CARE HOMES FOR OLDER PEOPLE
Queensbridge House 63 Queens Road Cheltenham Glos GL50 2NF Lead Inspector
Mrs Helen James Unannounced Inspection 13th February 2006 10:45 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 Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 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. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Queensbridge House Address 63 Queens Road Cheltenham Glos GL50 2NF 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) 01242 519690 01242 539059 Queensbridge Care Limited To be Appointed Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability over 65 years of age (1) of places Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One (1) service user in PD(E) category. Four (4) beds to accommodate service users between the ages of 50 and 65 years. 8th November 2005 Date of last inspection Brief Description of the Service: Queensbridge House is a large detached house, which has been extended and refurbished to provide residential accommodation for twenty-seven elderly residents. It is situated in a residential street close to Cheltenham Railway Station. The Home is on a bus route and is within easy reach of Cheltenham town centre. The accommodation consists of twenty-five single bedrooms, twenty-three of which have en suite facilities, plus one double room. Access is gained to the upper floors with the aid of the shaft lift, stair-lifts or stairs. Comfortable communal rooms are provided throughout the building. The residents have the benefit of an enclosed private garden, which may be enjoyed in Summer months. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven and a quarter hours on one day in February 2006 and was completed by one inspector. Twelve Care Standards for Older People were assessed on this occasion. Of these, two exceeded the standard, eight met, one almost met the standard and one was not applicable. Time during the inspection was spent speaking with the Acting Manager and staff, examining documentation and speaking with the residents. Those residents who were able to converse with the inspector discussed their admission, care, food, lifestyle and relationships with the staff at the home. The information gained from talking to and observing the residents in relation to care and welfare gained was then cross-referenced with resident’s individual care records. What the service does well:
Where they are able to, prospective residents visit the home with their relatives prior to admission. This familiarises them or their family with the home, facilities, staff and the other residents. Potential residents have their care requirements fully assessed before they are admitted to ensure that the Home is able to meet their needs. Care needs are well documented, reviewed and updated as care needs change and those seen adequately reflected the care needs of the individuals, they also demonstrated involvement of the resident. The Home provides social activities to suit the residents’ individual and group preferences. These appear to be enjoyed by the residents who get involved with them. It was evident through discussion with residents that most felt their views and ideas were taken into account, although some felt they were listened to and no action was taken, but the inspector could find no evidence of this as all the issues they raised especially concerning food seem to have been noted and actioned where possible. It was evident to the inspector that in a communal environment, it was never going to be easy to fully satisfy everybody with the action taken. All reported that they found the Acting Manager and staff very approachable and friendly. Residents were most complimentary about the care and the pleasant friendly manner of the staff employed at the Home. Many stated that “the home was lovely”, “staff wonderful, “friendly, approachable and helpful”, “ You are treated with respect and dignity”, “you can choose to participate in activities or not”. “Staff are very good and spend time talking with you” and “you can dictate your own daily routine and when you do things.” Most enjoyed living at
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 6 the home, but two residents felt that they could cope on their own at home now. What has improved since the last inspection? 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. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 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 Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 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): 1,2,3,5 & 6 Arrangements are in place to ensure that each prospective resident is fully assessed prior to admission and on admission, to ensure that all their specific care needs can be met by the Home. Residents or their relatives have the opportunity to visit the home. Intermediate care is not provided. EVIDENCE: Residents spoken with confirmed that they were assessed by the Manager of the home prior to their admission and were reassessed once they arrived at the home. They confirmed they are involved in the process with their relatives / representatives and the member of staff talking about their care. Documentary evidence was available to demonstrate this. Residents confirmed that they or their relatives visited the home prior to the admission and found the home to be very suitable. Residents had contracts but it was the relatives/representative who dealt with this and not the resident; they did not want the worry of this.
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 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 the following standard(s): 7,8 &10 All Health Care needs are fully met. Residents are treated with respect and dignity. EVIDENCE: Care plans are well documented and are developed for each resident following admission. On examination of care records it was evident that residents have a preadmission assessment and an admission assessment that informs the detailed individual plan of care which is developed in consultation with residents where possible. Residents sign a care plan agreement form on assessment and at the monthly review to demonstrate their involvement. The care plan indicates specific care needs and enables care staff to know how to assist the resident. Risk assessments, monthly weight and personal background information is recorded for each resident. A photograph of the resident is kept with the care file to aid identification. Daily recording was observed to be appropriate and informative. The care plans are reviewed at least once a month or more frequently if residents care needs change.
