Inspection on 29/06/07 for St Andrews Care Home

This inspection was carried out on 29th June 2007.

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

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

Other inspections for this house

St Andrews Care Home 12/10/06

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 Key Unannounced Inspection 29th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Andrews Care Home DS0000019533.V344268.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.V344268.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 www.bmcare.co.uk 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.V344268.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 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 A1(M) 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.V344268.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 over one day by one inspector. The inspector spent two hours with the most vulnerable service users in the area where people who have dementia are cared for. During this observation the inspector was be observing where the service users get their comfort, identity, attachment, occupation and their inclusion from. Notes were taken every five minutes to determine the service users’ mood, how they were engaged with staff, each other and their surroundings and how staff interact with them. This will be explained fully later on in the report. The inspector spoke with service users and staff. The Registered Manager was not present during the inspection. An Annual Quality Assurance Assessment was returned by the Registered Manager of the home prior to the inspection. What the service does well: What has improved since the last inspection? What they could do better: The care of those service users who have dementia must improve. The staffing ratio should therefore be reviewed, as the outcomes for the most vulnerable service users are not good. For example, there are four staff to care for 25 service users in the higher dependency unit and two staff to care for 12 service users in the part of the home where service users are less dependent. The inspector observed the staff struggle to meet the needs of very dependant service users. During the two-hour period of the observation staff were unable St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 6 to recognise the needs of the service users. At one point there were three staff members in the sitting area and two of these staff members were chatting to each other regarding family matters while some service users were ignored. When the inspector arrived at the home the door was open and there was nobody in reception. The inspector entered the home and went on to the unit that had the most vulnerable service users and was in the home for 10 minutes without any staff member being aware. This action was taken to highlight the potential insecurity of this building. Care plans did not contain sufficient information. The home is aware of this and new care plans have been designed. These new care plans are set out to contain good detail on the service users. The home has a room full of ‘activities aids’ but this room was locked on the day of the inspection. The weighing scales have been broken for two months; therefore it is not possible to monitor the weight of service users. Snacks are not available to service user when they want them. The Registered Manager must improve her knowledge of service delivery to service user who have dementia to be in a position to judge the quality of care delivered. Snacks must be freely available to service users. The home has routines in place which places the onus on very vulnerable service users to fit into rather than having a flexible needs led routine. 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. The summary of this inspection report can be made available in other formats on request. St Andrews Care Home DS0000019533.V344268.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.V344268.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All potential service users have their needs assessed prior to being offered a place, thus ensuring that their stay at St Andrews will be a positive experience. EVIDENCE: Four records were inspected and contained good information on the needs, wishes and aspirations of the service users. Service users’ care plans 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.V344268.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans lack sufficient detail on how to recognise and meet the needs of the service users. Medication was in order. Some service users were treated with respect, but the more vulnerable service users were not. EVIDENCE: Staff stayed in the sitting room with the service users and the inspector during the observation. Two of the staff on duty had had training in the care of service users who have dementia. After a burst of activity and chatting the staff did not maintain the interaction and started to talk among themselves about their families. Music was chosen by staff referring to the service users as ‘they’, (as in ‘they would like this’). The inspector observed five of the most vulnerable service users for a period of two hours to try to ascertain where the service users got their comfort from. The staff were warm and appeared to care for the service users but their interaction was mostly with the service users who were able to respond to the interaction. One service users was watching television the sound was turned down without the staff checking with St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 10 her or anybody else to see if they were watching. In the two hour period there was one episode of good staff interaction. Mostly there was no interaction with the five service users being observed or when there was interaction it was neutral. An example of this was a service user who appeared to want to walk; staff tried to get her to sit down. Staff did not show the expertise needed to care for people who have dementia. They appeared to care very much for the service users and staff were seen to be kind and compassionate but they did not have the skills and training to meet the needs of service users who are unable to express their needs. Service users were observed to withdraw into themselves when they were not attended too. Other area of the home where staff and service users could communicate easily with each other good interaction was observed. All staff observed were seen to be kind and caring. The home has several service users with complex needs. One service user has one to one care, as he is prone to aggression. His mental health needs must be re-assessed to determine if he is in the best home to meet his needs. On the day of the inspection the home was deciding if they could continue to meet the very complex needs of yet another service user. Every effort was being made to ensure they came to the most appropriate conclusion. Decisions were being made in partnership with social services professionals. It was clear that the home were not making this decision lightly. While it is understood that all the needs of service users may not be apparent on admission the assessment of service users must be continual and if needs are not being met these must be addressed. Medication was stored and administered appropriately. All service users have access to a local general practitioner. The home is aware that the care plans do not contain sufficient information. They are about to introduce a new one, which if used to its full capacity will be very good. They are very detailed and will take a great deal of work to get them up to date and in use. This could mean that staff are taken off caring duties to complete them. The home must ensure that the care of service does not get compromised to complete these care plans. St Andrews Care Home DS0000019533.V344268.