Inspection on 11/05/06 for St Angelas Convent

This inspection was carried out on 11th May 2006.

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 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 Angelas Convent 09/01/08

St Angelas Convent 10/05/07

St Angelas Convent 02/02/06

St Angelas Convent 14/06/05

St Angelas Convent 05/12/04

St Angelas Convent 06/07/04

St Angelas Convent 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE St Angelas Clifton Down Convent St Angelas Clifton Down Convent 5 Litfield Place Clifton Bristol BS8 3LU Lead Inspector Sandra Gibson Key Unannounced Inspection 11th May 2006 09:30 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 Angelas Clifton Down Convent DS0000026518.V293611.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 Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Angelas Clifton Down Convent Address St Angelas Clifton Down Convent 5 Litfield Place Clifton Bristol BS8 3LU 0117 9735436 0117 9706844 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) Sisters Of The Temple Sister Marie Louise Levern Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: St Angelas Clifton Down Convent is operated by The Sisters of The Temple, a Roman Catholic religious order. The manager and three of the senior care staff are sisters within the order. Additional lay staff are employed to fulfil care and ancillary responsibilities. It is registered by the Commission for Social Care Inspection to provide accommodation and personal care to 23 persons aged 65 years and over. The range of fees is between the range of £400 and £450 per week and extra charges are made for chiropody, hairdressing, etc. Currently this information is initially only provided verbally prior to admission and then confirmed in writing within a new resident’s contract. St Angelas is a large detached building in a suburb of North Bristol close to the countryside. Shops and community facilities are within 1/4 mile of the home. Accommodation is provided over three of four floors, in single rooms, all of which have en-suite facilities. There is a communal dining room on the ground floor, which is only used on special occasions by residents. There are no communal lounge facilities in the home. St Angelas home offers respite care when places are available. A shaft lift is in place to all floors. The top floor offers accommodation to independent guests of the Sisters of the Temple. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place midweek between the hours of 9:30am and 6:15 pm. Evidence was gathered from: Examining previous correspondence with the home including Regulation 37 (Death illness, other events notifications) and Regulation 26 monthly reports complied by the responsible individual, inspection reports, information from pre inspection questionnaire, residents surveys, relatives comment cards, talking to/observing residents, talking to the manager/talking to the administrator/talking to and observing staff, talking to one visitor, talking to and case tracking four residents, examining records, policies and procedures. What the service does well: The care provided to residents of St Angela’s is of a high standard. The staff ensure that residents have their individual needs met with privacy, dignity and respect both when they are alive and at the time of their death. Visitors are made very welcome and meals are well managed and provide daily variation, and good nutrition for people. The complaints procedure in place in the home is satisfactory . The arrangements in place ensure that residents and their represenatives are fully aware of how to make a complaint and know they will be listened to Residents benefit from living in a safe, comfortable, homely environment Staffing levels at night and during the day are satisfactory with a result that residents’ needs are met at all times There are good systems in place to ensure that residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The information provided to prospective residents and their representatives prior to admission to the home is in need of attention to ensure that people have the information they need to make an informed choice about where to live. The admission procedure has improved since the last inspection, but it is still not wholly satisfactory as it does not ensure that a person’s needs have been fully assessed prior to moving into the home. Without this information there is no assurance that an individual’s needs can be met. The opportunity to review the suitability of the home for new residents must improve so that the potential for unplanned admissions are avoided. There have been great improvements in the care planing system since the last two inspections. However, it is still not wholly satisfactory as the assessment process needs to be developed to ensure that residents’ individual needs are fully identified. The physical healthcare needs of residents continue to be well met with evidence of good multidisciplinary working taking place on a regular basis. However there have been no further developments in staff training since the last inspection. Attention to this training need must take place to ensure that residents’ mental health needs are met. The care provided to residents of St Angela’s is of a high standard. The staff ensure that residents have their individual needs met with privacy, dignity and respect both when they are alive and at the time of their death. However, staff may benefit from specialist training regarding equality and diversity to support them in their work. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 7 The medication administration system has improved greatly since the last two inspections. However further improvements are still needed to ensure that there are safeguards in place to protect residents and staff at all times. Systems in place to ensure that residents are protected from abuse have improved since the last inspection. However, further work is required to ensure that residents are protected from risk of harm. Residents and staff continue to benefit from an experienced manager who has begun to encourage an open style management approach. However, further attention to this change in management style is required to ensure that communication with staff and residents continue to improve. Support to care staff is still not satisfactory. There has been some deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staff that are appropriately supervised. Health and safety checks are not wholly satisfactory. Further attention must be given to staff training to ensure that the health, safety and welfare of residents and staff is promoted and protected at all times. 