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Inspection on 24/06/09 for St Andrews Residential Care Home

Also see our care home review for St Andrews Residential Care Home for more information

This is the latest available inspection report for this service, carried out on 24th June 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

From information obtained through this inspection the people who use the service can be confident that they will obtain a good standard of care and support. They will also be provided with the opportunity to continue to with their daily lives as they wish. They can be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. The service provides a homely comfortable environment that is able to accommodate their needs and has the necessary equipment to do so. Staff are friendly welcoming and supportive and have be provided with the training and knowledge to care for them well. The service is run in the best interests of the people who live in the home. Information from the whole inspection process shows that the service is managed well and effectively. Comments from residents, relatives and health care professionals in regard to what they thought they did well included: "Everything." "Marvellous." "The general running of the home is good." "Treat people as individuals" "Staff encourage people to join in with activities going on in the home." One resident said in a survey that the staff, "Make him feel at home and he always feels safe, happy and looked after." Further comments about the staff included, "Generally friendly and kindly support. Staff listen to comments. Generally helpful."St Andrews Residential Care HomeDS0000013138.V376567.R01.S.docVersion 5.2From a health professional, "Personalised care, very good at identifying and responding to needs of individuals" and with reference to health issues, "Sensible and appropriate use of GP, Nurse and emergency services."

What has improved since the last inspection?

The management have listened and acted upon the good practice recommendations made during the last inspection process. The staff continue to be focused on improving the experiences of the people they support through developing the environment of the home, the activities they undertake and providing a friendly homely atmosphere. Staff have been given the training they need to maintain the safety and well being of the people they support.

What the care home could do better:

They should continue to ensure that the record keeping reflects the care, support and decision making that is carried out on residents behalf. This is with particular reference to care planning, risk assessments and choices and wishes for daily activities. This would then ensure that there is a consistent approach to providing support and that all their needs will be met. Care should be taken to continue developing the control of infection practices, making sure that there are the facilities for good hand hygiene available for residents and staff to use in all parts of the home.

Key inspection report CARE HOMES FOR OLDER PEOPLE St Andrews Residential Care Home 184 London Road Headington Oxford Oxfordshire OX3 9EE Lead Inspector Ruth Lough Key Unannounced Inspection 24th June 2009 10:20 DS0000013138.V376567.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews Residential Care Home Address 184 London Road Headington Oxford Oxfordshire OX3 9EE 01865 741752 05603139853 st.andrews2@btinternet.com 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) St Andrews Residential Care Home Limited Mrs Vanessa Woolf Mrs Deborah Hodgson Care Home 23 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 23. Date of last inspection 26th June 2007 Brief Description of the Service: St Andrews is a residential home providing care, support, and accommodation to twenty three residents over the age of sixty five. The home is situated on a busy main route into Oxford city centre. There are local shopping and leisure facilities close by and easy access to the city and beyond. The original building has been added to and extended to provide the current facilities. There are nineteen single rooms and two double rooms. Eleven bedrooms have the benefit of en suite facilities. The garden to the rear of the home has been landscaped and is accessible to those who use a wheelchair. The home’s fees range from £716.88 to £765.20 per week. St Andrews Residential Care Home DS0000013138.V376567.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 the service experience GOOD quality outcomes. This was an unannounced key inspection process generated from the Good findings identified at the last assessment of the quality of the service by the commission in June 2007. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission, before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned within the required timescales and had been completed satisfactorily. The registered managers were present when we visited the service on 26th June, between 10:20 and 20:15. During the day the records for care planning, recruitment, and administration of the service were assessed. A number of people using the service were involved with the inspection process and we met with eight staff who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the ten people who are in receipt of support that we contacted, we received five responses at the time of writing this report. Five staff were also contacted through surveys, of which three responded. Two professional’s who have been involved with the service were also contacted and returned comments to the commission. We also were able to seek via telephone and email the opinion of three relatives following the visit to the service. From this visit it was found that recommendations that were made to improve the service during the last inspection process have been listened to and acted upon. There were a few areas that will need to continue to develop and some St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 6 good practice recommendations were given at the time of the inspection and can be found in the body of this report to be able to achieve this. What the service does well: From information obtained through this inspection the people who use the service can be confident that they will obtain a good standard of care and support. They will also be provided with the opportunity to continue to with their daily lives as they wish. They can be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. The service provides a homely comfortable environment that is able to accommodate their needs and has the necessary equipment to do so. Staff are friendly welcoming and supportive and have be provided with the training and knowledge to care for them well. The service is