Inspection on 12/09/06 for St Albans House

This inspection was carried out on 12th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Albans House 16/01/08

St Albans House 20/02/06

St Albans House 05/01/05

St Albans House 15/07/04

St Albans House 31/03/04

St Albans House 07/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 St Albans House 59-61 St Albans Avenue Queens Park Bournemouth Dorset BH8 9EG Lead Inspector Catherine Churches Unannounced Inspection 10:00 12 and 25 September 2006 th th 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 St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Albans House Address 59-61 St Albans Avenue Queens Park Bournemouth Dorset BH8 9EG 01202 397817 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) Mr Timothy Martin Culley Mrs Sally Eileen Culley Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2006 Brief Description of the Service: St Albans house is located in a quiet residential area of Bournemouth between Queens Park and Charminster. Most local amenities are available in Charminster, approximately ¼ mile level walk from the home. The home is registered for 28 residents in the category of older people (OP) and is run by the owner/managers Mr and Mrs Culley. The care home comprises two houses linked together at ground and first floor levels. Accommodation is provided on the ground and first floor as follows: Ground floor 9 bedrooms, 6 with full ensuite, 3 with toilet and wash hand basins. First floor 17 bedrooms, 10 with full ensuite facilities, 5 with wash hand basins, 1 with toilet and wash hand basin. Residents have access to a variety of communal areas. The home has a large lounge area linking to a dining room. Along the length of the home to the rear of the property is a large conservatory overlooking the garden. The large grounds are well maintained and contain an oriental sunken garden area in addition to the large lawn area. Seating is provided outside in the summer months. Upstairs the two properties are linked via a covered sun terrace providing further communal seating. All communal areas are tastefully decorated and plants and flowers add to the domestic character of these rooms. All food is cooked on the premises and the menus offer a range of choices. St Albans offers a wide variety of activities on a regular basis including physical exercise, musical evenings, card and board games, reminiscence therapy and regular interdenominational church services. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key, unannounced inspection undertaken 12th September 2006 with feedback given to Mr and Mrs Culley on 25th September 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection was February 2006. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and compliance with requirements and recommendations made during the previous inspection. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent observing routines within the home and talking with residents, visitors and staff. Prior to the inspection survey/comment cards were sent out to residents, relatives, GP’s, healthcare professionals and care managers. Seventeen responses were received from residents, 17 from relatives, four from GP’s and 3 from healthcare professionals such as District Nurses. Analysis showed a very high level of satisfaction with all aspects of the home from care, to staffing and food. The residents in particular are an able and vocal group who have scored the home highly and were clearly appreciative of the support and care they receive. What the service does well: St Albans House provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is well presented and has nicely maintained gardens. The home consistently maintains good standards of care, activity, food and accommodation. Most areas inspected on this occasion were found to be satisfactory. The home is positively managed and well staffed. The staff group is stable and were observed to be respectful, helpful and caring. All residents spoken with were positive about the care and attention that they receive. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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 St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents needs are satisfactory. This means that residents can be certain that the home is aware of most of their requirements prior to their admission to the home and that the staff will therefore be able and prepared to meet these needs. EVIDENCE: Documentation for three residents was examined as part of the case tracking procedure used during this inspection. Two of these residents had been newly admitted to the home since the last inspection. Both pre-admission assessments were viewed. They had been undertaken by Mrs Culley and included a visit to the prospective resident. Documents included the information specified in the National Minimum Standards. It was noted that a letter confirming, that following assessment, the home can meet their needs and evidence that the Statement of Purpose, Service Users Guide etc had been given to the resident, was not always available. This was a requirement at the last inspection and must now be acted upon. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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, 9 & 10 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. Systems for care planning and resident consultation are in place but could be reviewed and improved to provide more effective information and therefore further enhance evidence that the home meets the needs of residents. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. Residents’ medication at this home is well managed, therefore promoting good health. Minor issues regarding recording of medication require improvement to further safeguard resident’s safety. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled and at home and their privacy is respected. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 10 EVIDENCE: Care Plans and related documentation regarding care for 3 residents were examined. After careful analysis and discussion, it was found that the required information was available. Evidence was available on file and through discussion that GP’s, district nurses, specialist nurses and other health professionals are called upon whenever the need arises. Medicines in the medication cupboard were examined together with administration records. It was noted that only one signature was present for medicines added to the MAR (Medicine Administration Record) by hand and that not all homely remedies were recorded. All staff that administer medication have received training. The home has a policy for the promotion of privacy and dignity. During the inspection residents confirmed (where they were able to) that they were happy with the care they received and that either they or their representatives are involved in reviews. Recently completed survey cards also confirmed that residents feel respected by staff and are able to maintain their privacy when receiving personal care or visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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 and 15 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. St Albans House provides a caring, homely and relaxed environment. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and needs. EVIDENCE: The owners and staff in the home clearly understand the importance of activity and fulfilment. To this end there are frequent trips out in small groups or on a one to one basis, various parties and visiting entertainers. Residents are also encouraged to continue any interests that they followed prior to moving to the home. One person still takes great pleasure in laying the dinning tables for lunch, a hairdresser visits regularly and there are also organised board games, puzzle and manicure sessions. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 12 Question 7 of the resident’s questionnaire sent out prior to the inspection asked: “Are there activities arranged by the home that you can take part in?” 4 people responded “Always” 8 people responded “Usually” 5 people responded “sometimes” 0 people responded “never” The visitor’s book showed that there is a constant stream of visitors to the home and discussions with staff confirmed this as well as the fact that many residents are taken out by visitors. During the course of the inspection visitors were observed in the home. They were made welcome by staff and clearly had a good relationship with the staff. Discussion with residents and staff as well as examination of records and observation during the inspection evidenced that residents are assisted appropriately to exercise choice and control over their lives. Relatives and staff confirmed that, in their opinion, a suitable and varied diet is provided in the home. Foods records were examined and confirmed this to be the case. Residents said they enjoyed their food. One person commented “the food is first class”, the staff had comprehensive lists of likes and dislikes and a wide range of meals are prepared to suit all tastes and appetites. Question 8 of the resident’s questionnaire sent out prior to the inspection asked “Do you like the meals at the home?” 9 people responded “Always” 8 people responded “Usually” 0 people responded “sometimes” 0 people responded “never” St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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 and 18 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. St Albans House has a satisfactory policy and procedure for the making of complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be listened to and matters of concern will be acted upon. Arrangements for protecting service users from abuse were satisfactory. This means that St Albans House is a safe environment that will protect residents from abuse. EVIDENCE: St Albans House has a satisfactory complaints procedure that is included in the Service Users Guide and residents contract. Question 9 of the resident’s questionnaire sent out prior to the inspection asked “Do you know who to speak to if you are not happy?” 13 people responded “Always” 3 people responded “Usually” 1 person responded “sometimes” 1 was left blank St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 14 Question 10 of the resident’s questionnaire sent out prior to the inspection asked “Do you know how to make a complaint?” 9 people responded “Always” 7 people responded “Usually” 1 was left blank Policies and procedures for adult protection and whistle blowing were checked and found to be satisfactory. The CSCI address and telephone number have been added to these documents as a result of a recommendation made in the last report. Staff have all had copies of the homes policy and procedure for recognising and preventing abuse but have had no formal training. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26 Quality in this outcome area is judged as adequate. This judgement has been made using available evidence including a visit to this service. The home is nicely presented. Residents live in a well-maintained environment with their own possessions around them. The home is clean, hygienic and free from offensive odours. Lack of a hoist means that, in some circumstances, the home is not able to maximise resident’s independence and may put residents and staff at risk through poor moving and handling practices. EVIDENCE: A tour of the premises confirmed that the home is nicely decorated and furnished. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements. St Albans House is well maintained with good access to communal areas. It is light and airy and furnished and decorated to a good standard. The atmosphere is homely and relaxed. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 16 During discussions it became evident that the home did not have a hoist to assist any residents who become bed bound or fall on the floor and are unable to get up. Staff had a good understanding of infection control procedures and the relevant protective clothing was available. There was a detailed infection control policy in the home that covered all of the required areas and staff confirmed that they had received training in this area. Training records were also available to support this. Question 11 of the resident’s questionnaire sent out prior to the inspection asked “Is the home clean and fresh?” 