Inspection on 12/10/06 for St Andrews Care Home

This inspection was carried out on 12th October 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 Andrews Care Home 29/06/07

St Andrews Care Home 15/11/05

St Andrews Care Home 03/05/05

St Andrews Care Home 22/11/04

St Andrews Care Home 17/08/04

St Andrews Care Home 16/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE St Andrews Care Home Great North Road Welwyn Garden City Hertfordshire AL8 7SR Lead Inspector Marian Byrne Unannounced Inspection 12th October 2006 11:00 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 St Andrews Care Home DS0000019533.V309844.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 Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews Care Home Address Great North Road Welwyn Garden City Hertfordshire AL8 7SR 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) 01707 324208 01707 324248 Colley Care Limited (Trading as B & M Care) Carol Georgina Stevenson Care Home 70 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (31) of places St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: St. Andrews is a care home for 70 older people, 39 of whom may also have a dementia. The building has three floors and a passenger lift. The bedrooms are all single occupancy and have en-suite facilities. There is ample parking to the front of the home and extensive landscaped gardens with courtyards and well maintained flowerbeds. St. Andrews is located in a semi-rural area, between the villages of Digswell and Lemsford. It is near the A1M road and a short drive from Welwyn Garden City, with its wide range of shops and facilities. There is limited public transport nearby but the home has its own vehicle for the benefit of the residents. The fees of the home range from £600 to £650. St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over one day. All areas of the home were visited but the majority of the inspection was carried out with the most vulnerable service users - those who have dementia. The Registered Manager was present for the majority of the inspection. Staff were welcoming and open. Lunch was taken with service users. All key standards were inspected. What the service does well: What has improved since the last inspection? What they could do better: A requirement has been made at this and the previous inspection that a review of staff numbers takes place. This should include the views of care staff and should check the numbers of staff on duty at peak times in the home. The use of wedges or small pieces of furniture to prop doors open must cease and it St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 6 could put the lives of the service users at risk should there be a fire. Small areas of the home are showing signs of wear and tear this must be addressed. 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 Andrews Care Home DS0000019533.V309844.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 Andrews Care Home DS0000019533.V309844.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 All service users who are admitted to the home have a thorough assessment. Quality in this outcome is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Four records were inspected and contained good information on the needs, wishes and aspirations of the service users. Service users are reviewed after six weeks giving informed choice to the service users on whether they wish to stay at St. Andrews. St Andrews Care Home DS0000019533.V309844.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. Service users have care plans that reflect their needs, wishes and choices. Their health care needs are met. Medication is stored and administered appropriately. Service users are treated with respect and dignity. Quality in this outcome is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were inspected at this inspection. They contained all the appropriate information staff need to understand to provide care to meet the service users health and welfare. The plans were reviewed and updated they contained risk assessments, full details of individual needs and how falls are to be monitored. Where possible service users have been involved in their care planning. Records showed that residents’ health needs are regularly monitored and that regular input is provided from Health professionals. Medicines were stored and administered appropriately. The privacy and dignity of service users was preserved at all times during the inspection. Staff were observed to St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 10 interact well with service users and were proactive in ensuring that the needs and comforts were being met. The inspector spent a high proportion of the inspection in the area of the home where people who have dementia were being cared. Here staff were engaged with service users and were proactive in ensuring the service users were usefully occupied. Care was observed to be given with compassion and feeling. With the exception of one incident where a member of staff took away a drink from a service user who had a chest cough however, the drink was soon replaced by another member of staff, the care was good. St Andrews Care Home DS0000019533.V309844.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): 12,13,14,15. Service users have their life choices met where possible. There is a constant contact with the outside community. The diet is good. Service users are assisted to exercise control and choice in their life. Quality in this outcome is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home had a constant stream of visitors. Service users were usefully engaged in meaningful activities. The dining room in the area of the home that cares for the most vulnerable service users was very busy with staff and service users engaged in making posters for a forthcoming ‘Africa’ night. Other service users were sitting quietly with staff talking and reading the newspaper. The service users appeared to be happy and the interaction between staff and them was good. The inspector took lunch with the service users the food was served at an appropriate temperature and was tasty and of good appearance. Service users were assisted to eat with care and dignity. Staff were aware of service users tastes and assisted them to choose lunch. The dining room was very noisy at lunch time, making conversation very difficult. The home does not handle service users monies. St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 12 St Andrews Care Home DS0000019533.V309844.