run in the best interests of the people who live in the home. Information from the whole inspection process shows that the service is managed well and effectively. Comments from residents, relatives and health care professionals in regard to what they thought they did well included: “Everything.” “Marvellous.” “The general running of the home is good.” “Treat people as individuals” “Staff encourage people to join in with activities going on in the home.” One resident said in a survey that the staff, “Make him feel at home and he always feels safe, happy and looked after.” Further comments about the staff included, “Generally friendly and kindly support. Staff listen to comments. Generally helpful.” St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 7 From a health professional, “Personalised care, very good at identifying and responding to needs of individuals” and with reference to health issues, “Sensible and appropriate use of GP, Nurse and emergency services.” What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 8 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 St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service can expect to have their needs assessed before a decision is made that the home will be able to offer a place for them to live there. EVIDENCE: One relative supplied information that the home was recommended by a professional service and were provided with sufficient information to enable the person they support to make an informed choice to live there. The opportunity for a trial stay was also given prior to the decision to stay permanently. Their impression when they visited was the home was smaller than many, more personal and staff were friendly. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 10 Five of the residents who completed the survey stated that they had enough information about the home to help them decide if the home was the right place for them. Two others stated that a member of the family managed this on their behalf. The care records for four people that live in the home were looked at to see what processes are carried out to establish that the service will be able to meet their needs. One person had decided to stay in the home after a period of recuperation there, after medical treatment in hospital. All four had been admitted to the home within the last twelve months. From information available all the people whose care records we reviewed most were privately funding their care and therefore, had not had an assessment of their needs carried out by a social service’s professional. Through discussion with the managers and some of the residents it was identified that prospective users of the service are visited either at their own homes or at hospital where their needs, personal choices and other information is obtained. They also use information provided by the hospital discharge planning, individuals own GPs, and any other healthcare professionals involved in their care. During the last inspection process in June 2007 it was found that there was very little documented evidence of the assessment of individuals needs before they are admitted to the home. Since then it could be seen that there is a recorded pre admission assessment carried out which is then used to develop the care planning. A review of the detail of the information obtained shows that there are gaps where some of the key questions have not been asked when assessing an individual. Such as the physical support they think they may need, detail of any communication difficulties they have, and extra care they may require for any continence needs. However, some of this information could be seen in the care planning documents instructing staff of how their needs are to be met. The written records did not show the comprehensive knowledge that both managers were able to provide verbally. The concerns about the quality of the documented assessment process were passed back to the managers during the inspection visit. A recommendation was made to ensure that the pre admission assessment document is enhanced so that a holistic approach is made to identify any needs and therefore will support their decision making that the home will be able to meet them. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the record keeping does not support the actual good quality of the care provision given to people living in the home. EVIDENCE: Through discussions with some of the people living in the home, they expressed that they thought their overall needs were being met including support for personal care should they require it, access to medical care, and to continue with being as independent as possible. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 12 Five care records, including the four looked at in regard to the assessment of individuals needs before they went to live in the care home, were reviewed. This was to see what care planning is developed from the information obtained in these assessments and that the needs of the person concerned are clearly identified, and actions to meet them can be implemented by staff. The care records that were reviewed included a summary sheet which had greater detail than the pre-admission assessment document. This information included the reason for the person’s admission to the home, their allergies, and brief comments about their usual pattern of day. The person’s health and medical needs are noted and the contact details of their next of kin and any health or social care professionals involved with their care are recorded. The care plans seen, had information about any identified need the person may have, intended outcome for the individual and any actions by staff to take to achieve them. However, this information in some of the records assessed was more of an overview and did not give great instruction and the topics were not necessarily holistic only highlighting the specific needs not general key activities of living. Better detail had been put in the care records developed for some of the people who were under continuing care support from the PCT(Primary Care Trust), but those seen were quite lengthy documents and in parts were not able to support staff find the necessary information for the activity they wish to carry out with the person. Added to the care records are four areas of potential risk to the individual that are assessed such as falls, nutrition, mental capacity and manual handling. These did not provide much documented information to support the decision making for the scoring or use the information fully to identify the dependency level or need of the person concerned. All this information would be helpful in planning for ensuring the necessary support and intervention are in place should the persons needs change and overall staffing and support levels required in the home to meet them. In all the records reviewed they have an area to note the monthly monitoring of the persons weight, however the monitoring appears to have not been carried out regularly for one person or not all for another. One of the managers did state that they were in the process of purchasing ‘chair’ scales as it had become a concern that they had not been able to achieve this with a high number of residents due to their physical and mental health. One person who clearly had fluctuating weight loss as a known problem in the assessment and care planning records, did not have any supporting documented evidence that this was being monitored closely irrespective of the inability to weigh them. The individual’s records are kept in two folders, one for current day to day activity, and the other for holding the more long term information such as letters, medications on admission, and copies of information from their GP. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 13 Some of the information would be better kept together as to assist staff to have comprehensive picture of the person concerned. Information given during the last inspection process was that all the care planning tools were under review and development. This was to improve the detail given; including noting information about GP and any other health professional’s interventions or involvement in the persons care. Since then they have implemented the monitoring tools identified previously, a log to note GPs visits and they summarise monthly the key events effecting the person giving a better profile of any change in their needs. From looking at the current records there are still areas they need to continue developing. It was clear that the staff and managers were very quick and took positive actions to seek the necessary healthcare support for individuals when they needed it. Through discussion with staff and managers they were able to confirm verbally, supported by information from some of the residents and relatives that this occurred when concerns arose. The record keeping that evidenced this, did not necessarily hold sufficient detail about these actions or ensure that the care plan showed the changed needs and how the staff were able to meet them. One GP put in a returned survey in regard to what the service does well, “Personalised care, very good at identifying and responding to needs of individuals” and with reference to health issues, “Sensible and appropriate use of GP, Nurse and emergency services.” The daily records written by staff to show the outcomes and experiences of the people they support were very variable in quality. Some entries show what the person had experienced for the day, what activities they had been involved with, and their general well being and in some parts, their mood. This is particularly good as to continually assess that the home is meeting their needs and if any concerns with their physical and mental health should be addressed. However, some records with references to ‘Usual afternoon pattern’ are uninformative as they currently do not record the persons chosen daily routine as part of the care planning. The records for medication administration and the information about individuals needs for assistance were looked at to see if safe practices are carried out and they obtained what they were prescribed. The records in the individuals care files showed that the MAR (Medication Administration Records) are completed well and that medications are given as instructed. As noted previously a list of the medications an individual is prescribed are kept with supporting information for staff to read as to aid them understand what the medications are for. For one person the initial assessment of the persons needs records identified that they were able to self medicate, however there was not information to show that there is a formal risk St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 14 assessment carried out to ensure their safety or others for them to do so. This is not in accordance with guidance given in ‘The Handling of Medicines in Social Care (Royal Pharmaceutical Society of Great Britain)’ which directs care home providers to ensure safe practices. The managers were able to confirm that the person concerned had safe and secure facilities in their room to hold their own medicines and that there was a method of checks and review when medications are obtained on the individuals behalf from the pharmacy. However, none of these actions taken by staff to ensure safe practices is recorded in the individuals care records. The policies and procedures for medication, although they have been updated need minor adjustments to give clear direction in regard to self medication and the homes support for people to do so. These concerns were passed back to the managers during the inspection visit. From looking at the care records and some discussion with the managers the home does not have a systematic approach to seeking information about personal choices and wishes people may have at the end of their lives. The managers expressed a wish to develop this area of support that they can offer people living in the home and have started exploring training opportunities for staff and themselves. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are given the opportunity to exercise choice over their lives and are supported be able to maintain some their interests for as long as they are able. Meals and menu planning meet their health needs and personal choices and sensitive support is given when required. EVIDENCE: Comments from some of the relatives about the support provided to individuals for daily living included; “Treat people as individuals” St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 16 “Staff encourage people to join in with activities going on in the home.” A further comment was made as an observation by a relative, as to staff not always able to differentiate between short term memory and dementia when providing activities and interaction with residents. Some of the people who live in the home who were involved with this inspection process did state that there was a mixture of activities going on, some of which they joined in with, but generally if they were fit mentally were not necessarily stimulating enough for them. They were quick to add that they appreciated that it was difficult to accommodate to all interests with the number of people living in the home. Through discussion with them and the relatives involved in this inspection it was apparent that the staff were very supportive as to ensure that their outside interests and pursuits continue as long as the individual is fit and