CARE HOMES FOR OLDER PEOPLE
Faith House Station Road Severn Beach South Glos BS35 4PL Lead Inspector
Grace Agu Key Unannounced Inspection 27th June 2006 09:15 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 Faith House DS0000066329.V301681.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. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Faith House Address Station Road Severn Beach South Glos BS35 4PL 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) 01305 881765 01454 633311 Mrs Toni Sylvana Stevens Mr Gary Brian Stevens Mrs Toni Sylvana Stevens Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1 May accommodate up to 8 persons aged 65 years and over requiring personal care only The two first floor bedrooms are used for residents who have full mobility and who can safely negotiate the staircase with staff guidance in event of fire. 2 Date of last inspection 24th January 2006 Brief Description of the Service: Faith House is a privately owned care home providing accommodation for eight elderly people. The property is a bungalow with first floor extension. On the ground floor there are six single bedrooms, four of which have en-suite facilities. There are a further two en-suite bedrooms on the first floor as well as a staff sleeping-in room. The home has one bathroom with an assisted bath. The large kitchen/diner is very much the heart of the home, with a large dining room table where the service users and staff take meals and spend time together. There is also a spacious and comfortable lounge for service users to enjoy. Faith House is located in Severn Beach, near to the sea wall and overlooking the Severn Estuary. The train station is approximately 100 yards away, where journeys into the centre of Bristol can be taken. There are also a number of local shops and a Post Office within a short walk. The home is located near to the M5 and M4 motorways, and the nearby Cribbs Causeway shopping complex provides a wider range of larger shops. There are several daytime clubs in the nearby locality that service users can attend if they wish as well as the local church. The owner, Mrs Stevens works full time at the home, supported by her staff team and her husband. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over eight hours and was undertaken to review the requirements made at the last inspection and to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. At the last inspection before the new owners took over three requirements were made, it was pleasing to note that the home had made efforts to ensure that the requirements were met. At this inspection it was noted that there were discrepancies in relation to safe administration of medications and an immediate requirement was made to remedy the situation. Action plan in regard to how the home is to prevent further occurrence was received at the Commission for Social Care inspection within the time-scale set. Six residents and two staff members were spoken with at the inspection. A number of records were viewed and a tour of the building was undertaken. The residents were noted to be relaxed and staff were noted interacting with residents in a dignified and respectful manner. What the service does well: What has improved since the last inspection?
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 6 The manager stated at a discussion that there has been on-going refurbishment since the take over to include: New flooring in main and small bathrooms, showers, en-suite facilities, bedrooms, lounge/dining room and quiet room. New carpet had been installed in the main corridor and through the home. New dishwasher and Hot cupboard had also been installed in the kitchen. To enhance security of the home, the outside bedroom windows had been repaired. Furthermore a security fence with gate and locked door to the outside building had been provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that residents are assessed before admission to ensure that their needs will be met EVIDENCE: The home’s statement of purpose has detailed information about services and facilities to be provided. The home also has a Service Users’ Guide that is given to prospective residents and or their relatives when they visit to enable them to make an informed choice about moving to the home. The care records of two recently admitted residents were viewed. There was detailed assessment from Social Services as well as the home to include physical, mental and social needs. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 9 This assessment was undertaken to ensure that the needs of the resident would be met at the home. Also seen in the files were confirmation letters from the home of its ability to meet the residents’ needs. One of the residents whose care file was viewed confirmed that they visited and were assessed at home before admission. Terms and conditions of their stay was also noted in the care files viewed. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed and respected. Doctors and other health professionals are involved in their care however, the home fails to protect them through unsatisfactory drug administration practices EVIDENCE: Whilst the home has changed ownership, most of the residents have been living in the home for many years. The last inspection before the change over evidenced that the residents’ physical emotional and social needs were assessed and care plans were in place describing how the needs were being met. There was also evidence of assessed potential risks to the residents and plans were in place to minimise the risks. This inspection showed no change from the above.
