CARE HOMES FOR OLDER PEOPLE
Cestria House 45 Sanderson Road Jesmond Newcastle Upon Tyne Tyne & Wear NE2 2DR Lead Inspector
Jackie Burke Unannounced Inspection 09:30 31 January 2006
st 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 DS0000000435.V259075.R01.S.doc Version 5.0 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. DS0000000435.V259075.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cestria House Address 45 Sanderson Road Jesmond Newcastle Upon Tyne Tyne & Wear NE2 2DR 0191 281 8714 0191 281 0377 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) Bawi Homes Limited Mrs Kathleen Burns Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (21) of places DS0000000435.V259075.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Cestria House provides a home for up to 24 older people who require residential care. Three of the residents may also have dementia care needs. Nursing care is not provided. The home is a three storey converted house. There is a passenger lift to each floor. There are also mezzanine floors, which give access to a small number of bedrooms and these can only be reached by short flights of stairs; therefore people staying in these rooms need to be physically mobile. All of the bedrooms in Cestria House are single. There are three bathrooms in the home with assisted bathing or shower facilities and seven W.C. facilities in addition three bedrooms have en-suite facilities. There is a small garden to the front of the house with seating for residents and a large courtyard to the rear of the building. Cestria House is located in the residential area of Jesmond and is close to a shopping area in Acorn Road and to local amenities including a library and public transport links. DS0000000435.V259075.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the report of an unannounced inspection, which took place on Tuesday 31 January 2006; the inspection began at 9.30am and took six hours. During this time a tour of the premises took place and a sample of records were inspected. The manager, deputy manager took part in the inspection process and five staff were spoken to during the day. In addition I spent time with ten service users and spoke with one visitor to the home. What the service does well:
Cestria House provides a pleasant homely atmosphere for those who live there and for visitors to the home. The home is well managed and has a caring and enthusiastic group of staff who appear to enjoy their work. The management team and many of the staff have worked together in the home for a number of years, which ensures good consistency of care and stability and a commitment to meeting the needs of service users. There is evidence to show that the managers and staff provide good care and support and that this is provided in the best interests of residents. The manager operates an open door policy and knows and welcomes all service users to the office and as she walks around the home. The manager and deputy demonstrate commitment to training and development in their voluntary input to a degree course in the Care of Older People and in their support and encouragement to the staff group in developing skills and knowledge through training. DS0000000435.V259075.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The service users guide and statement of purpose are still not available in tape format Lift buttons need to be replaced. The sluice room is not currently accessible and must be cleared of paint tins stored in there and adequate lighting provided. A system should be developed to ensure that light bulbs are checked and replaced promptly. The fire safety strip on the ground floor bathroom door has been repaired but is peeling away and needs to be replaced. The proprietor must ensure that Regulation 26 visits are carried out and copies of reports must be forwarded to CSCI and to the Registered Manager. The Registration certificate must be fully displayed. The staff rota must contain clear details of staff, roles the date and a key to codes used A contract with an electrician needs to be established.
DS0000000435.V259075.R01.S.doc Version 5.0 Page 7 The bathroom on the 2nd floor needs to be cleared and restored to working order to provide residents with choice and access to adequate bathing facilities. Medical Device Alerts should be actioned and filed for easy access to staff; cascade training relating to medical device alerts should be documented. Filing and organisation within the office needs to be improved. 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. DS0000000435.V259075.R01.S.doc Version 5.0 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 DS0000000435.V259075.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, & 4 Prospective service users have the written information they need to make A choice about where they live. Service users have their needs assessed before moving into the home and are assured that those needs will be met. Service users are confident that the home will meet their needs. DS0000000435.V259075.R01.S.doc Version 5.0 Page 10 EVIDENCE: The service users guide and statement of purpose have not yet been produced in a range of formats to enable service users to make an informed choice. A tape copy of the material has begun and has yet to be complete. During the inspection three case files were examined and they all contained assessment information from a care manager. Assessment documents cover areas of social needs, health and personal care needs. The manager also does her own assessment prior to admission and this forms the basis for the care plan, which is developed for each individual. Service users spoken to commented on how well, staff work to make sure they are well cared for and one person said that his brother was unable to care for himself independently at home and the manager and the staff have done wonders with him and he feels better knowing that he is safe and well cared for. DS0000000435.V259075.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Service users 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 are protected by the homes policies and procedures for dealing with medicines. Service users feel they are respect and their right to privacy is upheld. EVIDENCE: Three care files were examined during this inspection and relevant information relating to health personal and social care needs is contained within them was of an acceptable standard. In one file information relating to a problem with weight loss and subsequent action taken appeared to be fragmented however daily records are kept in a different file. It is a recommendation that all relevant information be kept together to inform the care planning process. Records in files examined show that health care appointments are made promptly for service users and action followed. One person who was experiencing arthritic pain, was supported by staff, painkillers were
