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Inspection on 15/11/05 for St Andrews Care Home

Also see our care home review for St Andrews Care Home for more information

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Without exception the residents spoken to said they were happy living in the home and praised the staff and Manager. There was a relaxed atmosphere evident during the visit and there appeared to be good relations between care staff and service users in all areas. Some residents were looking forward to going out to lunch that day, and said that everyone gets the chance to go out in small groups on a rota basis. The Manager and staff have been working with Health Professionals on a project to reduce the numbers of elderly people being admitted to hospital from care homes and on the prevention of falls in care homes. New initiatives have been adopted in the home to the benefit of the residents.

What has improved since the last inspection?

All hazardous substances are kept locked away in the home to prevent accidents and staff were aware of this policy. Staff training has continued and 75% of care staff are now trained to NVQ level 2 or above.

What the care home could do better:

A requirement has been made 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. Levels of activities in the home are good but are also being reviewed and, as care staff are also involved with this provision, an increase in activities may also mean more care staff are needed.

CARE HOMES FOR OLDER PEOPLE St Andrews Care Home Great North Road Welwyn Garden City Hertfordshire AL8 7SR Lead Inspector Pat House Unannounced Inspection 15th November 2005 10:15 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.V260475.R01.S.doc Version 5.0 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.V260475.R01.S.doc Version 5.0 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.V260475.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 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. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day with two inspectors. The Manager was present during the visit. Service users and care staff were spoken to and all parts of the home were visited. A selection of records were checked and the mid-day meal was seen. In some cases, where a standard was assessed and met at the last inspection, it has not been reexamined here, although evidence that good practices were continuing would have been noted during the visit. What the service does well: 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 Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 6 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.V260475.R01.S.doc Version 5.0 Page 7 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. Standard 6 does not apply to this home. All prospective service users are able to visit the home before taking up a permanent place to ensure the home is appropriate. All residents are given a written contract so that the conditions of residency are clear. EVIDENCE: Standards 1, 3 and 4 were fully assessed and met at the last inspection. All prospective residents are able to visit the home at any time prior to taking up a permanent place, although it is mainly relatives who make these visits. All residents in the home are given, and sign a contract, which sets out all appropriate details including which room is to be occupied. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 8 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 and 11. Standard 10 was assessed and met at the last inspection. The health care of service users is monitored and promoted by staff in the home and details are set out in care plans. The home’s policies and procedures ensure that medication is handled appropriately and that service users and their families are supported and receive the best care possible at times of illness and death. EVIDENCE: Care plans have been reviewed and updated throughout the home and contain risk assessments, full details of individual needs and how falls are to be monitored. Staff in the home are continuing to update the plans of service users with dementia and are working to make these plans link with daily care and recording. 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. Staff at the home have been working with a local team of nurses on an initiative, which aims to prevent the need for hospital admission for elderly residents of care homes. The manager had implemented more records to monitor individual fluid intake and this links in to the programme of falls prevention taking place. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 9 District nurses continue to make routine calls to service users in the home and the doctor has weekly clinics at the home. Medication administration was checked on one unit in the home and no errors were found in the storage or recording. The home has a written policy for medication administration and staff were aware of this. However the policy on homely medication needed some amendments, which the Manager said would now be completed and this will be added to the main policy. Staff were also reminded that, where written instructions are included on medication records, two staff members should sign these details to ensure accuracy. The home has policies covering Death and Dying and staff said that all possible care and support were given to service users and their families at such times. Family members are able to spend days and nights with their relative in the home if they wish and the condition of service users who are ill is closely monitored by staff at all times. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 10 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): These standards were not assessed on this occasion. EVIDENCE: All four standards were fully assessed and met at the previous inspection. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 11 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): These standards were not assessed on this occasion. EVIDENCE: These standards were fully assessed and met at the previous inspection. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 12 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): 19,20,21,22,23,24,25 and 26. Service users live in comfortable, well maintained surroundings and are provided with appropriate equipment and facilities, which help to meet their needs and promote their independence. EVIDENCE: The home was generally clean and well presented and there were no unpleasant odours in any of the areas visited. Bedrooms were bright and well furnished and most had been personalised with the residents’ own fittings and some furniture. In the dementia units, bedroom doors had the residents’ photos displayed, to enable service users to identify their own room. Bathrooms were clean and contained liquid soap and paper towels to promote good hygiene. There is adequate communal space in the home and the residents on each unit have their own lounge areas and dining rooms. These areas are well furnished. There are also sufficient assisted bathrooms and toilets to meet the needs of service users in the home and there are grab rails in appropriate places around the building. All bedrooms are for single occupancy and provide adequate space for service users. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 13 The home was comfortably warm during the visit and hot water was being delivered at safe temperatures. The home has a sluice room with a sink, which is separate from the laundry. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 14 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 28. Standards 29 and 30 were fully assessed and met previously. Staff training enables care workers in the home to provide professional standards of care for the residents’ benefit. Staffing levels and staff distribution in the home should be reassessed to ensure all care needs can be met in an appropriate way. EVIDENCE: At the last inspection there were 13 care staff on duty as well as the Manager and deputy, and there were 12 care staff working on this occasion. There are 6 care staff on duty at night. Staff and service users who were spoken to, felt staff numbers were usually adequate in general, but felt that there were times when care staff were “rushed”. In particular, there seemed to be inadequate staff numbers on the “Higher Needs Unit” during the visit, where staff were still making beds at 11 a.m. Care staff here thought another care worker was needed at peak times. The Manager has been monitoring the accident records for the home and there appear to be a large proportion of falls occurring in the early morning and late evening. This may also indicate that a review of staff numbers is needed for these times of the day. There has been on-going training provided for care staff. Currently 75 of the care workers in the home are trained to NVQ level 2 or above. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 15 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): 31,32,33,34,35,36,37 and 38. Service users live in a well managed home where policies and procedures help to protect their interests and where staff practices promote their welfare. EVIDENCE: Staff and service users spoken to praised the management in the home and said that they felt their views were listened to and acted on and that the Manager kept them informed of changes to the running of the home. Staff said they have meetings, which are minuted and there are usually two residents meetings each year. 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 home has appropriate insurance cover in place. There is no cash held at the home for service users. St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 16 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.V260475.R01.S.doc Version 5.0 Page 17 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 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 18 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. 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. Timescale for action 16/01/06 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 Good Practice Recommendations St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 19 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. Extracts may not be used or reproduced without the express permission of CSCI St Andrews Care Home DS0000019533.V260475.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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