able to do so. A recent trip to a zoo appears to have been enjoyed by residents and support to walk to the shops is also a pleasure that a number other residents appreciate. One resident put in a survey, “I had a lovely trip to the zoo last week.” As previously identified, there is only a brief note in the summary of individual’s details to show their activities and interests they wish to continue with and little information about the persons chosen daily routine. The managers did comment that this was an area that they were aware that they needed to improve as to assist them to provide meeting the social and emotional needs of the people they support. One member of care staff takes the lead in providing the majority of the activities in the home, some of which are focused on group events such as musical entertainers, craft activities, and reminiscence. Others are more to supporting individuals on a one-to-one basis. All the staff who were involved with this inspection process appeared to be keen to support people to live as they wish and to continue to maintain an interest in daily tasks and activities going on in the home. Residents are encouraged to do little tasks such as shelling broad beans, cake making, and planting the strawberry plants in the raised bed in the garden area. A resident who more recently came to live in the home has been assisting with painting with watercolours with some of those more interested in pursuing this as a new hobby. It could be seen that staff are putting information in the daily records to identify the participation and enjoyment an individual has in an activity or event that they have been involved with. However, there is no formal method of evaluating this at present as to assist with identifying if they are meeting St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 17 the needs, wishes and choices of the people they support. Very little is noted about any spiritual or cultural needs the individuals may have in the care records that were reviewed and therefore it was difficult to establish if they had any particular needs that required support from staff for. The people who were involved in the inspection process gave very positive comments and were quite complimentary about the meals they were provided with. They were able to confirm that their personal preferences were met, they were offered a varied menu, and the quality and the presentation of the food was very good. One resident stated that many varieties of fresh vegetables were included in lunch time meal, usually five every day. During the day the main meal was observed and it appeared that all the residents present were thoroughly enjoying what had been served. For those requiring support staff were sensitively providing assistance and encouragement. From information given and what could be seen, generally each meal time, some of the staff sit with the residents and participate eating their meals together. During this meal there was a general atmosphere of inclusion, conversation and enjoyment for most of the residents in the dining room and lounge area. Only a small number of people choose to remain in their rooms for meals. Residents stated that they were regularly given a glass of sherry before their meal should they wish, which they enjoyed very much. Staff were seen to check if residents wanted the planned meal or sweet before serving and any changes were accommodated. The cook gave information that the two week rotational menu plan was under review and was usually developed between her and the managers, using the information obtained in the original assessment of need process and that from feedback from staff during the residents stay in the home. The cook expressed that she spent time with individuals seeking information about their personal preferences and obtaining their opinion and their enjoyment of the meals that had been provided. She was able to give good detail verbally of this acquired knowledge, but had little recorded as to evidence this. She was advised to record detail as supporting documentary information to ensure that all staff are able to provide the meals when she is absent in accordance to individuals dietary needs and choices. A relative provided information that staff were routinely providing a snack of cereal to the person they support at night before settling although this was not necessary clearly noted in the care records that were reviewed. Another St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 18 relative gave an observation that they were good at being flexible if someone missed or did not want a meal at the planned mealtimes. The cook gave information that they always use fresh meat and vegetables and it could be seen that there were plenty of items in the store cupboard for snacks if required. They place fresh fruit in the communal areas for people to have should they wish and residents can have a cooked breakfast everyday. Comments from some of the residents in regard to the food provided included; “I enjoy the food given to me.” A comment as to improve the service was, “A slightly more variable diet, especially at suppertime. Meals can be predictable.” St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be confident that their concerns or complaints are listened to, and acted upon. There are systems in place to protect the people living in the home from possible abuse or harm. EVIDENCE: The people who were involved in the inspection process confirmed that they thought they were listened to if they had concerns and that staff responded well and put things right. One relative stated that they could talk to any of the staff in the home and the managers were quick to put actions in place. The complaints policy and procedure were looked at to see what information is given to the people who live in the home and others should they wish to express a concern. The complaints procedure is left on display in the front of the home and we were informed, included in the Statement of Purpose. During St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 20 the last inspection it was identified that the complaints procedure did not give the 28 days as the expected period of time that a complainant could expect a response to any concern. The complaints procedure that was seen does give a timescale of investigation and response as 7 days and a brief outline of the general process of managing a concern. The home has a complaints log that is used by all staff to log, record all information and note actions taken. The log does not give a full indication of the timescales of the investigation and conclusion for complaints and in parts could compromise confidentiality. From information given by the managers minor concerns are not always