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Inspection on 23/08/05 for Salmonsbury House

Also see our care home review for Salmonsbury House for more information

This inspection was carried out on 23rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

There continues to be a friendly welcoming atmosphere in this Home. The staff have developed friendly working relationships with the residents, their families and each other. They appear to work well as a team. Clear well considered care plans are prepared for each resident, ensuring that each member of staff is aware of their care needs. The Home is to be complimented for fully involving the residents in planning, preparing and planting the gardens for the summer months. Two of the residents had particularly enjoyed the processes and were justifiably proud of the results. Members of staff at the Home have access to all mandatory training plus any other education that they require to undertake their duties competently.

What has improved since the last inspection?

The Home has addressed the one requirement identified at the previous inspection and now ensures that residents are provided with full information about financial arrangements relating to their care.

What the care home could do better:

The Home must make some minor improvements to their record keeping procedures but they comply with the Care Standards Regulations in most respects.

CARE HOMES FOR OLDER PEOPLE Salmonsbury House Station Road Bourton-on-the-Water Gloucestershire GL54 2BQ Lead Inspector Eleanor Fox Unannounced 23 August 2005 09:45 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. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Salmonsbury House Address Station Road Bourton-on-the-Water Gloucestershire GL54 2BQ 01451 820821 01451 822517 manager.salmonsbury@osjctglos.co.uk The Orders of St John Care Trust 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) Mrs Beryl Ratcliffe Care Home 40 Category(ies) of OP Old age (40) registration, with number of places Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16/2/05 Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Salmonsbury House is a purpose built care home located close to the centre of Bourton-on-the-Water. It is registered to provide nursing and personal care to 40 service users over 65 years of age; the Home is currently managed by The Orders of St John Care Trust. Salmonsbury House has 35 single rooms on the ground floor and a further 5 bedrooms on the first floor, four of the rooms have en suite facilities. A shaft lift has been installed to provide access to the upper floor. As yet, no decision has been reached about the use of the empty rooms on the first floor. These were previously utilised as office accommodation. The service users have the benefit of large comfortable communal areas and attractive private gardens that may be enjoyed during the summer months. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of 5.5 hours. It consisted of a full tour of the property; inspection of a selection of written care records; recruitment files and other available documents; plus discussions with the Manager, the Administrator and eight members of staff working in the Home. The inspector also had the opportunity to talk to six of the residents and to three relatives who were in the Home during her visit. She selected the residents in a random fashion but included someone who had been recently admitted and a person who was seriously ill. She checked their bedrooms and looked at all areas of their daily lives during her visit. Management of the Home has recently become the responsibility of The Orders of St John Care Trust; the Commission for Social Care Inspection has fully processed their application for registration. What the service does well: What has improved since the last inspection? The Home has addressed the one requirement identified at the previous inspection and now ensures that residents are provided with full information about financial arrangements relating to their care. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 7 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. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, and 6 A thorough assessment process plus the provision of detailed information about the Home, enables the majority of prospective residents to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: The Home now provides each resident or the person responsible for settling accounts with detailed information about the levels of any ‘RNCC’ financial contribution to which the resident may be entitled. Copies of the documentation supplied are also kept in the residents’ personal files. However, in recent months, only residents who are privately funded have received a copy of the terms and conditions for admission to the Home. Most of these details may be read in the information file, which is readily available in the front hall of the Home. A comprehensive assessment of each resident’s care needs following a documented format is undertaken prior to their admission to the Home. A copy of the completed documentation for a resident who was admitted recently was Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 10 read on this visit. The Home also has the benefit of any Social Services or other assessment, which may have been undertaken on the prospective resident. These are kept in the residents’ care files. The Home has a long waiting list and no available beds at the current time. Intermediate care is not provided in this Home. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Residents’ healthcare needs are fully identified and addressed; they are treated with respect by staff in the Home. EVIDENCE: Full clearly detailed individual care plans based on an overall assessment of needs are prepared for each resident in the Home; five were inspected in detail. A member of the nursing staff reviews each document on a monthly basis. Full daily records are also maintained. One person, already identified as at risk of developing pressure sores, now had a small area of pressure related discolouration on the right heel. A specific care plan had been commenced and appropriate treatment was being given. Pressure relieving equipment was being correctly utilised. There were also clear records that care from other healthcare professionals is sourced when required. One person had had care and treatment from a physiotherapist, optician, chiropodist and her General Practitioner in recent months. