CARE HOMES FOR OLDER PEOPLE
Queensbridge House 63 Queens Road Cheltenham Glos GL50 2NF Lead Inspector
Mrs Helen James Unannounced Inspection 8th November 2005 09:45 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.V263962.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. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 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.V263962.R01.S.doc Version 5.0 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. 21st March 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 service users. 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 service users have the benefit of an enclosed private garden, which may be enjoyed in Summer months. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours on one day in November 2005 and was completed by one inspector. Sixteen Care Standards for Older People were assessed on this occasion. Of these four exceeded the standard, twelve met the standard and one was not applicable. Time during the inspection was spent speaking with the Registered Provider and 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, lifestyle and relationship with the care staff and manager at the home. The inspector then spent time looking at resident’s individual care records, cross-referencing information relating to care and welfare gained from talking to and observing the residents. What the service does well:
Each prospective resident visits the home with their relatives/friends prior to admission, this familiarises them with the home, its facilities and the staff. They have all their care requirements fully assessed before they are admitted to ensure that the Home is able to meet their needs. The Home has the benefit of an experienced Provider and Acting Manager who was the Care Manager of the home. Both are greatly involved in the home on a day-to-day basis. They appear to have an open, friendly approach to the running of the home. This results in Queensbridge House being run safely and efficiently with residents’ rights being safeguarded and protected. It was evident through discussion with residents that they felt their views and ideas are always taken into account. They found the Provider, Acting Manager and staff approachable and friendly. They were most complimentary about the care, of the food served 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”,” they give you assistance when you need it”, ” You are treated with respect and dignity”, “you can choose to participate in activities or not”. “Staff spend time talking with you” and “you can dictate your own daily routine and when you do things.” They enjoyed living at the home and had made friends whilst they had been there. Care plans are well documented and are developed for each resident following admission and in the main contain all the required information for each resident. Management records relating to health and safety issues and regular checks were in place. There was evidence that if any action had been necessary that it had been completed. Lifestyle and hobbies are well recorded and social activities cater for individual interests. The activities are varied and are well attended by residents who
Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 6 thoroughly enjoy the activity programme. One to one sessions are also undertaken with those residents who do not enjoy group activities. 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.V263962.R01.S.doc Version 5.0 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.V263962.R01.S.doc Version 5.0 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): 3&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. Intermediate care is not provided. EVIDENCE: Residents 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 that they were involved in the process with their relatives / representatives and are involved when their care is reviewed at the home. Documentary evidence was available to demonstrate this. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 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 & 11. The care planning systems ensures that all members of staff have a clear understanding of the care each person requires and how it is to be given. All Health Care needs are fully met. Residents are treated with respect and dignity and end of life wishes are recorded. 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 pre-admission assessment and an admission assessment that informs the detailed individual plan of care. This indicates specific care needs and enables care staff to know how to assist the resident. These plans are developed for each resident in consultation with the resident and their families where possible. Residents sign a care plan agreement form on assessment and at the monthly review to demonstrate their involvement. 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.
Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 10 Daily recording was observed to be appropriate and informative with signature. The care plans are reviewed at least once a month or more frequently if residents care needs change. The inspector read care records for the residents spoken with during the inspection and found that 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. On some of the sample of care files examined it was noted that some information had not been completed on the admission assessment, one had the lifestyle questionnaire missing and one had end of life wishes missing. It is essential that all information is recorded appropriately. It was also noted that two residents were on active treatment for dementia. At the present time the home is able to deal with the residents assessed needs and there are no behavioural issues, but the inspector highlighted that once this was not the case the residents would require specialist care. There is good support from the Psychiatric Nursing service. The inspector requires the home to update all staff in Dementia care via training. GP and healthcare professionals’ 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 All care documentation is kept securely in the home and is readily accessible to all the staff responsible for providing care. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 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, 13, 14 & 15. Residents continue to have as varied 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 continue to be wholesome and nutritious with choice at each meal. EVIDENCE: Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 12 Residents at the Home are free to spend their day as they wish; they may sit in one of the communal sitting rooms, the conservatory or in the privacy of their own bedroom and participate in their own personal hobbies such as knitting, reading, listening to the radio or television etcetera. Several residents go out regularly with family or friends in the local neighbourhood, into town, to Church or to relatives’ homes. One resident goes home regularly for a long weekend when she is well enough. Some residents do not wish to go out at all. There continues to be regular activity sessions run by the senior carer and the programme includes arts and craft sessions, chair exercises, skittles, 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. On the day of inspection the residents were doing some chairs exercises, which they all appeared to enjoy several of the ladies were keen to participate in this. A documented life history is in place, which gives a personal account of individuals’ life/lifestyle and hobbies/interests; this assists staff in the planning of activities/entertainment. Two files read did not have these in place but the Manager reported that this was due to the fact that the family had not returned them yet. The Acting Manager would follow these up. Each Sunday afternoon there is a reminiscence session for residents, which they all enjoy. Residents are able to entertain visitors either in their own rooms, or in the communal lounge/or sitting areas of the home if they wish. Visitors are welcome in the Home at any time. Some of the residents have had telephones installed in their own rooms; others make use of the portable telephone facilities provided at the Home. Staff were observed knocking on doors when entering rooms and addressing residents respectfully. All residents are addressed appropriately by the name they prefer. Through discussion with residents it was evident that personal autonomy and choice are promoted fully at the home. Residents are able to bring their own furniture and personal possessions with them to the home. Residents reported that lunch was very tasty and well cooked they felt it was well presented and was sufficient in quantity and there was always a choice. Carers wore tabards to serve the meals and served them in a polite, unhurried manner. Most of the service users sat in the dining room; although a couple prefer to remain in their own room. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 13 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 Complaints procedures are in place and residents seem comfortable raising concerns with all staff. EVIDENCE: The Commission has received no complaints. Residents spoken with confirmed that if they had a problem/concern they would know who to approach and that the issue would be dealt with. One lady confirmed that the residents’ meeting was a good forum for raising things. The Acting Manager reports that she tries to see residents every day. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 14 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, 24 & 26 Residents live in a homely environment, which benefits from the continuous attention to decoration and repair. EVIDENCE: The Home is well maintained with an ongoing programme of maintenance and decoration to ensure the environment maintains a homely, comfortable ambience for the residents and is safe for them. All the required furnishings are supplied in communal areas and in residents’ rooms if required; many residents have 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. The laundry was not examined on this occasion. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 15 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): Staffing is adequate to meet the care needs of the residents living in the Home at the present time. The recruitment processes ensure that safeguards are in place to offer protection to residents living at Queensbridge House. EVIDENCE: On the day of the inspection, there were twenty- six residents living in the Home. In the morning, 8am until 2pm, the Provider, the Acting Manager and four care staff were on duty. In the afternoon from 2pm until 8pm there was the Acting Manager until 4pm and three care staff from 2pm until 8pm. 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 were a housekeeper from 8am until 2pm, Handyman from 8am until 2pm and laundry assistant from 2pm until 6pm. Only one resident requires regular use of the hoist and this resident is being reassessed for a place at a nursing home. All the other residents require assistance, prompting and supervision. There have been five new members of staff since the last inspection and on examination of personnel files recruitment practice was good and all the information required under the amended regulation 19 was in place for all except two. Most information was obtained prior to the individual starting
Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 16 work but where this was not possible the Acting Manager reported that staff worked alongside another member of staff until all documentation was back. The inspector noted that: • One file did not have a copy of birth certificate or a photograph. • One had no CRB/POVA this had been sent but was returned because information was missing. The home is now waiting for the result of this check although there is a CRB dated January 2004, prior to POVA check. A documented signed interview record is kept. An induction checklist is in place and this had been signed confirming what specific areas had been covered during induction. All new staff, except one, Criminal record bureau screening (CRB) and Protection of Vulnerable Adults (POVA) checks were examined by the inspector. One member of staff is under eighteen and works as the laundry assistant. The Acting Manager is in the process of developing the training programme for next year to cover all mandatory training and all other training identified during supervision sessions. Staff and residents have formal minuted meetings on a regular basis. Both groups are given the opportunity to include agenda items and participate. Both staff and residents felt that items were dealt with appropriately albeit there is not always agreement, as some issues cannot be solved for the individual without it impacting on others, so inevitably an agreed compromise is found. Evidence of this was seen via the minutes. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 17 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): 35, 37 There continues to be good leadership, guidance and direction to staff from the Provider and Acting Manager to ensure the residents receive consistent, quality care, even whilst there are changes taking place. The Home has financial policies and processes in place to ensure that the residents’ interests are safeguarded. Practice promotes and safeguards the health, safety and welfare of the people using the service and staff. EVIDENCE: The home is applying to change Manager at the present time. The Care Manager is now ‘Acting Manager’, and is in the process of applying for approval by the Commission for Social Care Inspection (CSCI). She has been at the home a long time and is just completing her National Vocational Qualification
Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 Page 18 (NVQ) level 4 Managers Award. Whilst this change is taking place the residents have not noted any change to their daily lives or to the quality of response they receive from the management of the home. As this change is being implemented the Provider and Manager have reviewed the staffing, staff structure and responsibilities of staff, to ensure that an effective and efficient management structure is in place to meet the needs of the home and its residents. The Provider has increased the responsibilities of the Deputy Care Manager to enable him to support the Acting Manager in her role. The Provider and Acting Manager take responsibility for the personal monies for several of the residents. There was evidence that correct records are maintained and that individual secure storage is provided. These records are audited regularly. On examination of care records for specific residents it was noted that falls/incidents and visits requiring treatment in the casualty department were recorded. These accidents/incidents had been appropriately recorded in the accident book and notified to the Commission for Social Care Inspection (CSCI) via Regulation 37 notices. Environmental Health visited 8th August 2005 all requirements are done. Fire Officer visited March 2005 all requirements are done. Legionnella tests have been done and the report was seen. The Provider has now implemented regulation 26 reports and these were seen at the inspection. Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 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 X X 3 X X N/A 4 X X X X 4 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X 3 X Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 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.) Timescale for action 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Queensbridge House DS0000065411.V263962.R01.S.doc Version 5.0 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
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