CARE HOME ADULTS 18-65
St Andrews House Nursing Home 37 Rainhall Road Barnoldswick Lancashire BB18 5DR Lead Inspector
Mrs Marie Matthews Unannounced Inspection 19th January 2006 10:30 St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 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 Nursing Home DS0000022474.V278625.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 Adults 18-65. 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 Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Andrews House Nursing Home Address 37 Rainhall Road Barnoldswick Lancashire BB18 5DR 01282 816701 01282 816508 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) Oakfoil Limited Ms Gillian Harper Care Home 24 Category(ies) of Physical disability (24), Physical disability over registration, with number 65 years of age (3) of places St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Staffing will be in accordance with the Notice issued on 9th November 1998 The service should, at all times, employ a suitably qualified manager who is registered with the CSCI 6th July 2005 Date of last inspection Brief Description of the Service: St Andrews House is a large detached property located in the centre of Barnoldswick. It is registered to provide both nursing and personal care for twenty-four people who are physically disabled. Both men and women live in the home. The majority of rooms are single and all bar two include en-suite toilet and hand basin. There are three shared rooms that also have en-suite facilities. All rooms meet the minimum size requirement to allow people who use a wheelchair to be accommodated. There is a passenger lift to the first floor. The home is well provided with communal space. This includes a small gym and hydro pool that is open five days a week and managed by the physiotherapist and physiotherapy aide. There is limited outdoor space with a small garden area to the front of the building and a patio to the rear. However Barnoldswick is well adapted to the use of wheelchairs with many pavements being wheelchair friendly and local shops and facilities being easily accessible. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted at St Andrews House on the 19th January 2006. The inspection involved looking at records, talking to the registered manager, staff and five residents, a tour of the home and generally looking at what was happening in the home. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There were twenty people living in the home on the day of the visit. The atmosphere in the home was relaxed, homely and informal. Residents were seen enjoying varied activities throughout the home. The home was assessed against the National Minimum Standards Care Homes for Adults (18 – 65). This report should be read with the inspection report of 6th July 2005 for the reader to get a complete overview of the home. What the service does well:
The home always completed detailed assessments before anyone was admitted to the home, this made sure the home could look after people and meet their needs. Residents were able to make decisions and choices about their own lives and were involved in decisions about the day-to-day running of the home. Every effort was made to help residents to take part in suitable activities both inside and outside the home. An activities co-ordinator was responsible for arranging activities, entertainments and outings. On the day of the inspection residents were involved in various activities of their choice. Relationships between staff and residents were good and friendly relationships had formed. There was a relaxed and informal atmosphere in the home. The home was accessible, clean, comfortable and safe. Since the last visit a number of furnishings had been replaced and areas of the home had been decorated. Residents had personalised their rooms and were comfortable in their surroundings. Management and staff had been given suitable training so they had the skills and knowledge to look after the residents in their care. The majority of care staff had obtained a qualification in care. Systems were in place to ensure that the health, safety and welfare of residents, visitors and staff was protected. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. The home obtained detailed assessment information about prospective residents, prior to admission, to ensure they can meet their needs. EVIDENCE: Detailed assessment information had been obtained prior to admission to ensure the home was able to meet the resident’s needs. Individual service user plans had been generated from the assessment and the plans had been discussed with residents or their relatives. The plans showed that family members, residents and other health professionals had been involved in discussions about care. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Individual plans were developed from assessment information and contained detailed information about personal, social and healthcare needs; this ensured staff were aware of how to meet the residents needs. The home was good at involving residents or their representatives in decision making about all aspects of their lives in the home. EVIDENCE: Two individual plans were looked at. The plans had been developed from assessments and contained detailed information about personal, social and healthcare needs. There was evidence that residents, their family, friends or advocate had been involved in the development and regular review of the plan. One resident was able to discuss his involvement and discussions with his key worker. Any restrictions on choice and freedom had been fully discussed and documented in the plan. All residents had a key worker. One resident confirmed this. Residents were able to take responsible risks and had been involved in discussion about those risks. The use of bed rails was fully documented and had been discussed with residents and their relatives.