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 11 Residents spoken with stated that staff respected their privacy and treated them with respect. One resident stated, “ I am very happy here, staff are respectful, I have a choice of when I get up and retire. They answer when I ring the bell.” Another resident stated, “ I had a lovely bath this morning and also twice a week. You only have to ring the bell and they will come”. One resident stated “ This place is answer to my prayers, staff meet my needs, I like it here”. One staff spoken with confirmed that they are able to meet the needs of the residents through reviewing the care plans, regular hand over and discussion with the residents. The staff member spoken with demonstrated knowledge of caring for the dying and the importance of keeping information about the residents confidential. The two residents care files viewed evidenced that the General Practitioner and other health professionals were involved in the management of the residents care. The procedure for the administration, storage and disposal of medication was reviewed and was noted to be unsatisfactory. The Medication Administration Record Sheets (MARS) for two residents had missing signatures for medication administered and some medications were noted to be left in the blister packs but were signed as given (6/06/06, 13/06/06) and one medication was still in the blister pack without any explanation why these were not administered. It was also noted that on the day of inspection that two residents medication were hand written in the MARS with no signature and date and a resident on self- medication had not been risk assessed and no consent obtained to ensure adequate protection. At a discussion with the manager, the inspector expressed concern about these unsafe practices and immediate requirements were made for these to be remedied to ensure that the residents are adequately protected. The manager stated that all staff administering medication to residents had attended medication update training with the dispensing pharmacist as a matter of priority. Response to the immediate requirement including action to be taken to remedy the discrepancies noted was received at the Commission For Social Care Inspection within the time-scale stated. Staff interviewed were aware of policies and procedures for dealing with a dying resident and at the time of death. One staff member spoken with was aware of the importance of keeping information about residents confidential.
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 12 Faith House DS0000066329.V301681.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are enabled to maintain links with their families and are also provided meaningful activities however, whilst the food is nutritious there is no choice available. EVIDENCE: Staff are mindful of the type of activities to provide for the residents in relation to their capabilities. Each resident is assessed for the timing of provision of care as far as is practicable, their wishes are considered and where it is not possible the relatives and /or advocates are involved to ensure that individualised care is provided. One resident spoken with stated, “I prefer to stay in my room because I want to be able to read a newspaper, write letters and watch television. I only go out for meals. However there are plenty of activities here to enjoy.” Recorded activities included going out for walks and sitting out in the well maintained and secure garden. The manager showed the inspector one of the gardens where the residents are supported and encouraged to plant seeds and maintain. One individual spoken with stated that they enjoy gardening because
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 14 of the ‘joy you derive from it.’ One resident spoken with stated “ I walk around the sea front every morning on my own.” Staff were noted interacting with the residents in an informal and personalised manner. One staff spoken with stated that residents have visited Horse World; some residents enjoy knitting and gardening. One resident told the inspector that there is a church service at the home once a month and that most residents look forward to attending the service. The residents also look forward to watching Songs of Praise on the television on Sunday evenings. One resident told the inspector that they chose the home because of the Christian background. The resident stated, “ I am a Methodist, but not practicing but like a good hymn. I attend Songs of Praise but not the church service and people respect that.” Three other residents spoken with stated that they enjoy the service on the designated Sunday as well as the Songs of praise on Sunday evenings. The manager stated that the home was originally based on Christian ethos and that this is still maintained. The local church is very much involved with the home and organises a prayer meeting at the home every Wednesday. Residents who do not want to attend are offered an alternative activity. All activities attended by residents were noted individually recorded in their care files. The visitors’ book showed that the relatives and representatives regularly visit the residents. Residents spoken with stated that they had regular visitors. One resident spoke passionately about the family. The individual stated that the son lives abroad and that he phones regularly. Another resident stated that the family live locally and visit regularly. One comment card from a relative stated “ our relative always says there is no where she would rather be” One resident stated that they have recently celebrated their 100th birthday and that they received a telegram from Her Majesty the Queen. The lunch on the day looked nutritious and balanced and the residents spoken with stated that they enjoyed their meal. However the menu viewed had no choice of meals. It was agreed that the menu must be reviewed to offer the residents a wider variety. This will be reviewed at the next inspection. The kitchen was found clean and staff have attended basic food hygiene to ensure that the residents are adequately protected. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 15 Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 16 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): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are protected from abuse EVIDENCE: The home has appropriate procedures in place for the management of any complaint at the home. There was no recorded complaint and no complaint had been received at the Commission for Social Care inspection. There is evidence that staff have attended Protection of Vulnerable Adults from abuse training and has Protection of Vulnerable Adults policy; there was evidence of the South Gloucestershire Council document on how to report incidents of suspected abuse. The manager demonstrated knowledge of the procedure for reporting incidents of abuse if they occur. Staff are aware of the Whistle Blowing Policy and are able to report incidents of abuse without fear of reprisal. Evidence from the most recently employed staff files showed that an appropriate recruitment procedure was followed. Faith House DS0000066329.V301681.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 21 22 23 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents enjoy a suitable, safe and well-maintained environment EVIDENCE: The home provides a comfortable environment that is suited to the present category of residents, is able to meet their needs and is accessible to the community facilities. The premises are well maintained. The home has a spacious and welldecorated lounge and provides a relaxing environment for the residents. During a tour of the premises, all parts of the home were found clean and warm however, one resident’s room was noted with unpleasant odour. A requirement was made for the flooring in this room to be deep cleaned or replaced. It was pleasing to note the requirement made at the last inspection in relation to covering the radiators for residents’ safety had been met. Clinical waste is