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 10 The inspector read care records for two new residents who were spoken with during the inspection. The records confirmed the assistance and care that the residents stated they required. It also confirmed other information that they had shared with the inspector during the discussions. All care documentation is kept securely in the home and is readily accessible to all the staff responsible for providing care. There is good support from the psychiatric nursing service, GP’s and other healthcare professionals who visit the home. All visits are recorded appropriately with details of the visit and the advice/treatment given. Residents who are being visited by the district nurse have community care records kept at the home. All equipment needed for residents’ health care is supplied appropriately by the Community Nursing Services. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 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 the following standard(s): 12, 14 & 15 Residents continue to have as varied a lifestyle as they wish. Residents continue to be able to exercise choice and control over their lives and maintain contact with family and friends. The meals at the home are wholesome and nutritious with choice at each meal. EVIDENCE: Residents continue to be free to furnish their rooms with their own furniture and personal belongings. Those rooms seen were personalised and very homely. One person had recently moved into the home and they were extremely pleased that all their personal belongings and pictures were around them. There continues to be regular activity sessions run by the senior carer and the programme includes arts and craft sessions, chair exercises, skittles, floor dominoes, music appreciation, board games, manicures, quizzes and anything else that the residents would like. Some activity sessions are done on a one to one basis, others in groups. A record of the activities attended is kept for individuals. The programme is displayed in the home. On the day of the inspection the residents were having a game of floor dominoes played in two teams, which they thoroughly enjoyed. One resident goes home regularly for a long weekend when she is well enough.
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 12 Each resident is free to spend their day as they choose, within their own limitations. Residents who were able to speak with the inspector confirmed that they were treated with respect and they had choice in their daily routine. Some enjoyed the activities and others preferred to participate in their own personal hobbies. Food was discussed with residents during the inspection and the lunchtime meal was seen served, eaten and cleared away. Staff are allocated kitchen duties on shift, which involves heating and serving in the kitchen. Carers are then allocated to serving the meals to residents and they all wear tabards for these tasks. The Home has prepared precooked, frozen meals from a local company who deliver weekly. They heat and serve the food to residents according to the strict guidance supplied by the Company. Temperatures of meals prepared are recorded on the menu sheet as well as issues relating to quality and quantity. Comments from the residents are also recorded to allow the Provider to review the food and make any changes to the menu. The Provider also contacts the Company referring any issues to them relating to the quality of the meals so that they can change their cooking methods or suppliers if the food is not up to standard. There is a three- weekly menu and this is reviewed and adjusted depending on the likes and dislikes of residents, so that food served meets the nutritional needs and likes of residents. The manual of available meals has been developed by a dietician within the Company to ensure a nutritionally balanced diet of sufficient quantity. The manual gives the dietary value of all the constituents in each meal to allow balanced menu planning by the Provider. At the home there is always a main dish each day and an alternative is available for those who do not like the main dish or who do not want that dish that day. Specific diets are also catered for. On the day of the inspection residents had Turkey cottage pie, potato wedges or boiled potato, sliced green beans, diced swede with gravy followed by plum pie and custard or Semolina. Food was discussed with all eight residents spoken to. Some residents were totally happy with the meals, whilst others were quite critical of some meals they were served, but very happy with other meals that were provided. Some felt vegetables were too soft whilst others felt they were fine. Quantity was felt to be adequate by all as there is usually the opportunity for second helpings. Some Residents had a perception that there was a long wait between courses but there was no evidence of this during the inspection. Also this has been discussed at several residents meetings and the Provider and Manager have audited the serving practice on several random occasions and have found that there is not a long time between courses. Evidence of these discussions was seen in minutes of the residents’ meetings. One issue arising from the observation of the serving of meals was that one member of staff did not inform the residents correctly what the dessert was and this caused residents some anxiety.
