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Inspection on 06/07/05 for Five Stacks Residential Home

Also see our care home review for Five Stacks Residential Home for more information

This inspection was carried out on 6th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Five Stacks is a very comfortable environment and has a strong family ethos that is much appreciated by the service users living there. Frequent comments to inspectors have related to the small scale of the home and how the calm atmosphere supported service users.

What has improved since the last inspection?

The documents which make up the service users` care plans had been revised by the manager, and provide a more comprehensive overview of service users` needs and how staff should meet these. These would be enhanced by further developments, specifically in the elements relating to activity and emotional care.

What the care home could do better:

The registration of the home for care of service users with dementia was based on the ongoing development of the staff team`s knowledge and skills in meeting these complex needs, through training. The recruitment of staff has been difficult for the home and the impact of this is apparent in the lack of progression the home has made in meeting requirements, or meeting the expectations of the conditions of registration. Additionally the use of the manager`s post to support the care staffing does not detract from the ability of the post holder to spend time developing the service. The provision of activities that specifically are designed to meet the needs of service users with dementia requires further research and development.

CARE HOMES FOR OLDER PEOPLE Five Stacks Residential Home 209 Point Clear Road St Osyth Clacton on Sea Essex CO16 8JD Lead Inspector Sara Naylor-Wild Unannounced 6th July 2005 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 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. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Five Stacks Residential Home Address 209 Point Clear Road St Osyth Clacton on Sea Essex CO16 8JD 01255 820417 01255 820417 fivestacks@tinyworld.co.uk Mr John Sidney Donhou Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager post vacant Care Home 14 Category(ies) of Dementia - over 65 years of age (14) registration, with number of places Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 14 persons). 2. The registered person shall ensure that a continuing programme of development is provided for managers and staff in relation to dementia care and good practice, equivalent to the recommendations of the Alzheimers Society. 3. The registered person shall keep under review the provision of additional communal living space to meet the assessed needs of service users. 4. The registered person shall ensure that staff provision is increased to meet the needs of planned admissions of service users. Date of last inspection 21st March 2005 Brief Description of the Service: Five Stacks Rest Home is a former family dwelling house that has been extended and improved to form the present accommodation. The detached house is located within a residential area. The accommodation is within both single and twin occupied bedrooms on the ground and first floor. There is a passenger lift available. The communal space is ample, there being a main lounge area and a kitchen/dining room. The decoration, furniture and fittings were of a high standard and the whole house represents a comfortable living environment. The front of the property has been laid to hard standing but is enclosed by attractive trees and shrubs. The rear garden is large and features an enclosed swimming pool and sun terrace with extensive lawns. The garden is also enclosed with attractive trees and shrubs The home changed registered category of care to Older People Dementia Care in 2004. There were conditions attached to the registration that required the home to continue to review and develop the accommodation and staff training in dementia care. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was carried out on the 6th July 2005, although the inspection process was extended to allow the provider to supply the Commission with further information. During the inspection there was opportunity to observe the care practices of staff and to speak with service users. Since the last inspection visit the registered manager had resigned her post and a new manager Diane Howard had recently been appointed and was in the process of applying for registration with the CSCI. There had not been significant changes in the level of compliance for outstanding requirements from the previous inspection, and the opportunity was taken to utilise this inspection visit to ensure the new manager fully understood the expectations of the National Minimum Standards and provide guidance in attaining these. 14 of the 38 standards were inspected on this occasion. Of these, three met the standard and 8 were below compliance level. What the service does well: What has improved since the last inspection? The documents which make up the service users’ care plans had been revised by the manager, and provide a more comprehensive overview of service users’ needs and how staff should meet these. These would be enhanced by further developments, specifically in the elements relating to activity and emotional care. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 6 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. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 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 standard(s) 3 and 6 The assessments being introduced would provide a suitable level of information in respect of service users’ needs. The home does not provide intermediate care. EVIDENCE: The acting manager had considered the content and format of the assessment documents as part of her review of care planning. The newest versions of these asked for information in all aspects of the service users’ lives and would provide sufficient knowledge about these needs to commence a care plan. Advice regarding the depth of information the format allowed was given by the inspector, and the manager was encouraged to consider how the specific needs of dementia conditions would be identified. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 and 9 The revised care planning document provided detailed information regarding service users’ needs and how staff should meet these. The records included monitoring of health needs and visits from health professionals; these need to be transferred to care plans. Medication policies in place meet the good practice guidance. EVIDENCE: The care plans being introduced, at the time of the inspection, contained information regarding the service users’ capabilities and needs. These were divided into sections and a full explanation of the action staff were required to take was provided. The documents gave a good insight into the individual and should allow staff to fully understand the way in which their intervention would be most beneficial to the service user. Further developments should be considered in the introduction of a person centred perspective, as advocated by good practice guidance in dementia care, and the understanding and information available regarding social needs. This approach was discussed with the acting manager. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 10 The care plans contained monitoring sheets relating to the service user’s health and other related matters, such as skin integrity, fluid, dietary and weight charts. In addition the visits conducted by health professionals and their outcomes are recorded. This provides a comprehensive understanding of service users’ physical wellbeing. From issues raised in a formal complaint it was found that the information gathered in these documents was not always included in care planning and how the staff should respond to these. This requires further development. