V359507.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 the service experience good outcomes. The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. Staff have knowledge and understanding of Adult Protection issues which protects residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints about services provided at Threeways, to the home or to the Commission, since the last inspection. The nurse in charge confirmed that appropriate policies and procedures are in place. Each resident has a copy of the complaints procedure in their room with other information about the home. Most of the service users surveyed said they know who to complain to. Training in protecting adults is provided for all staff and those spoken with were able to demonstrate an understanding of abuse and what action they should take if they have any concerns. There is a policy in place about safeguarding vulnerable adults detailing procedures etc. Threeways DS0000014068.V359507.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): Standards 19, 20, 24 and 26 People who use the service experience excellent outcomes. The standard of the environment within this home is good providing residents with an attractive and homely place to live. Policies and procedures for infection control are in place and training is provided for staff to protect residents. This home is clean, safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Threeways provides a comfortable and homely environment for residents. There are two lounges on the ground floor with a separate dining room, and one lounge on the first floor, which is also used by some residents as a dining room. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 16 There are attractive gardens to the front and rear that are accessible to wheelchair users, and used when the weather permits. The garden is not overlooked and has seating areas. A gardener is employed by the home. Residents are encouraged to bring their own possessions with them and many have decorated their rooms with pictures, ornaments and some furniture. A relative said that the transition from another home for their relative was made easier because they were allowed to bring in some possessions and arrange the room. Infection control policies are in place and staff have received training in the use of gloves and aprons to protect residents, visitors and staff. 100 of service users surveyed said that the home is always clean. Threeways DS0000014068.V359507.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): Standards 27,28,29 and 30 People who use the service experience good outcomes. There are enough staff who are well trained and competent in meeting service users needs. Recruitment checks are robust which protects service users. Staff follow a sound induction which gives them the skills they need to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home follows recruitment procedures that require the relevant checks to be made, including two references and Protection of Vulnerable Adults/Criminal Registration Bureau checks. The home currently uses agency staff to cover vacancies and sickness. They use one agency and try to have regular staff for continuity. Service users said that they have the support they need but two mentioned that sometimes there is a delay at busy times. The senior nurse said that shifts are planned a month in advance and he tries to ensure that extra staff are on duty at busy times. There are separate staff for the laundry, cleaning, cooking, office and maintenance, this enables care staff to concentrate on personal care. Four permanent new staff have been recruited recently and are awaiting recruitment checks before they start in post. The Provider hopes that this will Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 18 reduce the number of agency staff used therefore giving more continuity to service users. The home has an in house trainer with training related to service users specific needs being offered on a rolling programme. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff There are good levels of staff with a National Vocational Qualification in care. The induction for new staff is thorough with competency assessed by the training coordinator. This gives staff the underpinning knowledge they need for the job. Regular staff meetings and one to one supervision sessions ensure that staff are supported and get a chance to air and discuss their views. Threeways DS0000014068.V359507.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): Standards 31,33,35 and 38 People who use the service experience good outcomes. The home is well managed with clear leadership and run in the best interests of service users. Service users views are listened to and underpin improvement at the home. Health & safety policies and procedures protect service users, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Deputy manager has been in charge of the day to day running of the home since the Registered Manager has been on sick leave. The Registered Provider and senior staff have supported the Deputy. The home is well organised with office based staff dealing with budgets, payroll, recruitment and other matters. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 20 There are maintenance and housekeeping staff enabling the manager to concentrate on the needs of service users. The senior nurse assisted the inspector during the site visit. He spoke with knowledge and understanding of service users needs. The management approach is person centred, open and inclusive. Regular staff meetings are held to enable staff to air their views and make suggestions about improving the home. Staff said that they work well as a team. Residents are encouraged to be involved in developing services at the home, through the quality assurance system and residents meetings. The Registered Provider said there are plans to improve the quality assurance system. Improvements have been made to the home after listening to service users including changes to the menu incorporating more fish and fresh vegetables and the purchase of a PA system for the hard of hearing. The home does not take responsibility for the finances of residents, they are supported by relatives or other representatives. Detailed records were seen of valuables the home holds on people’s behalf. Training covering all areas of health and safety is provided for staff including safe moving and handling and fire awareness. The maintenance manager ensures that regular checks of premises and equipment are carried out. The fire log book showed that regular checks and practice drills are carried out. The Provider plans to update the home’s fire risk assessment in light of recent changes to legislation. The Annual Quality Assurance Assessment (AQAA) completed by the home showed that the necessary checks are carried out protecting service users and staff. The AQAA showed good awareness of equality and diversity issues as well as evidence why the home is good value for money. The Provider and managers have identified where the home could improve and have put plans in place to make those improvements. Threeways DS0000014068.V359507.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 3 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X X X 3 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 Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? None 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. Standard Regulation Requirement Timescale for action 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 OP10 Good Practice Recommendations The Provider should think about fitting suitable locking devices to rooms as they become vacant to give service users choice. Threeways DS0000014068.V359507.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Threeways DS0000014068.V359507.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. 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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