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 13 The Provider informed the inspector that this would be addressed through education of staff and ensuring that they know what the menu for the day is and that they know what they are serving to the residents. Residents commented that they did not always know what the meal was for the day, the home has tried displaying this on a board in the dining room but this did not rectify the problem. Food is constantly reviewed by the Provider and Manager and amendments made to menus based on residents opinions of food, likes and dislikes and feedback from residents and relatives on a daily basis. Evidence was seen of this in the meeting minutes and on Regulation 26 reports. Residents meetings are held regularly. Minutes seen were very thorough in dealing with the issues that arose for residents. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 14 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): Not assessed on this occasion. EVIDENCE: Not assessed on this occasion Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 15 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 & 26 Residents live in a homely environment, which benefits from ongoing maintenance and improvements. EVIDENCE: The Home is well maintained with an ongoing programme of decoration and replacement of furniture to ensure the environment maintains a homely comfortable ambience for the residents. No maintenance issues where found except one bedroom door that was ‘squeaking’ rather badly each time it was opened. This needs to be addressed. All the required furnishings are supplied in communal areas and in residents’ rooms if required; many residents had personalised their rooms with their own furniture and pictures making them personal and homely. Cleanliness is of a high standard and no infection control issues were identified. Care staff undertake catering and some laundry duties as part of their daily routine and this does not compromise personal care. The laundry was examined and it appeared there were good systems in place for the management of the laundry in the home.
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 16 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 Staffing is adequate to meet the care needs of the residents living in the Home at the present time. Service users safety and well-being is paramount at all times. EVIDENCE: On the day of the inspection, there were twenty- four residents living in the Home, one of whom was in hospital. On duty in the morning from 8am until 2pm, were the Acting Manager and five care staff. In the afternoon from 2pm until 8pm there was the Acting Manager until 5pm and three care staff. At night from 8pm until 8am there were two care staff, one waking and one sleeping after residents have settled for the night. These staffing levels appeared adequate for the present resident group even though staff also deal with catering duties. Also on duty was the housekeeper from 8am until 2pm, the Handyman from 8am until 2pm and the laundry assistant. There has been one new staff member and her recruitment file was seen. All the relevant documentation was present. The inspector noted that: • There was no CRB/POVA back yet and there was the absence of a POVA First check. The acting manager confirmed that the full CRB/POVA check was returned because information was missing. The home has requested both and is waiting for the result of them to be sent. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 17 • On the application form there was a gap in the employment history and this requires further discussion with the applicant and documenting to ensure a complete employment history. It is required that the application form captures the full employment history not just previous employment. Following the inspection, the Provider discussed the POVA First issue with the Contractor who provides this service to the home to try and resolve the issue, as this has happened on several occasions when the Home has sent the appropriate documentation to them. The Provider will be ensuring that the Contractor fulfils their contractual obligations with regard to these checks in the future. (Evidence was seen of this via documented Emails). Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 18 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): There is good leadership, guidance and direction to staff from the Acting Manager to ensure the residents receive consistent, quality care, and staff find the acting Manager and Provider approachable and supportive. EVIDENCE: The Acting Manager has achieved her National Vocational Qualification (NVQ) level 4 Managers Award. She is waiting for an interview for approval by the Commission for Social Care Inspection (CSCI). She has just started the NVQ level 4 in Health and Social Care. The Provider has increased the responsibilities of the Deputy Care Manager to enable him to support the Acting Manager in her role and this is reported to be working well. The Provider is also at the home each day to support the management team. All accident and incident notifications under Regulation 37 are being appropriately recorded and notified to the CSCI Regulation 26 reports are being received monthly by the CSCI from the Provider and these demonstrate appropriate quality assurance information.
Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X X Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 20 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. 1. Standard OP25 Regulation 13(4) Requirement All radiators to be protected to prevent accidents. (Carried forward from last report as timescale for 2006.) Address the bedroom door that was ‘squeaking’ rather badly each time it is opened. The employment application form must capture the full employment history not just previous employment. Timescale for action 30/06/06 2. 3. OP19 OP29 23(2b) 19 schedule 2(6) 30/04/06 30/04/06 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. Refer to Standard OP15 Good Practice Recommendations Ensure that staff know what the menu for the day is and are able to inform the residents appropriately. Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Queensbridge House DS0000065411.V283351.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