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 and 13 The service provides some recreational activities for the whole service user group. However, there is not an individual approach to social stimulus and staff have not developed skills in delivering this. The visiting arrangements within the home met with the expectations of service users and their families. EVIDENCE: During the inspection service users were observed participating in group singing and discussions with each other and staff on duty. The activities on offer were discussed with the manager and an acknowledgement that the provision had not been developed in response to the specialist needs of service users. The impact of staffing levels and arrangements was also considered. Service users’ families have previously reported to the Commission that visiting arrangements are appropriate and that the home recognises the right of the service users to refuse visitors. There has not been any change to the policy or the arrangements it sets out. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16 and 18 The complaints policy was appropriate to the standard. The policy in respect of protection of vulnerable adults does not fully reflect the good practice guidance for Essex. EVIDENCE: The home’s complaints policy is satisfactory. There had been one complaint made to the Commission in respect of the care of a temporary resident that was considered under the Protection of Vulnerable Adults guidance by Essex Social Services. The allegation related to the monitoring and action taken in respect of the service user’s health care. The outcomes of the investigation established that the home had appropriately requested support from health professionals as required, and had recorded the care provided. However, there were some improvements required in the recording of diet and output required. Overall the conclusion was that the complaint was not upheld but that recommendations were made in relation to future care provision that would strengthen the quality of health care provided at the home. The manager had not reviewed the policy for protection of vulnerable adults. The current document does not contain the correct instructions for staff to follow in relation to the reporting of abuse. The manager was advised to revisit the Essex guidance in this matter and adjust the policy, making sure staff were aware of the correct procedures. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19 and 26 The environment is well maintained and safe. The premises are clean and hygienic and the laundry system is being reviewed to meet good practice guidance. EVIDENCE: The building continues to be maintained to a good level and presents a comfortable family environment for service users. The manager was reminded of the need to keep the provision of communal space under review as part of the conditions of registration for dementia care. The manager advised that the laundry system was under review to reflect the updated good practice recommendations from the Infection Control Nurses on the use of disposable laundry bags for soiled laundry. The home is kept clean and tidy with a good level of hygiene maintained by the systems operated by staff. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing numbers had not been reviewed against service users’ assessed needs. The numbers of care staff employed is insufficient to support the rostered hours. Staff working at the home have undertaken basic dementia training and show compassion and understanding to the service user group. However, the development of staff’s competencies in caring for service users with dementia has not continued. EVIDENCE: Discussions have taken place at previous inspections in respect of the home recruiting staff. They had encountered ongoing difficulties in attracting staff and as a result the staff group has reduced significantly over a period of time, despite ongoing efforts made to address the shortfall. The staff group is primarily made up of part time staff, some of which work one day a week, and the full time manager’s post. On the day of inspection the manager and one other was on duty and, due to the occupation of the manager in the inspection process, was reduced further. This is an insufficient staff number to support the roster, without the manager being involved full time in care duties. This detracts from the development role of the manager, which was significant in the lack of progress in areas such as care planning, etc. The registered person is required to give further consideration to this and provide the Commission with an action plan that will address this shortfall. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 15 At the time of the inspection there was no staffing calculation in place in order to determine the numbers of staff required to meet service users’ needs. It is particularly relevant to the provision of dementia care that support is provided by staff to service users in sufficient numbers. Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not assessed at this visit. EVIDENCE: Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x x Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 18 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 OP7 Regulation 14 Requirement The registered person must develop further service users plans of care to ensure they encompass all aspects of the assessment and provide a basis for the care to be delivered. This is a repeat requirement. The registered person must develop the range of suitable occupational activities on offer to service users assessed needs and preferences. The registered person must ensure that the protection of vulnerable adults policy meets current guidance. This standard was not assessed at this inspection, therefore is carried over to the next report. The registered person must ensure that the homes recruitment procedures adhere to the requirements of Regulation 19, Schedule 2, specifically that staff are not employed without first obtaining a CRB check. This standard was not assessed Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 19 Timescale for action 31st October 2005 2. OP12 16 (2)(n) 31st October 2005 30th September 2005 3. OP18 13(6) 4. OP29 18,19 Schedule 2 31st October 2005 5. OP30 19 at this inspection, therefore is carried over to the next report. The registered person must ensure that there is a staff training and development programme which meets National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 31st October 2005 6. OP35 25 This is a repeat requirement. The registered person must 31st ensure that records, which October demonstrate the current financial 2005 viability of the business, are available for inspection. This standard was not assessed at this inspection, therefore is carried over to the next report. The registered person must ensure that there are sufficient numbers of care staff and that the residential forum calculation is carried out to determine the appropriate levels. The registered person must ensure that the manager is provided with adequate opportunities to fulfil the expectations of the role, including the development of practice and policies. The registered person must ensure that all aspects of service users wellbeing are monitored, including diet, weight and fluid intake. The outcome of this record must be included in the action in care plans. 7. OP27 18 30th September 2005 8. OP32 18 30th September 2005 9. OP8 14 31st October 2005 Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 20 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 OP31 OP28 Good Practice Recommendations It is recommended that the manager obtains a National Vocational Qualification level 4 qualification or equivalent by 1.4.2005. The registered person is recommended to ensure that a ratio of 50 care staff members are trained to National Vocational Qualification level 2 or equivalent by 1.4.2005. This standard was not assessed at this inspection, therefore is carried over to the next report. The registered person should ensure that staff supervision is carried out six times a year. This standard was not assessed at this inspection, therefore is carried over to the next report. The registered person should ensure that the practice for dealing with soiled laundry meets current good practice guidance. 3. OP36 4. OP26 Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 1st Floor Fairfax House Causton Road Colchester CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Five Stacks Residential Home I56 I05 S17941 FiveStacks V221583 UI060705 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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