Inspection on 22/02/06 for St Andrews House, Ashburton

This inspection was carried out on 22nd February 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 House, Ashburton 10/01/07

St Andrews House, Ashburton 27/09/05

St Andrews House, Ashburton 01/02/05

St Andrews House, Ashburton 07/07/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE St Andrews House West Street Ashburton Newton Abbot Devon TQ13 7DU Lead Inspector Michelle Finniear Unannounced Inspection 22nd February 2006 10.10 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 House DS0000003810.V267713.R01.S.doc Version 5.1 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 House DS0000003810.V267713.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Andrews House Address West Street Ashburton Newton Abbot Devon TQ13 7DU 01364 653053 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) Mrs Rosemary Christophers Mr Jeremy Christophers, Mr Duncan Christophers Sally Jo Rhodes Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include Service Users under the age of 65 years. Date of last inspection 27/09/2005 Brief Description of the Service: St Andrews House is a privately owned care home for elderly people, some of whom suffer from physical and mental health problems associated with old age, in the categories of OP, DE and PD. The home is a detached period property set in its own walled grounds, consisting of the original rectory with an extension built several years ago. The home is well kept and managed by family owners and has a registered manager, who oversees the day-to-day running of the Home. There are two lounge areas and a garden room, which also serves as a dining area located on the ground floor. There are also some Service User bedrooms on this level with the rest being on the first floor, which is accessed via a shaft lift or staircase.All rooms are currently used for single occupancy and most have ensuite facilities.The Home has attractive and well maintained grounds with level access for Service Users.The Home is situated within a short walk to local shops and amenities. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, (which means neither the owner nor service users were given advanced notice of the date or time of the inspection), and it took place over 5 ½ hours on a weekday in February 2006. To complete the inspection a tour was made of some of the property, discussions were held with the manager, three staff members and seven service users. In addition a meal was shared with six service users and discussions were held over lunchtime about the home and their lives. Time was also spent with service users who were more frail, observing interactions and some care tasks such as supporting service users with eating and moving and handling. What the service does well: The home provides comfortable and attractive accommodation, with en-suite facilities, accessible level gardens and a choice of communal space for service user use in three lounges. Service users have a range of needs, however the home manages to integrate this variation within the space available. This means that communal areas are well used during the day, with a variety of activity going on. An excellent menu is prepared with evidence of several choices and healthy eating principles in use, ensuring service users enjoy a varied and nutritious diet. The home has thorough care plans, which reflected well the service users needs and the actual care given by staff. Plans include risk assessments and other user specific assessments, such as falls risk assessments, to ensure service users abilities and choices are maximised whilst their safety is maintained. The level of staff training is commendable, and ensures that service user needs are well met. Comments from service users included “It’s marvellous here”, “the girls (Staff) are lovely”, and “Couldn’t be better”. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The registered provider must ensure that all radiators are covered or have low surface temperatures. This is to ensure all hot surfaces are protected, so that service users are protected from coming into prolonged contact, e.g. through falling against a hot radiator. Any charges made to service users for services at the home should be publicised in the service user guide or service user statement of terms and conditions. This is with particular reference to compulsory charges, and is to ensure that service users are aware of exactly what they are to pay and what they can expect to receive in return. The home must carry out a risk assessment for the unguarded wood burning stove in the dining room/lounge, and take appropriate action to protect service users from any risks of coming into contact with this hot surface. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion but core standards as a minimum were seen at the last inspection of September 2005. For information on the homes compliance with these standards please refer to the report produced following that inspection. EVIDENCE: These standards were not inspected on this occasion but core standards as a minimum were seen at the last inspection of September 2005. For information on the homes compliance with these standards please refer to the report produced following that inspection. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 The home has full and recently improved care plans which provide staff with full information on how service users are to be cared for. Medication systems are safe. EVIDENCE: Four service user files and plans were examined in detail and then related to the individual service users concerned to ensure plans were up to date and reflected current care needs. A new system for care planning has been implemented since the last inspection. This system will allow for improved information on service user needs to be assessed, and for more comprehensive information to be gathered. Plans are to be signed by the service user wherever possible, and several were already signed by the service user or their representative. This ensures that plans are in accordance with the service use wishes. One service users plan contained comprehensive information concerning their wishes in relation to their long term care. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 11 Service users medication is maintained within the home in a locked cupboard, and risk assessments have been undertaken for those service users who wish to self-medicate. These could be seen in service user files. The home uses a monitored dosage system for the administration of medication, which means that the pharmacist dispenses the medication in a series of blister packs for the home to use when administering. This means that staff can easily see whether medication has been given, and reduces the risk of errors. The home has had a recent problem with the dispensing pharmacy, which is being investigated by the pharmacist organisation. The home was responsive in this situation and was proactive in supporting the service user. The incident was reported appropriately. The medication cupboard was inspected and found to be clear of excess stock, and the records seen were recorded appropriately to ensure a full audit trail could be carried out. Administration of controlled medication was satisfactory, and the home has provided a dedicated medication refrigerator. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Service users have opportunities to take part in interesting activities and follow lifestyles of their own choosing. This includes retaining contacts outside of the home. Service users receive a varied menu of wholesome food. EVIDENCE: Service users have opportunities to take part in organised activities that are available at the home or to follow lifestyles and activities of their own choosing. Discussions with service users indicated that some had regular visitors or went out into the local town, took exercise throughout the home and grounds, watched television, read, listened to the radio, played cards or socialised in the home. The home has an full programme of activities available. On the day of the inspection there was a cards group in one lounge to which people from outside the home were invited, which had made for a lively and busy feel, as well as encouraging and fostering good relationships with the local community. Other activities on offer on the homes weekly programme include Bingo, classic film afternoons, craft sessions, armchair aerobics, healing clinic and pampering afternoons, karaoke and ‘sing-alongs’. In addition to the more formal activities staff could be seen during the day interacting well with service users, engaging in discussions over music on the radio in good humoured but respectful exchanges. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 13 Service users visitors are encouraged to the home, and having some activities being open to the local community helps to assists service users who are local keep in touch with their friends from outside of the home. The home offers trips out on occasion, and recent Christmas events included coffee mornings and a Christmas party. The service user questionnaire issued to all service users regularly contains questions on where service users would like to go and any activities service users would like the home to arrange on their behalf. This includes opportunities to be taken to local religious services of various denominations. Visitors are welcomed at any time. Service users have opportunities to make choices in their daily lives as far as their physical or mental condition will allow. Service users can as an example choose when they get up or go to bed, and one service user confirmed that they have an early morning cup of tea bought to them at 6 am as they are by nature an ‘early riser’. Although there is a natural daily routine and rhythm to the home, for example with mealtimes etc, meals may be kept back or served early if service users are going out or as seen on the day of the inspection were having their hair done. This demonstrates flexibility. Dietary needs of service users are well catered for with a balanced and varied selection of food available. Lunch was shared with several service users, and observation was undertaken of the support given to others who needed assistance with feeding. The lunch on the day of this unannounced inspection was roast leg of lamb, roast potatoes, carrots, cauliflower and broccoli cheese and mint sauce. Dessert was an Autumn fruit salad and cream. The evening meal was to be ham and cheese sandwiches, with scones and cream. Menus were displayed on the table, which gave a more formal air to dining and allowed service users to notify the cook in advance if they wished for an alternative meal choice. Discussions were held with the homes cook in particular on the nutritional needs of service users with dementia. Meals are home cooked and were attractively served in several venues throughout the home. Service users commented that the food was of a good quality. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 14 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 inspected on this occasion but core standards as a minimum were seen at the last inspection of September 2005. For information on the homes compliance with these standards please refer to the report produced following that inspection. EVIDENCE: These standards were not inspected on this occasion but core standards as a minimum were seen at the last inspection of September 2005. For information on the homes compliance with these standards please refer to the report produced following that inspection. No complaints have been received concerning this service. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 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): St Andrews house provides a comfortable environment for service users, however some attention is still required to hot surface protection. EVIDENCE: St Andrews house comprises of an old period property with a purpose-built wing attached to the rear. All bedrooms have en-suite facilities of either showers or baths, and there are three separate communal areas for service user use. There are extensive gardens to the rear, and some parking to the front. The Fire Officer last visited the home in May 2004, and the Environmental health officer visited in February 2005. Regular fire drills and practices are carried out at the home. and the home has contracted for external fire training for staff, certificates for which were seen. This helps to ensure that service users are protected as far as possible from the risks of fire. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 16 All areas of the home seen on this inspection were clean, warm, odour free and comfortable. The homes laundry is small but centrally located, and plans are in hand to replace the current provision in the near future. Infection control practices seen were satisfactory, including for the disposal of clinical waste, which is kept outside of the home and collected by contractors regularly. This means service users are protected from a risk of cross infection or odour. Rooms vary considerably in shape and size, and although there is a chairlift to the period rooms at the front of the property some still have small flights of stairs either within the room or to access the room itself. In the rear of the property with the purpose-built extension there is a passenger lift to access the first-floor rooms. Some rooms on the first floor have balconies which are risk assessed. All bedrooms have locks fitted to the door to enable service users to lock their room if they so wish, however it is understood that currently only three service users have requested keys. Most rooms were not locked during the tour of the home. Since the last inspection the home has had safety film fitted to some of the low period windows in the first floor rooms, so ensure service users are protected from any risks if they should fall against the glass. A series of environmental risk assessments have been carried out, both for the environment of the home and also for the care tasks carried out within it. These risk assessments, regularly updated, review any risks inherent within the environment and detail any measures to be undertaken to remove or reduce the risks to staff and service users. Discussion was held on the provision of radiator covers or other hot surface protection. The home has commenced a programme of hot surface protection, however this is not has not been finally completed, despite several previous deadlines being set, and presents a potentially serious risk to service users from coming into contact with a hot surface for example following a fall. This may result in further action being taken. The manager confirmed that water temperature regulation to a maximum of 43°C has been provided to all baths and showers, and it is understood that this will be increased in the near future to provide regulation to all wash hand basins. Service users rooms showed evidence of personalisation, with items of their own furniture, photographs and paintings. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 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): 30 Staff are well trained. EVIDENCE: The home has a training and development programme and a training needs analysis for all staff. These documents were seen along with samples of staff files which demonstrated evidence of training that had been received. Staff at the home have just received training in customer services, and training is being delivered in team building, first aid, care of medication, dealing with difficult people, stress management, bereavement, diabetes, stroke care, exercise, crafts, infection control and fire training within the coming year. A number of staff are also completing NVQ programmes, which are a measure of the level of competency of a staff member in relation to their job. A senior care staff member is to be nominated to be an Infection control officer and another is to do the 4 day first aid at work course in the near future. The manager has recently undertaken a course on appraisal skills, and has completed her RMA/NVQ Level 4 which is a specialist award in relation to managing a care home. Discussion was held on the recent issue of standards for dementia care training. In the last year staff at the home have received an in house training session on therapeutic activities for service users with memory loss. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 18 Staff who administer insulin have received specialist practical training and ongoing monitoring from the District nurse, who has agreed that specified staff are competent to give the medication. This is because this medication is given by injection. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 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): 33, 35 The home has good systems in place for quality assurance and the management of service user finances. EVIDENCE: St Andrews House has a comprehensive system for assuring the quality of service provision. The home is subject to regular internal audit, and there are systems for consulting with service users and significant others about the service they receive. This includes both a service user questionnaire and a quality assurance audit process, which follows the National Minimum Standards for Older people in structure. This information is then used to form the basis of an Annual development plan for the home. These systems help to ensure service users have a formal say in the way in which the home operates or care is delivered. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 20 The home has limited involvement with service user finances, and encourages relatives or other supporters to deal with this wherever possible, if the service user is no longer able to deal with their own affairs. For day to day accounts within the home bills are issued. This includes for example funding for hairdressers, paper bills, chiropody and minor expenditure on such items as sweets, cards and stamps from the homes own facility. The home makes a small charge in addition to the hairdressers own fees, which is used towards funding other activities and this should be details in the homes service user guide. A senior carer within the home deals with the collection of small amounts of cash for one service user, which has been set up as a formal arrangement with her bank. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 2 x x x St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 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. 1 Standard OP19 Regulation 13 Requirement Timescale for action 28/03/06 2 OP19 13 The home must carry out a risk assessment for the wood burning stove in the dining room/lounge, and take appropriate action to protect service users. The registered provider must 28/04/06 ensure that all radiators are covered or have low surface temperatures. Previous dates for compliance 30/8/04, 30/4/05, and 30/11/05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1OP35 Good Practice Recommendations Any charges made to service users for services at the home should be publicised in the service user guide or service user statement of terms and conditions. This is with particular reference to compulsory charges. St Andrews House DS0000003810.V267713.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 House DS0000003810.V267713.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!