14 people responded “Always” 3 people responded “Usually” St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 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 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, 28 and 30 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. The home was well staffed ensuring that residents receive the care and attention they need in an unrushed manner. The staff team remains stable; this provides a good level of consistency and continuity for residents. Staff have not yet received the required NVQ training but do have extensive experience. Residents should feel assured that they are in safe hands; training will provide further support and knowledge for staff. The home has introduced training programmes to ensure that staff have the necessary skills to enable them to undertake all aspects of their role competently. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the needs of residents. Responses from comment cards confirmed that sufficient numbers of staff are on duty and provide a good standard of care. Mrs Culley reported that the staff employed in the home have been in post for many years and therefore have a great deal of experience. They are all unwilling to undertake NVQ training so the home is unable to meet this St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 18 standard. They are willing to undertake various short courses and Mrs Culley has developed a detailed training programme of short courses to try to go some way to ensuring that staff receive up-to-date training and a number of staff have attended courses since the last inspection. Procedures are in place to ensure appropriate recruitment but no new staff have been employed since the last inspection. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35 and 38 Quality in this outcome area is judged as good. This judgement has been made using available evidence including a visit to this service. Mr and Mrs Culley have owned and managed St Albans House since 1980 – they therefore have extensive experience of managing the home and caring for the elderly. The management arrangements for the home support good care practice for the residents. Quality monitoring systems need to be better defined and coordinated in order to demonstrate that the home is run in the best interests of the residents. Sound practices and procedures are in place regarding residents’ finances. The health, safety and welfare of residents and staff is protected by the systems that the home has in place for staff training, maintenance and risk assessment. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Culley is a qualified RGN and has extensive experience of caring for the elderly. The home has a brief policy regarding quality assurance. This lacked in detail, self-monitoring surveys were out of date and there was no analysis of previous responses or annual development plan. Mrs Culley confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. No cash or valuables are held in the home for residents. Fire records, staff training records and accident books were examined and found to be up to date and detailed. St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 21 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 1 X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 St Albans House DS0000003982.V312000.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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. Standard Regulation Requirement The registered person must confirm in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the residents needs in respect of his/her health and welfare. 25/9/06 This requirement is made for the second time. The registered person must operate a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. Evidence of a new employees identification must be held on file, 2 written references and a Criminal Records Bureau/POVA check must be obtained prior to an employee commencing duties or being confirmed in post. 25/9/06 This requirement is carried over as no new staff have been employed so it is not possible to test whether safe recruitment practices are operated although systems in place indicate that this would now be the case. DS0000003982.V312000.R01.S.doc Timescale for action 1. OP3 14 30/11/06 2. OP29 19 30/11/06 St Albans House Version 5.2 Page 23 3. OP30 12 & 18 4. OP22 23(2) and 13(5) It is a requirement that All staff must receive induction training to NTO specification within the required timescales. 25/9/06 This requirement is carried over as no new staff have been employed so it is not possible to test whether safe recruitment practices are operated although systems in place indicate that this would now be the case. The registered person must ensure that suitable equipment, such as a hoist, is provided which is capable of meeting the needs of the service users. 30/11/06 30/11/06 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 OP7 Good Practice Recommendations It is recommended that systems for care planning and resident consultation are reviewed and amended so as to provide greater compliance with the National Minimum Standards. Any changes to prescription details or new prescriptions that are hand written on to medication administration records should be checked and counter signed by a second member of staff. All homely remedies must be recorded. It is recommended that staff undertake training in preventing and recognising abuse and the actions they should take should they suspect abuse. A plan must be developed and implemented to ensure that 50 of care staff are trained to a minimum of NVQ level 2 in care Further work must be undertaken with regard to quality assurance systems in the home, by means of surveys, analysis and annual development plans, in order to demonstrate that the home is meeting its aims and objectives and statement of purpose DS0000003982.V312000.R01.S.doc Version 5.2 Page 24 1. 2 OP9 3 4 OP18 OP28 5 OP33 St Albans House Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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