noted as staff appear to be very prompt in responding and rectifying concerns. They were advised to look at the method they use for logging concerns and complaints for quality monitoring processes and keep separate records that can protect any personal information. From the current records seen any concerns are dealt with effectively and actions taken to improve and the persons involved are kept informed of the outcomes. The processed for managing any concerns about possible abuse or harm were looked at to see if staff understand their responsibilities and know what to do if they thought a person was at risk. From what we could understand from the staff involved in the inspection process they were aware of what they should look for and to whom to report concerns to. They knew where to source information if it was required but some of the carers were slightly hesitant to know the contact point for the local safeguarding team. The manager was made aware of this and put actions in place to ensure that the information was more visibly on display for staff to find. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained well and meets the needs of the people who currently live there. EVIDENCE: The home in the main is not purpose built but has been adapted from two larger than average family homes situated in a mainly residential area on the main route through to the centre of Headington. The position of the home to the proximity of the centre of Oxford and local amenities ensures it remains as St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 22 part of the community. From information given by some of the residents and their relatives, this was a key reason for choosing to come to live in the home. The Annual Quality Assurance Assessment submitted by the registered managers gave information that there continued to be a programme of renewal, refurbishment and development to improve the facilities for both the residents and how the service is delivered. Recent changes have included the implementation of a wet room to offer residents a more flexible and pleasant experience for personal care than was available previously. From looking at a number of bedrooms, communal spaces and bathroom facilities it could be seen that there was a good programme of redecoration carried out as most of these areas all appeared to be clean, bright, and well decorated. It was also clear that residents were able to personalise their rooms with their own belongings and furniture within the confines of the room sizes and shapes. Staff have made effort to support a married couple to remain together. They have the use of two adjacent rooms, one used as a living room with access to the enclosed garden area, the other as a bedroom. Both rooms are situated at the far end of a corridor in part of the home and give the feel of private accommodation. Only one concern was the quality of the facilities in a toilet on the ground floor where the decoration was ‘tired’, difficult to keep clean, and had limited space for people to use it. Neither was there space for carers to support them to access it without possibly compromising the individual’s dignity. A boiler is situated behind the toilet, above the cistern and causes concerns that a resident using it could injure themselves when using the toilet. The manager could not confirm that there had been a risk assessment carried out on these facilities with regard to the specific needs of the residents that use this. A bathroom on the first floor, from information given by one of the managers is under used, as the facility is more appropriate to those who are more able. The door to this was partially blocked by furniture internally. The manager was advised to review and seek professional advice as to ensuring that these two bathroom/toilet facilities are fit for purpose and meet the needs of the people who use them. The manager did make the commission aware that they had carried out a review of the toilet facilities available in near proximity to the communal areas. They have already identified that they need to improve these as at present residents have to either travel a reasonable distance to the nearest one on the ground floor or return to their rooms if they have en suite facilities. Current planning applications to do this and some other redevelopment to improve the home have been submitted to the local planning office and are waiting to be approved. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 23 The manager present was further recommended to look at making a more permanent screening in one of the other shared bedrooms should the need arise to offer greater privacy to the people who use it. Both residents who reside there are presently mobile enough to use the en suite facilities for personal care. It identified in the surveys returned to the commission and through the telephone contact made to relatives following the inspection that residents and their relatives thought the home was kept clean, fresh and pleasant to live in. This could be seen throughout the areas of the home that were reviewed. One area that has improved is with control of infection management is the placement of disinfectant hand gel outside all bedrooms for staff and visitors to use. They will need to continue with some further improvements that meets with Department of Health, Infection Control Guidance for Care Homes, to ensure that all bathrooms/toilets are provided with paper towels for residents and staff to use as to reduce the spread of infection around the home. Some of the bathrooms did not have paper towels or dispensers and there was no facilities for drying hands. Additionally they will have look at the provision for storage of personal toiletries in the shared bedroom accommodation as to reduce staff inadvertently using the items for the other resident living in the room as there appeared to be very little separation of items in one of the rooms visited during the inspection visit. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a sufficient number of skilled and experienced staff employed to meet the current needs of the people who live there. EVIDENCE: Comments made about the staff from relatives included; “Always willing to take the time.” “Very good to diffuse restlessness and agitation.” This was in response to how they managed their relative’s dementia. In regard to what they do well one resident put, “Generally friendly and kindly support. Staff listen to comments. Generally helpful.” St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 25 One GP made an observation about the staff, “By far the most friendly and helpful staff of any I’ve worked with. Call me only when necessary.” From what could be seen and from information given by residents, relatives and visiting professionals there appears to be a sufficient number of skilled and experienced staff on duty in the home. The duty rota that was available showed that there were sufficient numbers of staff in the home during the daytime and we were informed that the necessary extra staff are employed for specific activities or events if required. At night the service continues to have one member on staff on duty with another sleeping-in to be called at any time should support be needed. The managers confirmed that on occasions that the number of staff on duty are increased to meet any changed care needs that residents may have. However, as previously noted in regard to care planning, the information obtained from assessing individual’s care and support dependency needs is not used as effectively as it could be. Using this collectively would support any decision making to implement any changes in staffing levels, safety concerns, and identifying specific training needs for staff. The managers provided information that there is very little turnover of staff. The majority of the staff employed in the home have been doing so, for a considerable length of time, which is beneficial to the people they support as there is a consistent team of carers caring for them. One recruitment record for a member of staff who had been employed since the last inspection process was reviewed. This was to see what practices they have in place and that the process ensures that suitably skilled and experience staff are employed. The manager also gave information that this member of staff was in the process of leaving in the next few days as she had attained her qualification in nursing and would be moving to an appropriate role elsewhere. From the records it was apparent that the applicant is required to complete the basic information in an application form, provide proof of identity and give documentary evidence of any training or qualifications they may have. For this candidate they had provided their CV which included their full work history although the current application form does not request this. They had also given the necessary information in regard to professional referees. However, there was evidence that verbal references had been obtained but not written as is required. The managers were informed that a review of the current recruitment policy and procedure would be advisable to ensure that the necessary information is obtained and recorded to show that a robust process has been carried out in preparation should they need to employ new staff. The managers gave information that within the current staff team, as well as themselves, there are four other Registered Nurses working as carers. They were able to show supporting information that they carry out checks on their St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 26 registration status, regularly. In addition to this there are a small number of trained healthcare professionals working as carers in the home. The number of care staff with NVQ 2 is four, NVQ 3 is three, and one of the Registered Managers has attained their Registered Managers Award. The other is looking to add to her skills in the near future. The skills and qualifications of the staff employed are above what is normally expected in a care home that does not provide nursing care. The managers have a programme of training for staff to ensure that they have the necessary skills and knowledge for health and safety and the protection of the residents from possible harm or abuse. They also provided information that some staff have had training for dementia, Alzheimer’s, and all of the staff for safe medication practices. St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run well and in the best interests of the people who live there. EVIDENCE: The residents, staff and relatives that we spoke to confirmed that they thought the shared management role for the home worked well. Both registered managers retain their registration with the Nursing and Midwifery Council as qualified nurses; one has completed a Registered Managers Award to support St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 28 her role. Each take the lead in particular areas of the management of the home, but they could confirm that they communicate on a daily basis any changes in circumstances and make appropriate decisions together. They continue to use a formal process to seek the opinion of the residents, their relatives and any professionals who come in contact with the home and it could be seen that the information they obtain is used effectively in the business planning and development of the home. It was also very apparent that there is very good communication between all staff, residents and others and as comments from all those involved in this inspection process were very complimentary of the relationships they had with each other. The service does not manage or hold money on any resident’s behalf and when necessary they will invoice the resident or their representative for any extra costs that may occur, such as hairdressing, chiropody or any item that is considered extras in their terms and conditions of stay in the home. The home has the necessary policies, procedures and information for safe working practices for staff. The core training given to staff provides them with the skills and knowledge for safe moving and handling, fire safety, first aid, food hygiene, and infection control. Through observing the practices carried out in the home, these generally meet the required standard. However, the managers were advised to look at improving the facilities further for good hand hygiene by making paper towels more readily available in communal bathroom/toilet areas, the practices for securing stores of domestic chemical and personal toiletries in unlocked areas, and to seek advice for fire safety measures for the rooms of those who wish to leave their bedroom doors open. The records for some of the fire safety and routine maintenance of gas and electrical systems were reviewed which supported the information given by the home in the Annual Quality Assurance Assessment that these are carried out regularly. Comments from residents and their relatives in regard to what they thought the home did well were; “Everything.” “Marvellous.” “The general running of the home is good.” “Make him feel at home and he always feels safe, happy and looked after.” St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 29 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard Good Practice Recommendations St Andrews Residential Care Home DS0000013138.V376567.R01.S.doc Version 5.2 Page 31 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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