CARE HOMES FOR OLDER PEOPLE
Adamstan House Nursing Home 187 Mill Lane Sutton St Helens Merseyside WA9 4HG Lead Inspector
Mrs Lynn Paterson Key Unannounced Inspection 26th June 2007 10:00 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 Adamstan House Nursing Home DS0000005446.V344129.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. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Adamstan House Nursing Home Address 187 Mill Lane Sutton St Helens Merseyside WA9 4HG 01744 819815 01744 850330 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) Adamstan Limited Jeanette Margaret McCrudden Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 34 service users to include:*Up to 34 service users in the category of OP (Old age not falling within any other category). One named service user under pension able age may be accommodated within the overall number of registered places. 18th July 2006 Date of last inspection Brief Description of the Service: The home is registered to provide nursing care for up to 34 older persons over 65 years of age and is situated in a residential area with good access to St. Helens town centre and local amenities The home provides accommodation over two floors and has 34 single bedrooms. A passenger lift and stair lift are provided for ease of access to the upper floor. The home is purpose built and offers single accommodation only. Service Users are encouraged to personalise their private bedrooms. The home benefits from a variety of communal seating areas to include a large lounge, separate dining room, library area, quiet room and a conservatory that provides a pleasant view of the gardens and lake setting at the rear of the home. All garden areas are accessible to the residents with outside seating and awnings and car parking facilities are provided to the front and side of the property. The registered providers of the home are Adamstan Limited and fees are currently charged at £446.00.per week. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Adamstan House was carried out on 26th June 2007 and undertaken on an unannounced basis. The inspector met with 27 residents 11 staff, the registered manager, registered provider and 5 people who were visiting relatives in the home. Policies, procedures care plans, completed questionnaires and daily records were viewed and a tour of the premises undertaken. Fieldwork included case tracking five residents, which involved reading all documentation relating to the residents daily living and speaking with the residents and staff who were associated with their care. What the service does well:
Staff advised that the home is exceptionally well managed by the manager and staff said they feel totally supported and valued. Comments included; “The manager has provided staff with motivation by valuing us and providing us with ongoing training and support” “We just love working here now, the manager treats us well, we are able to discuss anything at all with her which makes us work well as a team”. Staff said they are provided with a good level of training to enable them to keep up to date with all relevant care practices. Resident’s families/representatives said they are very impressed with the high standards of care provided by the staff. Comments included: “It is lovely to see the gentleness and respect with which the people living here are treated”, “Look at J now, he is great, he has improved so much since he has been here”, “It’s a pleasure to visit my mum here as I know she is very well looked after and loves the staff and the services provided”. Comments were also made about the high standards of food provided and comments included: Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 6 “The food here is second to none, it is always of a very high standard”, “The menu is varied, food well prepared and exceptionally tasty”, “We get very good quality food. We get plenty of variation, good choice, look at the way it is presented, it is always like this, not just because you are here”. The home continues to maintain its high standards of furnishing, fabrics and hygiene and has recently been awarded a certificate of excellence for kitchen hygiene. People who use the service said staff were kind and caring and treated them with respect. Comments included“The staff always ask me what I want them to do before they assist me”, “Staff are nice, they give me lots of help with everything. They make me feel special”, “Its good to have these people around to help”, “I need to be here but I think the staff are very good and know what they are doing”. The manager and registered provider work together to ensure that quality assurance systems are in place to make sure the home is run in the best interests of the people living in the home. What has improved since the last inspection? What they could do better:
Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 7 The overall management of the home is good and the management team constantly monitor and review all policies and procedures as a good practice issue. It was noted that the service users guide and statement of purpose was being amended to include recent changes to the service and contracts of residence were being revised to make sure that all people living in the home, or their representatives, were fully aware of their rights and the services of which, were their entitlement. It is recommended that the manager continue with this process to ensure all policies procedures and protocols are current and in line with relevant legislation. 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. Adamstan House Nursing Home DS0000005446.V344129.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 Adamstan House Nursing Home DS0000005446.V344129.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3. Quality in this outcome area is good. People who make application to live at the home are provided with clear information about the service and receive a full assessment of need prior to being offered accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that she was in the process of updating the service user guide to include adding recent changes to the service re staffing and service provision and also revising the service contracts for the people who were living or about to live in the home. Discussions with a representative of a person living in the home confirmed that s/he had been recently provided with these amended documents. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 10 Care files examined as part of the case tracking process held full pre assessment details of the needs, wishes and capabilities of people prior to them being offered a place at Adamstan House and detailed how the home would meet assessed need. Discussions with people who live at the home confirmed that they had received a full pre admission assessment prior to admission. Adamstan House Nursing Home DS0000005446.V344129.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10. Quality in this outcome area is excellent, Staff ensure the health and personal care needs of each person who lives at the home are discussed, agreed and recorded and plans put in place to provide care appropriate to need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans had been revised since the previous inspection and held full detail of health and social care and of how, when and by whom this care was to be provided. Care plans viewed held signatures of all the people who had been involved in them being drawn up and records showed that monthly reviews of care had been carried out. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 12 Discussions with people who live at the home and their representatives revealed that care was provided by staff that fully understood their role. Comments included; “`I always feel safe with the staff, they know what they are doing”, “Staff treat me well, the care staff look after my general care and the nurses look after my health needs” “Staff always speak to me about what they are going to do and ask me if it is alright. They treat me ever so well”. “I visit here most days and know that staff are very caring and good at what they do”, The matron/manager revealed that all aspects of medication were dealt with by Qualified nursing staff and medication policies, procedures administration and storage arrangement were well managed. People who live at the home and their representatives said staff treated them all with respect and were considerate about privacy and dignity issues at all times. Staff said they had been trained to carry out quality care in which the individual needs, wishes and capabilities of each person was respected and practices put in place to ensure diverse needs were addressed and met wherever possible. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. Quality in this outcome area is good. Activities and interests are arranged to suit the wishes of the residents. Food provision is varied well presented and of a high standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans viewed held information about the needs wishes preferences and capabilities of the people living in the home and staff said that daily living routines were arranged accordingly. People living in the home spoken with said they generally “did what they wanted” each day but were provided with options for them to choose. For example one person said they liked to have a little sleep after lunch another said they went out with family and another person revealed that s/he enjoyed receiving visitors each day. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 14 The activities programme showed that an activity or interest was provided every day and people who live in the home were observed participating in gentle exercise, chatting amongst themselves, enjoying visits from friends and family and enjoying the company of staff. Most people spoken with said they had family /friends to assist them with decision making but records show that advocates are provided when required to assist people living in the home to exercise choices and be in control of their lives wherever possible. People living in the home and their representatives said the food provided was wonderful. Comments included: “The menu is varied, always choices, wonderful food”, “The food is glorious, plentiful, well cooked, well presented, and splendid to eat”. “We get very good quality food. We get plenty of variation, good choice, look at the way it is presented, it is always like this, not just because you are here”. The kitchen area and food stores were well maintained and it was noted that the home had very recently been awarded a certificate of excellence for the hygiene standard of the kitchen. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18. Quality in this outcome area is good. Complaints policies are in place and resident’s representatives know about the complaints system and are confident any complaints will be listened to and dealt with quickly. Staff are trained and knowledgeable in all aspects of adult protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy identified the complaints process ,and people who live in the home and their representatives advised that they knew how to complain if they wanted to. They said that the home manager and staff were very approachable if they needed to discuss anything. The complaints book was viewed and it was noted that no official complaints had been recorded since the previous inspection. Staff spoken with, were clear in their understanding of what constituted adult abuse, and of what to do if they suspected abuse was taking place Staff training records revealed that staff, were provided with ongoing adult protection training and staff said they found the training to be useful and informative. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 16 Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19.25.26. Quality in this outcome area is excellent. The home ensures that residents live in a clean safe comfortable environment in which equipment is provided to enable the residents to maximise their independence This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans and daily records identified that people who live at the home are assessed as an ongoing process and aids/adaptations are provided as required. A tour of the premises revealed that the home has hand -rails and ramped access in the home and all bathroom and toilets are equipped with aids appropriate to need. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 18 It was noted that the home provided spacious communal rooms to include 3 lounge areas, dining room and conservatory, which included an outside awning area, overlooking well maintained grounds. Housekeeping records revealed the home had a thorough cleaning programme in place to include the daily cleaning of carpets and floors to ensure the premises was clean and hygienic and free from any unpleasant smells. The bedrooms of the people who live at the home were homely and personalised. People who live at the home said they were very happy and comfortable their rooms and felt very much at ease in the home. The home presented as being well maintained with good quality fabrics and furnishings in place and representatives of the people who lived at the home said they were always impressed by the high standards of cleanliness, decoration and general maintenance of the premises. Observational practices and discussions held with staff revealed that the home carries out daily risk assessments to ensure the safety and comfort of the staff and people who reside in the home and their visitors and this was seen to be commendable. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30. Quality in this outcome area is excellent. The home has clear recruitment policies to ensure that staff members who are appointed are carefully vetted prior to commencement. Staff, are well trained and provided in sufficient numbers and skill mix to ensure residents are safe and well treated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff records identified that staff were not employed in the home without the appropriate checks being undertaken to include Criminal Records Bureaux (CRB) checks and appropriate references being provided. Recruitment policies were clear and identified that equality measures were utilised to ensure all prospective staff was provided with a fair interview process. Records show that staff turnover is low and the home can provide consistency of staff.
Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 20 Staffing rosters revealed that the staffing levels and skill mix were adequate to meet the assessed needs of the current people living in the home of the home. The staff rota identified that 7 care staff, 2 qualified nurses, 2 kitchen staff, 2 domestic staff and 1 laundry assistance were on duty in the home. The manager advised that the home recognises the importance of NVQ training to the home and for individual’s personal development. Staff spoken with said they had been encouraged and supported to undertake training, which they felt made them feel valued. Comments included: “The manager encourages me to develop my skills. She gives me plenty of support”, “Staff are provided with ongoing training to assist them with their own personal development. I have recently been provided with training in wound care and catheter care”. All staff spoken with or observed carrying out their duties presented as most capable and totally committed to the provision of high quality care for the people living in the home. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33.35.38. Quality in this outcome area is excellent The home is very well managed and uses quality assurance methods to make sure that the views of the residents/residents representatives as to the running of the home are recorded and addressed. The home employ maintenance staff and utilise clear health and safety policies and procedures which promote and safeguard the health, safety and welfare of the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In discussion it was noted that the manager constantly monitors and reviews policies and practices and it was revealed she had updated some policies and
Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 22 practices in the home and was in the process of updating statement of purpose, service user guide and terms and conditions of residence. She has implemented new quality assurance systems to include the use of questionnaires to ensure the service is run in the best interest of the people who live at the home. Staff supervision policies have been updated and all staff now receives formalised structured supervision, which they say has very much assisted them in their roles. The manager demonstrated in discussion that she is very experienced in her management role and continues to develop her skills and attends meetings, training and development courses to ensure she has full knowledge and understanding of any changes in practice or legislation Comments received from staff about the manager included: “ The manager is really great, she supports us and leads by example”; “We know we will always get support from the manager, she is easy going but not a soft touch, understanding, listens to what we have to say.” “The manager leads the staff well, we know where we stand and nothing is ever a problem to her she always has the right answer”. “ The manger is so approachable, we are never afraid to speak with her, she is great. Nobody is afraid to ask her for advice she has an open door policy”. “The manager respects us and we respect her. If we ever do anything wrong we are not afraid to tell her as she will assist us and tell us how to do it properly”, “She is understanding and if we need telling off she will do it but does not hold it against us.” Discussions with people who live in the home and their representatives and comments recorded on questionnaires reveal that they feel the home is run in their very best interests. Comments included: “The manager and staff make sure we always get what we want”, “The staff are good and kind and ask us our opinions about everything. We are asked what food we want, what entertainment we want, if we want to go on trips, everything is centred around us”. “I visit here almost every day and find that the wishes of the people who live here are always taken into account. It’s a very good home and very well run”.
Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 23 Records show the home administrator does not hold any responsibility for the financial management of the people who live in the home. However the manager has systems in place to ensure that the financial interests of residents are safeguarded. Records show that staff received full training in all aspects of health and safety and the home employs the services of a maintenance person to ensure the health and safety of staff and residents is protected. Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 24 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 4 4 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 25 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. 1. Refer to Standard OP1 Good Practice Recommendations Statement of purpose and service users guides should at all time’s accurately reflect the current staffing and service provision of the home. It is recommended that the manager continue to revise and amend all documentation to reflect the current changes. All people who live at the home should have a contract /statement of terms which reflect the charges and the services provided and the terms and conditions of residence. It is recommended that the manager continue to revise and amend the contracts/statement of terms and conditions to ensure that are current and factual. 2. OP2 Adamstan House Nursing Home DS0000005446.V344129.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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