Inspection on 08/03/06 for Salmonsbury House

This inspection was carried out on 8th March 2006.

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.

Other inspections for this house

Salmonsbury House 21/06/07

Salmonsbury House 23/08/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Salmonsbury House Station Road Bourton-on-the-water Cheltenham Glos GL54 2BQ Lead Inspector Ms Eleanor Fox Unannounced Inspection 8th March 2006 10:00 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 Salmonsbury House DS0000064587.V276669.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. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Salmonsbury House Address Station Road Bourton-on-the-water Cheltenham Glos GL54 2BQ 01451 820821 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) The Orders of St John Care Trust Mrs Beryl Ann Ratcliffe Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2005 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 residents 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. The vacant rooms on the first floor, previously utilised as offices, now provide staff accommodation. The residents have the benefit of large comfortable communal areas and attractive private gardens that may be enjoyed during the summer months. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of four hours. During the day she talked to six of the residents, read their care records, visited their bedrooms and observed their interaction with members of staff. One person had been admitted to the Home very recently and was able to discuss her initial positive impressions about the Home. The inspector also observed the service of the mid-day meal. The inspector spoke with seven visitors and various members of staff, and looked at a selection of recruitment records and other documents, which were available in the home on that day. Comments and views of some of the people who met the inspector have been reflected in this report. Finally, the inspector talked to the Manager and to her Deputy, both of whom were on duty during the day and who were most cooperative in providing information as requested. What the service does well: Clearly detailed care plans are developed for each resident, ensuring that members of care staff are made aware of the residents’ care needs. A very good standard and variety of food is served at the Home; all the residents who were questioned were most complimentary about the meals they receive. Robust management policies and processes are implemented, ensuring that the residents live in a secure and stable environment. There continues to be a warm and welcoming atmosphere at this Home with staff appearing to work well as a team. One visitor was most impressed by the friendly reception he had received. Residents also spoke positively about “the wonderful staff” at Salmonsbury House. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 6 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. Salmonsbury House DS0000064587.V276669.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 Salmonsbury House DS0000064587.V276669.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): 2 and 5 The provision of comprehensive information and the invitation to visit the Home, enables prospective residents and their families to make an informed decision about any proposed admission. EVIDENCE: Observation of signed documentation in residents’ personal files showed that each person is provided with a copy of the terms and conditions for admission to the Home; clearly written information is supplied to each person. The relative of one person who had recently been admitted to Salmonsbury House confirmed that she had been given the opportunity to visit the Home, meet the staff and see all the available facilities prior to her Mother’s transfer. Both she and the resident herself said that she was already settling into the new environment and both were hopeful that this person would be happy at the Home. Salmonsbury House DS0000064587.V276669.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 and 9 The care planning systems in place provide the staff with the information they need to care for all the residents’ needs. Medication systems require some minor improvements to ensure that residents are not put at any risk of potential errors. EVIDENCE: On this occasion care records relating to four of the residents were selected as part of a case tracking exercise. In each example detailed care plans based on an assessment of care needs had been developed to guide the staff in the care required. These were reviewed and updated appropriately. As an additional review, meetings are arranged to include the resident, key worker, relative (if appropriate), manager and social worker to ensure that the resident is receiving optimum care. Records of these meetings are maintained on file. All medications are stored securely. On the whole, drug administration is addressed correctly although there were occasions when handwritten entries on the documentation had not been signed and countersigned by a witness, posing a potential risk to the residents. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 10 In another example, it was unclear when Diazepam 2mg should be administered. Care plans must be developed to provide guidance for staff when drugs are prescribed, “As required”. Some directions had been written in abbreviated Latin text. Any directions to staff should be written clearly in English on the medication sheets. Photographs had been provided for each person to assist identification. A revised medication policy has just been introduced; the nurses had signed to confirm that they were aware of the contents. Salmonsbury House DS0000064587.V276669.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): 14 and 15 The Home’s positive approach to residents being able to make choices and carrying out their personal preferences is reflected in the behaviour of the residents and the attitude of the staff. A good choice and variety of meals ensures residents receive a nutritious and balanced diet. EVIDENCE: Residents are assisted to make choices in their daily lives and to be as independent as possible. Advice on how to source advocacy support is also readily available to anyone requiring this service. Residents are free to personalise their rooms with pictures, small items of furniture and treasured possessions. During conversation, one lady commented that she regarded Salmonsbury House as her home and the residents as her extended family. Another resident was observed assisting a member of staff to serve hot drinks in the Home. She was evidently enjoying the task. The majority of residents ate their mid-day meal in the attractive dining room. This area has recently been redecorated and the provision of replacement furniture is now planned. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 12 The residents were given the opportunity to eat their food in a peaceful unhurried fashion. There is a choice of two main dishes each day but other alternatives are also available. Some people required their meals to be served in liquidised format. These were also served in a fashion to ensure that they still appeared appetising. Those residents who required assistance were helped in a sensitive and friendly manner; a carer gently encouraged one person to consume her food. Observation of the menus showed that the residents receive a varied choice of food. Cooked breakfasts are provided, if desired. One person said, ”You get wonderful food here” and another who was unable to communicate verbally “beamed” his enjoyment of the meal he was eating. The kitchen was clean and well organised. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 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): 18 The employees’ knowledge and understanding of the Home’s Adult Protection procedures helps to provide a safe environment for the residents. EVIDENCE: The Home has documented policies and procedures addressing all areas of abuse. Each person has been provided with his or her own copy of the policies. Staff have also watched a video on the subject. Members of staff receive formal training on these topics and will be attending a seminar on the subject during April. Members of staff are informed formally that they may not benefit from a resident’s will or accept any gifts. Employees provide signed confirmation that they are aware of this policy. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 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 The residents are provided with a good standard of homely accommodation EVIDENCE: A tour of Salmonsbury House showed that the Home is maintained and decorated to a good standard. The handyman is responsible for undertaking an ongoing programme of redecoration; the communal areas are now being redecorated and in some cases, refurbished. A new assisted bath was due to be installed on the day following the inspection. A replacement call bell system will also be provided shortly. One resident spoke positively about the new pictures in the dining room. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 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): 27 and 29 Residents receive care from a stable competent workforce; the recruitment practices that are followed help to ensure residents are fully protected. EVIDENCE: On this occasion there were forty residents accommodated at the Home, many of whom have high dependency needs. Observation of the duty rota sheets showed that there were was normally a trained nurse with seven carers on duty each morning; a nurse and five carers each evening and a nurse with two carers overnight. Members of staff who were questioned agreed that they were normally able to ‘manage’ although it was sometimes very busy at the Home. The records relating to members of staff employed since August 2005 were read in detail. In both examples, full recruitment procedures had been followed. The prospective employee had completed an application form and medical questionnaire and had attended a formal interview. Records are maintained of the processes. Two written references are obtained and enhanced Criminal Record Bureau screening is completed. Employees are fully inducted to their new roles. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 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 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): 33 and 37 There is a thorough programme of self-review and consultations in place at the Home; some additional details are required to ensure that residents gain full benefit from these processes. Robust management policies and procedures are followed, ensuring that the residents’ rights are protected. EVIDENCE: The Home continues to have a good focus on quality improvement. Any complaints, accidents or adverse incidents, and satisfaction with the provision of food are all monitored closely. The Home has also just been successfully assessed in an external quality audit. A family satisfaction survey has recently been conducted by the Orders of St John Care Trust. The Manager has received a generalised feedback on the results but is not yet aware of any specific details about her Home. Once these have been identified, a quality improvement report will be generated. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 17 All the records seen on this occasion were maintained correctly and stored securely. Residents do have access to their records if they wish. Photographs are provided for each resident. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 18 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 3 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x 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 x x 2 x x x 3 x Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 19 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 2 3 Standard OP9 OP9 OP33 Regulation 13(2) 13(2), 15(1) 24(2) Requirement All handwritten entries in the medication administration sheets must be signed. Care plans must be prepared to guide staff when medications are prescribed, “As Required” A Quality Improvement Report must be provided for the Home Timescale for action 30/04/06 30/04/06 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. 1 Refer to Standard OP9 Good Practice Recommendations Medication administration instructions should be written in clear English. Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 20 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 Salmonsbury House DS0000064587.V276669.R01.S.doc Version 5.1 Page 21 - 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. 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