DS0000000435.V259075.R01.S.doc Version 5.0 Page 12 administered and a discussion took place to remind her of the outcome of a recent GP visit. Risk assessments are carried out and people are regularly weighed and outputs monitored and the GP is informed of any concerns. Records in files confirm that prompt referrals are made to address health care concerns. During the inspection I spoke with ten service users and each person commented positively on the staff and the care they received in Cestria House. One person said that she thought the staff were excellent especially the young ones as they had a good attitude and were “like a breath of fresh air to her”. A relative said that it was a relief to know that his brother was being so well cared for and that the manager and staff had made efforts to get to know what he liked and to get him involved in helping out in the garden, as a visitor to the home he said that he felt very welcome. There is a medication policy at Cestria House and the medication system was checked during the inspection and controlled drugs audited. Medication administration records and controlled drug records were found to be accurate. Staff who administer medication are provided with training and residents who wish to retain control of their own medication are able to do so. Interaction between service users and staff were observed during the day and staff demonstrated that they knew the people in their care and their needs and treated people with respect and affection. One lady who was distressed about a visitor coming on a certain day was reassured and calmed by staff. DS0000000435.V259075.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 The lifestyle of the home matches the expectations of service users. Visitors are welcome and service users are encouraged to maintain links with the local community. Service users wishes are respected and they have control over how they live their lives. Meals are well managed and provided to suit the needs and preferences of service users. EVIDENCE: Service users spoken to during the inspection spoke positively about the staff and the service provided at Cestria House. There is a good range of activities provided in the home and over the Christmas period a number of events were organised including entertainers a shopping trip and a Christmas lunch out at the New Kent Hotel. Last week ten people went out to a local pub for lunch with staff and people are encouraged to play games and listen to music within the home. The manager maintains an activity diary, which enables staff to monitor and evaluate activities and events and to plan future events with service users. The use of the television in the main lounge has been reviewed with service users during residents meetings since the last inspection and people have said that they like the TV and want to have it on during the day.
DS0000000435.V259075.R01.S.doc Version 5.0 Page 14 People can choose what they want to eat and when they want to eat it; one person likes to eat specific combinations of food whilst another likes to have ice cream at the same time each day. Staff take time to encourage a wider variation of food but are aware of the importance of individual choice also. On the day of inspection a choice of hot lunch was available and residents had mince and dumplings or cheese pie with vegetables and roast potatoes with fruit and jelly to follow. Food portions were adjusted to suit individual preference and food was well presented, tasty and served hot. People eating lunch said that the food was always very good and that they looked forward to mealtimes. Teatime menus are varied and include soup and hot snacks as well as sandwiches. Drinks are served throughout the day and fruit and cold drinks are available in the kitchen. Dietary needs can be catered for and currently kitchen staff provide food for people with diet-controlled diabetes. The chef has reviewed menu planning since the last inspection and residents have been consulted about meal preferences during resident meetings. DS0000000435.V259075.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Service users are confident that their complaints will be taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: There is a complaints policy at Cestria House and the procedure has been followed. The complaints log was examined during the inspection and the last complaint was made in February 2005 and relates to noise from an extractor fan and was made by a neighbour. The complaint was responded to and action taken to minimise the noise. Service users spoken to were clear that they would speak to the manager if they had a complaint but were eager to point out that they had no complaints about the service or the staff. There is a whistle blowing policy at Cestria House and some staff have been provided with POVA training and training is scheduled for the remainder. Staff spoken to were aware of the need to protect vulnerable adults and were clear about what they would do if they had any concerns about the care of people living in the home. The manager has improved the procedure for checking new staff before employment and staff files checked contained Criminal Record Bureau checks and written references as well as identity confirmation. DS0000000435.V259075.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25 & 26 The home is homely but continues to show signs of wear and tear. There is limited access to bathrooms within the home. Specialist equipment is available within the home to maximise independence Service users live in safe, relatively comfortable surroundings The home is clean pleasant and hygienic. DS0000000435.V259075.R01.S.doc Version 5.0 Page 17 EVIDENCE: The numbers on the lift buttons have been enlarged but the lift button is now broken and must be replaced as a matter of urgency. The sluice room is being used to store decorating materials and paint tins and cannot be accessed by staff; the light bulb in the sluice room is no longer working and needs to be replaced. The sluice should be used to clean commode pots and it seems likely that this is not the case as it is difficult to get in and the light is not working. The sluice needs to be cleared and lighting replaced. Specialist hoist equipment is due to be replaced next week in the bathroom on the ground floor and the existing hoist is to be moved to the first floor bathroom. The bathroom on the second floor is currently used for storage and smells slightly damp and consequently is not used. An extractor fan should be fitted in this bathroom and work done to provide a choice of bathroom for service users. There are currently insufficient bathrooms for the numbers of people living in the home and this must be addressed DS0000000435.V259075.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 & 30 Service users needs are met by the numbers and skill mix of staff Service users are in safe hands Service users are protected by the recruitment policy and practice of the home Staff are trained and competent to do their jobs. EVIDENCE: The manager and staff team have worked in the home for some considerable time and have built a good team of staff who work together to make sure that service users needs are fully met. Morale is good within the staff team and members work together to ensure consistency and stability. Service users spoken to were very positive about the staff. One lady told me that she had no complaints and in fact would go so far as to say the staff were excellent. Another person said that the staff were very nice especially the young ones and that all the staff had a good attitude. Staff spoken to recognised the support of management and colleagues and said that they were encouraged to take part in training and to develop their skills. One person spoken to said that she had left Cestria House to work elsewhere but had returned as she had missed the people. Another said that it was a good team and the shifts suit her lifestyle. Staff rotas were examined and whilst the rota has improved since the last inspection it was handwritten and remains unclear and the key was not in use.