St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 10 Residents were able to make decisions and choices about their own lives. This was supported by documentation, discussion and observation. Residents were participated in all aspects of the home including meetings, selection of new staff, individual and group discussion and satisfaction surveys. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 16. The home ensured residents could take part in a range of appropriate and fulfilling leisure activities that ensured social and personal needs were met. The home promoted resident’s independence, choice and decision-making. EVIDENCE: All standards were assessed and met at the last visit. From observation and talking to people it was clear that every effort was made to help residents to take part in suitable activities. One resident said he had taken on extra responsibilities around the home and was due to start work that would involve him in the local community. An activities co-ordinator was responsible for arranging activities, entertainments and outings. Residents were involved in various activities inside and outside the home on the day of the inspection. There was evidence that residents were supported with their choice of activities. Staff were seen knocking on doors and waiting for permission to enter. Staff chatted with residents in a friendly manner.
St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 12 St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. The management of medication was generally good but the policies needed minor review and staff needed to follow these procedures to ensure residents safety. EVIDENCE: Medication management policies and procedures were clear and detailed. However minor additions needed to be included and these were discussed with the registered manager. The medication system was well managed and clear records were kept. Staff were reminded that handwritten charts must be witnessed and appropriate signage and link chains were needed where oxygen was in use or stored. Reviews of medication were recorded and regular advice visits by a pharmacist had been carried out. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None assessed. EVIDENCE: All standards were assessed and met at the last inspection. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The home provided a clean, comfortable and attractive environment for residents to live in. EVIDENCE: The home was accessible, clean, comfortable and safe. A number of furnishings had been replaced and areas of the home had been decorated as part of the ongoing maintenance and renewal programme. The conservatory ceiling fans had been repaired and quotes were still being obtained to supply window blinds to reduce the heat in the summer months. One resident said the new lift had been ‘much better’. The frames to the rear of the house still needed painting. The home still did not have a sluicing disinfector to reduce the risk of cross infection and was unable to meet this standard. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. The home needed to improve the way it recruited new staff to ensure required checks were in place and residents were protected. The home ensured that management and staff were competent and qualified to meet the needs of the residents in their care. EVIDENCE: Two staff files were looked at. One file contained an undated testimonial that had been supplied as an employment reference. Evidence to support Protection of Vulnerable Adults checks had been requested, received, a record of the identification number, level of disclosure and outcome was not seen on either files. This was discussed with the registered manager. There was good evidence that residents were involved in the selection of new staff. All new staff had received thorough induction training that included a review of policies and procedures. All staff had training and development plans in place; these evidenced ongoing training. The majority staff had achieved an appropriate care qualification that gave them the skills and understanding to care for the residents in the home. The registered manager had achieved an appropriate management qualification and had also undertaken further training. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The home had safe systems in place to make sure the home was a safe place to live and visit. EVIDENCE: A service users survey had been completed in December 2005. The results of this were due to be made available to residents and their representatives. Systems were in place to ensure the health, safety and welfare of residents, visitors and staff was protected. All service and maintenance documentation was up to date. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X 2 X X 3 X St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 19 YES 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. 2. Standard YA20 YA30 Regulation 13 13 Requirement The registered person must ensure that transcribing of medication is witnessed. The registered person must ensure that a sluicing disinfector be provided to reduce the risk of cross infection. Timescale of 31/1/05 not met. The registered person must operate a thorough recruitment procedure and ensure all checks are completed and recorded in full. Timescale for action 06/03/06 06/03/06 3. YA34 29 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA20 Good Practice Recommendations Medication policies and procedures should include procedures for PRN medication and covert administration. Signage and trolleys or link chains should be provided where oxygen is stored or in use.
DS0000022474.V278625.R01.S.doc Version 5.1 Page 20 St Andrews House Nursing Home 3. 4. YA24 YA39 The registered person should consider fitting suitable blinds in the conservatory. The results of the recent service users survey should be published and made available. St Andrews House Nursing Home DS0000022474.V278625.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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