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 18 correctly disposed of and measures are in place to support appropriate infection control. It was noted whilst walking about that there was rust on the base of the fixed hoist in the ground floor bathroom; the manager stated that this would be repaired during the refurbishment at the home. The manager also stated that there has been on-going refurbishment since the last inspection. These included new flooring in two bathrooms and one en-suite bathroom, repairs in the rear bedrooms. The garden was noted to be well maintained and had suitable garden chairs for the relaxation of the residents and their families during the summer months. The garden is walled and an extra security fence has been built to provide added privacy and security for the residents. Faith House DS0000066329.V301681.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with sufficient numbers of staff to meet their needs, adequate training is also provided to its staff to protect the residents EVIDENCE: Two staff members and a cleaner were on duty on the day of inspection as well as Mr and Mrs Stevens the providers. Staff spoken with stated that there are always two staff members on each shift during the day and one staff member on night shift. The rota reviewed on the day confirmed that two staff were on duty from 8.30 am –3.00 pm, two staff from 3.00 pm- 10.00 pm, one staff from 10.00 pm – 8.00 am. Evidence from the staff training records showed that staff have attended training on basic food hygiene, manual handling and Protection of Vulnerable Adults from Abuse. One staff spoken with confirmed that they have undertaken National Vocational Qualification (NVQ) at level 2 and that some training was undertaken before the present owners took over. The two staff on duty on the day were noted to be very professional in their observations and took appropriate action following specific care needs of the
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 20 residents. Residents were very complimentary of staff and the home. One resident stated “ staff do everything for me, they are very good”. Another resident stated “staff are very kind here, all I have is praise for them” Records of two recently appointed staff evidenced that appropriate recruitment procedures were followed as well as appropriate induction to enable the staff to familiarise themselves with needs of the residents and the home’s general routine before assisting them with personal care. A new comprehensive induction format to be used by the home was seen on the day. Faith House DS0000066329.V301681.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 36, 37 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed; Residents are protected through appropriate health and safety practices. EVIDENCE: Mrs Toni Stevens is the current registered manager of Faith House. Mrs Stevens has acquired skills and experience over the years to enable her to support the staff to provide good standards of care for the residents. At a discussion Mrs Stevens stated that the biggest challenge they had encountered since takeover was working with the residents to ensure that their needs were met considering that they are still emotionally attached to the previous management of the home.
Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 22 Mrs Stevens stated their aim is to ensure that the residents are safe and comfortable with the change in their environment. The management also works with staff to accept the s Staff spoken with stated that the manager is approachable and will listen to concerns raised. Staff are more involved in decision-making. One resident stated that the manager is “approachable and comes round to see us ”. Another resident stated, “The new owners are very good, they have made a lot of changes and they are very good to us. They are a lovely couple”. One comment card received from a relative stated “my mother is extremely well cared for and very happy at Faith House. I hope that if I ever need one there will be a home for me which is as good as Faith House”. Documentation in relation to health and safety procedures were in date, the fire logbook evidenced that the last fie drill was on 9/01/06. Electrical Inspection and installation certificate is being awaited following recent rewiring work at the home. The manager stated that the Fire Officer visited the home on request from the home and advised that the wallpaper should be removed in due course to ensure fire safety. The home manager stated that the wall papers identified in the upstairs hall way will be removed during this refurbishment period. The Gas inspection certificate was noted to have expired and due for renewal on 20/05/06. The manager stated that they are currently looking for experienced registered Gas Installers to attend and service the boilers. It was agreed that the certificate be sent to the Commission as soon as the work is carried out. Records evidenced that staff received regular supervision to ensure that they are supported in their responsibility of providing personalised care to the residents. In relation to Quality Assurance the manager stated that new care plans have been introduced to ensure that the needs of the residents are met. Staff are supported to be involved in developing the care plans and also in reviewing them. The management meets with staff on a regular basis to ensure a smooth transition from the old way of working to a better way for the benefit of residents, staff and the home in general. The manager also stated that the home has an open door policy to enable residents, relatives, friends and other visitors to approach the management at any time to talk about any issues, confidential or otherwise. Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 23 The home has policies and procedures to include Whistle-Blowing, Medication. Protection of Vulnerable Adults from Abuse, Manual Handling, Confidentiality, Meal planning, Nutrition and Infection Control. All residents’ records were noted to be securely locked away Faith House DS0000066329.V301681.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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 25 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 2 3 Standard OP26 Regulation 23 16 13 Requirement Deep clean or replace the flooring in identified resident’s bedroom. Provide residents with alternatives in their menu Ensure that all hand written medication on the MARS are signed and dated; All medication not given must not be signed for; Reasons must be clearly stated for medication not administered. Ensure risk assessment is undertaken and consent obtained for a resident on self-medication. Timescale for action 27/07/06 27/07/06 27/06/06 OP15 OP9 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 Faith House DS0000066329.V301681.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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