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 12 Three residents who were sitting together in one of the communal areas were most effusive in their praise of the staff who cared for them. They confirmed that carers are polite and respectful; the inspector observed that this was the case as she walked around the building. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 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 standard(s) 12 and 13 Commendable opportunities are provided for varied and stimulating activities and social contacts, as desired. EVIDENCE: The member of staff responsible for arranging activities was available to talk to the inspector. She described many of the activities that are arranged following consultation with the residents. Photographs in the front hall show residents’ participation in the choice of plants and the preparation of the garden for the summer months. It was still looking very attractive, much to the pride of one person who had been involved in some of the work. Another person spoke enthusiastically about a recent trip to Highgrove. There were visitors in the Home throughout the day; two people had come to take their respective relations out for a meal. Members of staff acknowledged each person in a friendly fashion. The home has a newsletter to inform relatives of ongoing events in Salmonsbury House; they are encouraged to be involved in these if they wish. One person mentioning three members of staff by name was most positive about the care given to her relative. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 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 standard(s) 16 A satisfactory complaints system enables service users and their families to feel assured that their views would be listened to and acted upon. EVIDENCE: A fully documented complaints procedure has been developed for the Home. This is readily available to residents, their visitors and members of staff at Salmonsbury. Although there have been no formal complaints in recent months, there is a file maintained to record any suggestions, concerns plus actual complaints. Complaints are monitored by senior personnel in the Company. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 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 standard(s) 19, 25 and 26 A safe and well maintained environment provides residents with comfortable homely accommodation. EVIDENCE: The Home continues to be well maintained with carpets replaced and rooms redecorated on an ongoing basis. The ground floor corridors and dining room are about to be repainted. Salmonsbury House has taken the decision to discontinue the alcohol license; the bar area will now become a residents’ shop. Radiators are guarded and windows protected. Water temperatures are checked and recorded appropriately; they remain within safe limits. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 16 Laundry is collected, washed and stored correctly. Each person wears their own well-presented clothing. Clinical waste is segregated and collected by a specialised contractor. The whole home was clean, fresh and free of any offensive odours. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 17 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 A well-trained stable workforce enables the Home to provide a good standard of care to the residents. EVIDENCE: On the day of the inspection, there were forty residents living in the Home; one of whom was in hospital following a fall. In the morning, the Manager, two nurses (one was working in a supernumerary capacity) and 6 carers were on duty to look after the people living there; one nurse and five carers were due to be on duty in the evening; with a nurse and two carers working at Salmonsbury House overnight. Members of staff who were questioned agreed that, although they were busy at times, these numbers were adequate to give care to the residents at the home. Inspection of three personnel records showed that careful recruitment procedures are followed when employing new members of staff. All the required employment checks are undertaken before the member of staff joins the team but information about their full employment history plus the reasons for any gaps in employment is not yet obtained, as is required. Staff training continues to be addressed methodically and most appropriately at this Home. Mandatory training includes First Aid, Manual Handling, Food Hygiene and Fire Safety. Other available training is advertised internally. All newly appointed members of staff undergo induction in the Home and also attend a 3-day induction course corporately. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 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 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) 31, 35 and 38 Residents and staff at Salmonsbury House have the benefit of experienced committed management. Systems are in place to ensure that the finances and the health, safety and welfare of people using the service are safeguarded. EVIDENCE: The Registered Manager, an experienced trained nurse, has just successfully completed the Registered Managers Award. She has also attended update training to ensure that she keeps abreast of any developments in all aspects of her current role. The administrator looks after the personal monies for most of the service users. These are kept in individual envelopes and are locked away securely. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 19 All transactions are fully documented and countersigned. Checks for the selected residents showed that these are all recorded accurately. ‘Health and safety’ issues are addressed well at this home. Members of staff have access to all mandatory training and necessary maintenance of equipment is undertaken in a timely fashion. Records were provided for inspection. Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 20 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x 3 x x 3 Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? 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 2 Regulation Requirement Timescale for action By 30.9.05 2. 29 Regulation Each person must be provided 5 with a written copy of the terms and conditions for admission to the Home Schedule Each employee must provide a 2.6 full employment history plus a satisfactory explanation for any gaps in employment By 30.9.05 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 Good Practice Recommendations Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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 Salmonsbury House D51_D03_s64587_Salmonsbury_v234800_260705_Stage 4.doc Version 1.30 Page 23 - 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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