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): 16,18. The home deals with issues as soon as they arise. It has a complaints policy. The service users are protected from abuse. Quality in this outcome is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaint in process at the time of the inspection it was being handled appropriately by the home. The home has not had any other complaints since the last inspection. Issues are usually dealt with and resolved as soon as they are raised. Staff spoken with, were aware of Adult Protection issues and who to approach if they had any worries about the welfare of the service users in the home. St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 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): 19,26. The home was safe and well maintained. Small areas of the home’s carpets must to be cleaned or replaced. Small areas of the home were not suited to purpose. Quality in this outcome is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home was clean, fresh and odour free. The carpet in one area of the home was stained and dirty in the sitting room where the most vulnerable service users are cared for. Door wedges were in use on the day of the inspection. The use of door wedges could compromise the welfare of the service users in the event of a fire. The kitchen in the same unit is very small and cramped. When the food trolley is in the kitchen there is not sufficient room to plug it in and serve food safely. Food was hot on the day of the inspection however this must be rectified, as the staff cannot control the temperature of the food served. The dining room was very noisy and a noise St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 15 assessment should be conducted around the serving of lunch. Individual rooms were personalised to reflect the personality of the service users who live there. Other communal areas were comfortably furnished and had newspapers, magazines and books available for service users. St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 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 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): Staff were trained to carry out their duties to service users. The home has a robust recruitment practice. The numbers of staff on duty in some parts of the home may not be adequate. Quality in this outcome is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: All staffing files inspected contained the appropriate information on staff including two references and a Criminal Records Bureau check. Staff spoken with were able to inform the inspector about their recent training and the impact it had on improving their practices on delivering care to service users who are suffering from dementia. Currently 75 of the care workers in the home are trained to NVQ level 2 or above. One area of the home has 14 service users who are in the early stages of dementia the staffing ratio in that part of the home is 2 staff members to 14 service users. The Registered Manager must review this ratio to ensure optimum care for service users at all times including staff breaks and lunch times St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38. The home is well managed and run in the best interests of the service users. The health and safety of service users could be compromised through the use of door wedges. Quality in this outcome is adeuate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed and run to in the best interests of service users who live in the home. Formal staff supervision is taking place and the Manager said she is working towards this happening every three months for care staff. There is a Quality Control system in operation in the home and questionnaires are sent to service users and relatives at regular intervals. The Manager monitors the responses to these questionnaires and links findings to future planning for the home. The use of wedges to prop doors open in the home must cease. The St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 18 home has appropriate insurance cover in place. There is no cash held at the home for service users. Almost all residents have families who manage their finances and provide them with money, and families are invoiced for any money paid out by the home. Records examined were well maintained and appropriately stored. Fire records were checked and were in order, with equipment checks and fire drills up to date. No hazardous substances were left out on the day and domestic staff spoken to had received health and safety training and were aware of risk assessments for the cleaning products they were using in the home St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 20 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. 1. Standard OP27 Regulation 18(1)(a) Requirement The Registered Provider must review care staff numbers in the home to ensure that adequate numbers of staff are on duty at all times. This standard has been brought forward from the last inspection 2 3 OP26 OP38 23 (2) 16 The Registered Manger must ensure that all floor covering in the home is free from stains. The Registered Provider must ensure that food can be served at an appropriate temperature and that that temperature can be maintained and measured. The Registered Manager must ensure that doors are not propped open. 31/10/06 12/10/06 Timescale for action 15/11/06 4 OP38 23 (4) 12/10/06 St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 21 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 OP15 Good Practice Recommendations The Registered Manager should conduct a noise assessment in the dining rooms over lunch to identify and if possible eliminate unnecessary noise. St Andrews Care Home DS0000019533.V309844.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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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