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not meet the daily needs of all service users thus exacerbating the debiliting effect of dementia for some. EVIDENCE: Daily life as detailed on previous standards is very lacking in useful occupation and offering comfort to the vulnerable service users. The home has a room full of articles that could assist staff in occupying and entertaining service users but the room was locked. When the inspector mentioned this to staff and manager, the response was that is was available for staff to use. Staff did not feel that this was the case and felt under pressure to ensure that the resource was not damaged and therefore did not use it to the determent of the service users. The management of the home must resolve this issue. There was a constant stream of visitors to the home on the day of the inspection. The inspector witnessed them being welcomed into the home and they were given an opportunity to speak to staff should they need to. Service users who have dementia have to adhere to the routine of three meals a day and there were no snacks available to them. There is lack of understanding of the nutritional needs of service users who have a dementia. St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 12 Meals were served in the dining room and service users were given the choice of where they would like to eat, in their own rooms or in the sitting room. There were no menu pictures available for the less able service users to make an informed choice on what option to take. The food that was served looked appetising and was well presented. Staff did not show that they understood the nutritional needs of service users who have dementia. Several of the service users were very thin and the scales has been broken for two months making monitoring their weight loss/gain impossible. The service users who have very limited ability appear to have to fit into the routines of the home rather than the home recognise the debilitating effects of dementia and meet their needs. St Andrews Care Home DS0000019533.V344268.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are taken very seriously and dealt with in accordance with the home’s policies and procedures. Staff were aware of the safeguarding of adults procedure. The home was not secure on the day of the inspection. EVIDENCE: Complaints are investigated in accordance with the home’s policies and procedures. Staff when spoken with were aware of the procedure on safeguarding adults. On the day of the inspection the inspector entered the home and access to the unit where people have dementia. The inspector was in home 10 minutes before a member of staff was aware. St Andrews Care Home DS0000019533.V344268.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This would have been good if the flooring was more suitable. This judgement has been made using available evidence including a visit to this service. The environment meets the needs of the service users. The home was clean and fresh on the day of the inspection. The floors are very noisy this must be addressed, as this is distracting to some service users with dementia. EVIDENCE: The home is regularly maintained and on the day of the inspection it was well maintained. The Registered Manager must ensure that the entrance to the home is secure. The home was clean, fresh and odour free. All service users have safe access to the home’s gardens. The floors in the dementia unit are very noisy in the two hour observation carried out by the inspector the noise was very distracting and uncomfortable. A noise assessment must be carried out and related to the effects on service users with dementia. St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff need more training to care for people who have dementia. The staffing ratios in the afternoon are not sufficient to meet the needs of the service users who have dementia. Staff are recruited appropriately. EVIDENCE: Four staff’s files were inspected and were found to be in order. They contained the appropriate paperwork including a Criminal Records Bureau clearance and two references. Training records were available. Not all staff that care for people who dementia have had the relevant training this was evident in the outcomes for service users. Twenty-six out of 50 the staff have achieved NVQ 2 and a further five are working towards achieving it. The Manager must review the staffing levels and must provide evidence that the needs and aspirations of the service users are being met. This includes providing evidence of where service users get their comfort, identity, attachment, occupation and sense of inclusion from. The staff were seen to be kind and caring, the inspector observed some very good interaction between staff and service users. There were other incidents where staff were at a loss to meet the needs of very vulnerable service users who could not communicate their needs or wishes. St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. Quality in this outcome area is adequate. This would have been good had there been more evidence that the needs of very vulnerable service users are understood and met. This judgement has been made using available evidence including a visit to this service. The evidence gathered for this inspection would indicate that the management of the home does not fully understand the needs of vulnerable service users who have dementia. EVIDENCE: The manager of St Andrews was not present at the time of the inspection. There was not sufficient evidence to show that staff at the home understand the needs and aspiration of service users who have dementia. This was apparent in the lack of insight in care plans and the need to have all the staff trained who deliver this care. Staff while very kind and compassionate were lacking in direction and training. The home endeavours to run in the best St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 17 interests of the service users but without dedicated trained staff this is not happening in all instances. Examples of this have been given earlier in the report. Appropriate checks are carried out on electrical and fire equipment. The last inspection required a review of the staffing levels in the home. This requires a thorough assessment of all the service users; there was not evidence that this had occurred. Failure to comply with the timescales set out in this inspection could result in a notice of legal enforcement action being taken. St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 St Andrews Care Home DS0000019533.V344268.R01.S.doc Version 5.2 Page 19 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 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. Failure to meet the timescale could lead to enforcement action The Registered Manager must ensure that all service user have a comprehensive care plan which includes how the service users is to be cared for and how that care is to be delivered. The Registered Manager must evidence that the very complex mental health needs of the service user who has one to one care can continue to be met by the home. The Registered Manager must ensure that the dignity of the service users is respected by acknowledging the complexity of their needs and their inability to fit into routines. The Registered Manager and the DS0000019533.V344268.R01.S.doc Timescale for action 15/08/07 2. OP7 15 (1) 15/08/07 3. OP8 15 (2)(b) 12/10/07 4. OP10 OP12 12 (4)(a) 12/10/07 5 OP15 16 (2)(i) 29/06/07 Page 20 St Andrews Care Home Version 5.2 6 OP18 7 OP19 8 OP30 9 OP31 OP33 10 OP14 Registered Provider must ensure that snacks are readily available to service users. 12 (1)(a) The Registered Manager and the Registered Provider must ensure the safety of the service users by ensuring the building is secure and that no visitors can enter the home without staff being aware. 23 (2)(b) The Registered Provider must ensure that the noise created when walking on the dementia unit floor is eliminated. 18 The Registered Manager must (1)(c)(i) ensure that staff are trained to meet the needs of all service users. 9 (2)(b)(i) The Registered Manager must ensure that she has sufficient training in care of people who have dementia to ensure that home is run in their best interests. 12 (2) The Registered Manager must ensure that sufficient is known about service user to ensure that they retain as much control of their lives as possible. 29/06/07 15/08/07 15/08/07 15/08/07 15/08/07 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.V344268.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V344268.R01.S.doc Version 5.2 Page 22 - 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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