DS0000000435.V259075.R01.S.doc Version 5.0 Page 19 The manager would benefit from the use of a computer in the home to plan staffing rotas and to deal with other management and administration tasks. Care staffing in the home is as follows: 8am-3pm 4 3pm-9pm 3 9pm-8am 2 waking staff In addition the manager and deputy are available during the day until 5pm. An on call system operates during evenings and weekends. Staff files contain training records for staff and confirm that training is highly regarded within Cestria House and staff are encouraged to attend training. Discussion with the manager and information in files shows that staff are provided with induction training is provided to new staff and mandatory training is updated to existing staff. There are twelve care staff and five ancillary staff working at Cestria House; eight care staff are qualified to NVQ level 2 and four care staff are working toward their NVQ level 2 qualification. The manager and deputy both hold the Registered Manager’s Award and are qualified to level 4 NVQ. The manager and deputy have begun a degree course in the Care of Older People to continue to develop their skills and knowledge and this voluntary action demonstrates a high level of motivation and commitment. DS0000000435.V259075.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35,36, 38 Service users live in a home, which is managed by a person who is fit to be in charge, of good character and able to discharge her responsibilities in full. The home is run in the best interests of service users. The financial interests of service users are safeguarded. Staff are provided with supervision. The health safety and welfare of service users and staff could be improved. EVIDENCE: The Manager provides clear leadership, which ensures that the home is well run and the staff team are fully aware of their roles and responsibilities. The manager is held in high regard by her staff and by the service users spoken to during the inspection. One person said that the manager was a good boss and wouldn’t ask you to do anything that she wouldn’t do herself.
DS0000000435.V259075.R01.S.doc Version 5.0 Page 21 The home reviews aspects of its performance through a programme of selfreview and consultations, this includes seeking the views of residents, relatives and staff. Personal monies for residents are kept in the safe and receipts and records are kept. Financial systems were checked during the inspection and records are accurate. Staff files examined and discussion with staff confirm that staff are given regular 1:1 supervision during which training needs are identified and practice issues discussed. The owners of the home are failing to carry out regular audit visits and should do so to satisfy themselves that the home is being run appropriately, is complying with health and safety and to comply with the Care Home Regulations. Records of these visits should be kept and copies forwarded to the Commission for Social Care Inspection. Some issues on record keeping and organisation need to be improved to ensure good monitoring of the way the home is run. One part of the homes Certificate of Registration was on display in the hall, both pages need to be displayed. Complaints information should be updated to include accurate information relating to CSCI Staff rotas need to be written clearly and the key to staff roles used to give clear information. A maintenance contract must be established with an electrician to ensure that maintenance checks of the electrical wiring system are undertaken on a regular basis. Fire safety records were examined and equipment and lighting tests are up to date and recorded and fire alarms are tested weekly and records kept. Accident records are maintained staff should ensure that the date is recorded at the top of the accident form. DS0000000435.V259075.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 2 2 x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 DS0000000435.V259075.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 1 Regulation 4 Requirement The home must produce a comprehensive Service Users Guide and Statement of Purpose in a range of formats. The original timescale of 2/2/05 has not been met. Suitable bathing facilities should be provided to meet the needs of service users. The lift buttons must be replaced to ensure that the lift may be used safely. The lighting must be replaced and access improved in the sluice room. Regular checks should be made of lighting throughout the home. The Proprietor must ensure that Regulation 26 visits are carried out. Copies of the reports of these visits must be forwarded to the CSCI and the Registered Manager. The original timescale of 16/10/04 has not been met. Both parts of the Certificate of Registration must be displayed. The staff rota must contain details of the roles of staff, the full date and a key to the codes
DS0000000435.V259075.R01.S.doc Timescale for action 31/03/06 2 3 4 21 22 & 38 25 & 38 23(2) (j) 23(2)(c) 23 (2) (k) 31/03/06 03/03/06 03/03/06 5 33 26 31/03/06 6 7 37 37 NMS 28 17(2) 03/03/06 01/04/06 Version 5.0 Page 24 8 9 38 38 13 (4) 23(4) (c) (i) 23(3)(b) used. The fire warning strip should be replaced on the bathroom door near bedroom 9 The electrical wiring system must be inspected at appropriate intervals as determined by a competent, suitably qualified electrician. The results of the inspection must be documented within a Periodic Inspection Report. 03/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 7 33 Good Practice Recommendations Files should be reorganised to ensure that relevant information can be easily accessed The management team would benefit from having access to a computer in the office to manage staff rotas and administrative systems. DS0000000435.V259075.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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