CARE HOMES FOR OLDER PEOPLE
Southfield Park Road Stroud Gloucestershire GL52 2JQ Lead Inspector
Ruth Wilcox Unannounced 25 July 2005, 09.00 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. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Southfield Address Park Road Stroud Gloucestershire GL5 2JQ 01453 764892 01453 759642 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) The Order of St John Care Trust Mrs Ceila Kidd Care Home 36 Category(ies) of OP old age (35) registration, with number LD(E) Learning disabilities - over 65 (1) of places Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 30 November 2004 Brief Description of the Service: Southfield is a purpose built care home, providing long term personal care for thirty six older people, with one room designated to provide short term respite care. The home is also accommodating one named person over the age of 65 years with a learning disability. The home is managed by The Orders of St John Care Trust, and is situated in a residential area of Stroud. Medical and nursing services are accessed for residents if needed, from community resources. The home is built on three floors with a shaft lift and chair lift accessing all areas. Residents’ private accommodation is situated on the two upper floors, and is provided by 32 single rooms and 2 double rooms. There are a number of assisted bathrooms, shower rooms and toilets situated in convenient locations around the home. On the ground floor there are two homely lounges, an activities room, and a very spacious dining room. There is a small shop situated in the corner of the dining area for residents’ convenience. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection over three and a half hours on one day in July. Residents’ care records were inspected, with the care of three residents looked at closely in particular. The arrangements for visitors, for enabling and supporting residents to exercise choice in their daily lives and to have a voice in how their home is run were inspected, as were the policies and procedures for protecting and promoting the safety of vulnerable residents. The registered manager and the administrator were present during the inspection, providing assistance where needed. Four staff were spoken to, and their access to training opportunities were looked at. Certain aspects of business management were inspected. A tour of the premises took place. Eleven residents and three visitors were spoken to directly in order to gain their views of the service and care they receive at Southfield. What the service does well:
Southfield provides a bright, clean and comfortable environment with a pleasant atmosphere for the residents living there. Residents are admitted to the home on the basis of a full and comprehensive assessment of their needs, with staff ensuring that they have easy access to all health care support once admitted. The home works positively with outside health agencies and health care professionals to benefit those living there. Residents in the home spoke very positively about the care they receive, and the manner in which it is given by staff, saying that staff are caring and respectful. Visitors too were very happy about the care their relative was receiving, and the way in which they themselves are received into the home by the helpful staff. Residents are able to pursue personal choice here, and can enjoy a good degree of independence if that is their wish.
Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 6 There are clearly written policies and procedures for the protection of vulnerable residents, and there are good training opportunities for staff working here; this includes adult protection training, with staff being able to demonstrate their awareness of such issues. The home has established a safe and transparent system to allow residents to place money or valuables in the main safe, keeping good clear records to protect the residents’ financial interests. Residents’ interests and welfare are also protected by the well-supported management structure at Southfield. What has improved since the last inspection? What they could do better:
The staff have done really well to improve the standard of care plan documentation over the past year, and in the main care plans are now well written, and are appropriate to the assessed needs of the residents. However, there continues to be certain aspects of recording that could be further improved, and a requirement has been issued following this inspection. The paintwork in the ground floor corridor is now deteriorating, with scuffed and damaged areas very visible; this should be prioritised for attention as part of the rolling programme of decoration and maintenance that is routinely undertaken in this home, so as to improve the overall appearance of this area. Also a partially completed repair to a damaged wall in the laundry room must be done to a standard that permits an easily cleanable surface in the interests of hygiene. In addition staff must be sure to strictly follow infection control procedures when dealing with certain items of laundry, also in the interests of hygiene.
Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 7 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. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.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 Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.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) 3 The home’s admission procedure ensures that all residents are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: Residents are admitted to the home on the basis of a fully documented assessment of their personal needs, which can be performed in hospital or in the person’s own home, as appropriate; a copy of the most recent preadmission assessments were adequately comprehensive. One resident confirmed that she had been seen and assessed by the home manager whilst she was in hospital. A new pre-admission assessment tool is being introduced under the new management of The Orders of St John Care Trust. Southfield does not provide intermediate care. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 10 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 & 10. There is a care planning system in place, which in the main adequately provides staff with the information they need to satisfactorily meet residents’ health and personal needs; fuller recording in some cases would further improve this. Personal support in this home is offered in such a way as to promote the residents’ privacy, dignity and independence. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of all their health and personal needs; three were selected as part of the case tracking exercise. In the main care plans are well written, and are regularly reviewed. Care plans generally contained a good basis for information, but could have been improved by more detailed recording; this included the information relating to precise continence support and mental health needs in the identified cases. There was very sensitive care planning to support privacy and dignity issues, and the fears and anxieties of one particular person. Some appropriate risk assessments had been carried out, with associated care plans. However, in one case an entry in the General Practitioner record
Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 11 indicated that the resident had suffered a fall; there was no associated falls risk assessment or care plan regarding this person’s risk of falling. Records contained clearly recorded health care interventions from external health care professionals, with clear indications that staff are working collaboratively with them to ensure that residents’ health needs can be met. Residents spoke very positively about the way in which staff assist them and care for them. One person said ‘they are excellent; they can’t do enough for me’. Others spoke of ‘being looked after very well indeed’, ‘staff respecting their independence’, and ‘the staff’s kindness and caring’. Staff were seen to be attentive and respectful during their contact with the residents. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 12 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) 13 & 14. The consideration and respect that is shown by staff towards residents ensures that residents are able to exercise control and choice in their daily lives, and can welcome their families and friends into the life of the home. EVIDENCE: Residents were spending their time how and where they chose during the morning. All said that staff are respectful to their choices, and that their families and visitors are welcome at any time. Visitors are invited to make contributions to the Southfield newsletter, and are invited to participate fully in the life of the home. Links with the community are maintained, with pastoral visits from a local church, and the local Member of Parliament visiting the residents on this day. The three visitors spoken to said that they always feel very welcome in the home, with staff being approachable, helpful and caring. One particular resident was glad to exercise her independence, managing her own affairs, receiving lots of visitors, and spending her time as she wished. There is information available in the home about advocacy, support and information services, which some may find useful. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 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 standard(s) 18. The home’s Adult Protection policies and staff’s knowledge and awareness of them helps to provide a safe environment, with the rights of residents upheld. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults, and has copies of other relevant documents and information available; a revised policy is being introduced by The Orders of St John Care Trust, though this was not seen at this time. All staff have done adult protection training either at induction, during their NVQ course or through an ‘in-house’ training session. Those members of staff spoken to were aware of the Whistleblowing procedures to follow if they had any concerns. Systems are in place to allow service users to place money with the home for safekeeping if they wish, with records kept, to which they can have access. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 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 standard(s) 19 & 26. The standard of the environment within this home is generally satisfactory providing residents with an attractive and homely place to live, despite two areas needing improvement in the laundry room. EVIDENCE: The home is generally very fresh and clean, well maintained and decorated. Since the last inspection some new curtains, chairs and carpets have been purchased. The home’s craftsman undertakes decoration work on a rolling programme, and on this occasion it was noted that the paintwork in the ground floor corridor was particularly badly scuffed and damaged, and should be prioritised for attention. The laundry room wall, which had been damaged by a leak some months ago, has still not been fully repaired. Given the permeable nature of the temporary repair, this is posing a cross infection risk in this room, and must now be more appropriately addressed. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 15 The laundry room was tidy and orderly. Washing that was in progress in one of the machines was not being washed at an appropriate temperature to disinfect the contents; the manager resolved to ensure that the contents were rewashed appropriately before being put back into use. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 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 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) 30. The arrangements for the induction and training of staff are good, with the staff able to demonstrate a clear understanding of their roles. EVIDENCE: New staff receive a structured induction training within the first six weeks of employment with additional in-house training; one new carer was able to confirm that she had been well supported by staff during her induction, and had worked in a supervised capacity. Training records show that there are regular opportunities for staff to have a range of mandatory and optional training, in order that they have the necessary skills for their work. Two staff spoke of a range of training they had undergone, which was relevant to their role. There is an evident commitment from The Orders of St John Care Trust (OSJ) since taking over the home, towards good training and development of the staff; a Training and Development policy links training to the NVQ programme. There is a designated training manager within the group of homes to which Southfield belongs. A new training matrix is to be introduced by OSJ. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 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 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) 33, 34 & 35. The systems for resident consultation are good, with evidence that their views are both sought and acted upon. Good management systems are in place to ensure that the welfare and rights of the residents are safeguarded. EVIDENCE: Satisfaction surveys have been carried out with residents and families in recent weeks, as part of the quality monitoring system; these surveys have yet to be analysed, but sought residents’ views on personal care and support, the premises, catering and management. Views and experiences about the home are also sought from residents and visitors with the availability of ‘Suggestions and Feedback’ forms. Two particular residents and three visitors all indicated their confidence in the manager and staff to address any concerns that may arise.
Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 18 The overall management of Southfield is now provided by The Orders of St John Care Trust, and evidence of robust financial and business management systems was inspected as part of the recent registration process. Some residents have placed personal money and valuables with the home for safekeeping. Thorough records for each person, which include transaction details, running totals, and receipts, are kept. Residents or their representative have signed to acknowledge some transactions, but where this has not been possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 3 3 x x x Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 20 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 7 Regulation 15(1) Requirement Staff must ensure that all elements of care planning are fully detailed, in order to clearly demonstrate how residents needs are to be met; this is with particular reference to continence and mental health needs on this occasion. Assessments to identify the residents risk of falls must be recorded, with associated plans of care to demonstrate how an identified risk is to be reduced. The repaired area of laundry wall must be completed with an easily cleanable surface to prevent cross infection. Staff must ensure that all items of foul laundry are washed at appropriate temperatures for disinfection purposes. Timescale for action 31/8/05 2. 7 13(4.c) 31/8/05 3. 19 13(3) 30/9/05 4. 26 13(3) 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Refer to Standard Good Practice Recommendations
Version 1.30 Page 21 1. 2. 19 The damaged paintwork in the ground floor corridor should be prioritised for attention in the rolling programme of decoration. Southfield D51_D03_64615_Southfield_v233635_250705_UI_stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucestr GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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