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 Angelas Clifton Down Convent DS0000026518.V293611.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 Angelas Clifton Down Convent DS0000026518.V293611.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): 1,3,4,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The information provided to prospective residents and their representatives prior to admission to the home is in need of urgent attention to ensure that people have the full information they need to make an informed choice about where to live. The admission procedure has improved since the last inspection, but it is still not wholly satisfactory as it does not ensure that a person’s needs have been fully assessed prior to moving into the home. Without this information there is no assurance that an individual’s needs can be met. The opportunity to review the suitability of the home for new residents must improve so that the potential for unplanned admissions are avoided. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 10 EVIDENCE: The statement of purpose and service users’ guide were both examined. It was observed that they were out of date and there were gaps in the information held as well as some misleading information. For example the statement of purpose does not provide information about the experience and qualifications that staff have achieved and the service users’ guide does not provide information about the fees and extra charges required. It also states that one of the aims of the home is to include registered nurse care. This information is misleading to prospective residents and their representatives as St Angela’s is a care home, which is registered to provide personal care and not nursing care. The manger assured the inspector that the staff at St Angela’s does not provide nursing care. If nursing care is needed on a temporary basis this is provided by the District Nursing service. It was noted that neither the statement of purpose or service users’ guide had been reviewed since they were developed in 2003. There was no evidence to confirm that prospective and current service users or their representatives receive this information. The inspector was informed that the majority of residents are self funding and therefore a needs assessment and care plan are not usually obtained from Social Services and Health prior to a resident being admitted. Following the last inspection, the documentation completed when a resident is admitted to the home has improved considerably. However, the information obtained before a decision can be made to whether the home can meet a prospective residents needs or to assess if a residents ‘s needs have changed is very poor or non-existent. The inspector was informed that manager has delegated the responsibility for obtaining individuals’ needs assessments to another member of the management team. It was noted that this person has considerable experience in care but no formal training in completing needs assessments. Following an additional follow up visit to the home by the inspector on the 6th December 2006. The manager of St Angela’s’ formally wrote to The Commission For Social Care Inspection to request the removal of the condition that three residents may be accommodated at St Angela’s when the primary focus of their care is as a result of dementia. During the last two inspections the manager has confirmed that there are no residents accommodated at St Angela’s whose primary focus of their care was as a result of dementia and this was confirmed in the care files examined. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 11 Prospective residents and their representatives are invited to look around the home before they move in on a trial basis. One resident commented. My.. …and myself went to visit St Angela’s during the week before my operation was scheduled. We had a very good interview and I was accepted for three weeks of convalescence. The nurses have been so kind and thoughtful. I have been very happy here and feel very well cared for”. Another resident said, “I came for two weeks to see if I liked it and never left”. However, there was no evidence to confirm that the trial period for a permanent placement is being formally reviewed between four to six weeks after admission. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There have been great improvements in the care planing system since the last two inspections. However, it is still not wholly satisfactory as the assessment process needs to be developed to ensure that residents’ individual needs are fully identified. The physical healthcare needs of residents continue to be well met with evidence of good multidisciplinary working taking place on a regular basis. However there have been no further developments in specialist staff training since the last inspection. Attention to this training need must take place to ensure that residents’ mental health needs are met The medication administration system has improved greatly since the last two inspections. However further improvements are still needed to ensure that there are safeguards in place to protect residents and staff at all times. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 13 The care provided to residents of St Angela’s is of a high standard. The staff ensure that residents have their individual needs met with privacy, dignity and respect both when they are alive and at the time of their death. However, staff may benefit from specialist training regarding equality and diversity to support them in their work. EVIDENCE: A sample of care plans were seen and it was noted how much they had improved since the last inspection The care plans seen during this inspection were written in plain English and gave detailed information about the care required for the individual residents. As discussed in the first section the inspector did not see needs assessments in place for these residents so was unclear to how the care plan had been developed with out this information. It was noted at the last inspection that there were long gaps in the daily running records. There have been some improvement in this respect with evidence of more frequent recording but further work is required. There was also evidence to confirm that there are ongoing plans in place to improve the care planning documentation. It was noted that this task had been delegated to a member of the management team and it was acknowledged by the inspector that an increased time scale was necessary for the home to meet the national minimum standards. Records confirmed that health professionals such as General Practitioners, District Nurse and chiropodists are contacted at the appropriate time. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. It was noted by the inspector that one resident has a mental health diagnosis but this is not the primary focus of their care at St Angela’s. During the previous inspection the inspector had observed staff coping reasonably well with this resident’s challenging behaviour but it was noted that they would possibly benefit from the support of the “In reach” Mental Health Team who provide support to staff working with older residents with mental health needs including severe anxiety. This would help staff understand and ensure that the rights of people with dementia and mental health needs are promoted. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 14 It was also noted that the majority of staff have received training in dementia care but not working with older people with mental health needs. It was noted that this support or training to work with people with mental health needs had not been organised since the last inspection. However, information provided confirmed that further training in dementia care was planned for 2006 All comments cards received and the one visitor seen during the inspection confirmed that relatives are always contacted if residents have an accident in the home or are admitted to hospital. The medication administration system was examined. It was observed that the quantity and amount of prescribed medication received into the home is now accurately recorded. A sample check of medication administered was checked and the majority of records were noted to be up to date and accurate except one. A few residents continue to be supported to self-administer medication. It was noted however that there was no risk assessment in place to protect these residents. Lockable storage facilities are available in all residents’ rooms. It was also observed that the security arrangements for the storage of controlled medication or medication that needs to be stored like controlled medication are still not wholly satisfactory. This situation has been ongoing since the last inspection. However evidence provided at this inspection indicated that arrangements to improve this system were due to take place with in the next couple of months. It was noted that two of the four members of the management team involved in medication administration have recently received training in medication administration and the storage of medication. This is good practice. Comments received from residents surveys and relatives comments cards included: “The sisters and other staff care for ….. with love and devotion. Her/His medical needs are attended to promptly and necessary medication provided and administered. I am satisfied with all aspects of care”. “The doctors make frequent visits and we never have a case of bed sores”. The inspector observed through out the inspection how residents were treated with dignity and respect by the staff. However it was noted that one resident referred to black staff as “coloured” nurses. The resident stated that “coloured nurses are inclined to call me darling. It does not worry me and it is not a criticism”. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 15 Residents seen during the inspection confirmed this. It was also noted in the residents’ surveys and relatives’ comments cards: “My ….has been a resident at St Angela’s for … during this time she has received care of the highest quality. The staff are always friendly, kind and caring to residents, families and friends.” “The care is excellent. There is an extremely high standard of professionalism”. The staff are excellent, friendly, helpful and kind”. “Splendid care and kindness at all times. The staff are willing to help at all times.” Written evidence also confirmed how well residents are cared for when they are dying and their relatives were offered good support during this time. Comments received included: “My …..who has terminal cancer went to St Angela’s on …..I have nothing but praise for the friendly cheerful attitude of the staff and the way in which s/he has been looked after. The last few weeks s/he has seemed rather better and I ‘m sure that St Angela’s should have some of the work in making her/him feel secure and comfortable” “Since my ….entered St Angela’s their vigilance, tenderness and attention to detail have meant that despite the inevitable decline in my …physical and mental powers in her extreme old age she has been able to live a comfortable, dignified life and happy life.” Experienced care staff spoken to during the inspection confirmed that in their opinion a high level of care was provided to all residents at St Angela’s. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Following the last two inspections the residents of St Angela’s are beginning to benefit from increased opportunities to experience a more stimulating and varied life style which may help to satisfy their individual social, religious, cultural and recreational needs. Visitors are made very welcome and meals are well managed and provide daily variation, and good nutrition for people. EVIDENCE: On the whole St Angela’s continues to provide a quiet lifestyle for residents where very few communal activities take place. This is noted to be satisfactory for the majority of residents who are fully informed about the lifestyle prior to admission and this is their preference. Many residents are visited frequently by friends and family and may be taken out for the day. Daily mass takes place in St Angela’s Chapel and all residents are made welcome. However, there was information to confirm that despite St Angela’s care home being operated by a Catholic Order of nuns that residents from different religious/ spiritual and cultural backgrounds are admitted to the home and their individual needs are met. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 17 Following the inspection conducted in June 2005 a dedicated member of staff now spends more time engaged in social activities with residents on a daily basis. It was noted during this inspection that further progress had been made with developing social activities for residents. It was pleasing to see that the communal dining room is now being used more frequently for residents to meet. There was written evidence to confirm that seven residents now participate in regular coffee mornings or tea parties. The manager said that following mass families and priests often join in with these events. Written evidence to confirm these social activities are taking place was also available in the residents’ surveys and relatives comments cards. “I like long walks up and down the corridors/ coffee mornings / sitting in the garden reading”. “I enjoy the coffee mornings in the home and the Corner luncheon club at Clifton Cathedral”. “I take part if I feel like it “ “I would not like constant activities; I like books and watching TV”. One relative said, “the activity that means a lot to my mother is Daily Mass in the Chapel. That is her ministry”. Relatives confirmed that they were always made welcome in the home. Comments such as: “The staff are very kind and helpful to my … and I am made to feel very welcome when I visit”. “My … is very happy as St Angela’s and it is like a second home to me and my family. I am welcomed into the Convent at any time of the day or night”. One visitor spoken to during the inspection confirmed s/he was always made very welcome in the home and that the manager and staff were very helpful. The inspector sampled the lunch menu that day and noted that the meal was wholesome and nutritious. The evening meal also looked appetising and well presented. Daily menus were also examined and they confirmed that variety and choice were available. This was confirmed in residents’ surveys and relatives’ comments cards: “The fish is delicious. I like all meals”. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 18 “The meals are delicious”. “I usually like the meals”. “I‘m not a very good eater at the best of times, so I don’t eat everything. But by ordinary standards the food is good.” “I always like the meals. I am …..years old and they say I eat better than any one else.” “I enjoy the food. We have plenty of it and varied meals”. “I can feed myself. I know from observation that those residents who cannot feed themselves are properly fed. The carers are very patient”. “My … says the food is good”. “My … has always said the food is excellent”. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure in place in the home is satisfactory . The arrangements in place ensure that residents and their represenatives are fully aware of how to make a complaint and know they will be listened to Systems in place to ensure that residents are protected from abuse have improved since the last inspection. However, further work is required to ensure that residents are protected from risk of harm. EVIDENCE: There have been no new complaints since the last inspection. Two residents consulted confirmed that they were aware of the complaints procedure and that they knew who to speak to if they had any concerns. One visitor told the inspector that if s/he had any concerns then s/he would speak to the manager. S/he said, “my … has been at St Angela’s for ….. years during which time she has received care of the highest quality” Information about how to make a complaint is available for visitors where they sign in the visitor’s book at the entrance to the home. The information is also available on each floor of the home. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 20 One resident spoken to said, “We are well looked after here. Staff are very nice and we have nothing to complain about”. Residents’ surveys confirmed this information: “It is a very well run home by caring nuns and staff. I am very happy here. I know how to make a complaint”. “I know how to make a complaint. The staff are excellent friendly and kind”. “I usually know how to make a complaint, but I have never had to make one”. “I have had no reason to make a complaint. I will go to the “head one” should it occur. I am very happy in the home where I have always wanted to finish my life …not yet!” “I would go straight to the manager if I was not happy. I am free to make a complaint if I wish”. “The manager is always available if I am not happy. I would make a complaint to her if I was not happy”. Relatives’ comments cards included: “I have nothing but praise for the friendly cheerful, attitude of the staff and the way in which she has been looked after”. Two members of staff spoken with during the inspection confirmed that there was a whistle blowing policy in place in the home. There is an Adult Protection policy and procedure in place in the home, which complies, with the Local Authority Adult Protection Procedure (No Secrets in Bristol). There has been no protection of adults allegations notified since the last inspection. Fifteen members of staff including the manager attended Protection of Vulnerable Adult training by an external organisation in November 2004 and a refresher-training course took place in March 2005. During the last inspection it was noted that neither the manager nor any of the staff team had attended Protection of Vulnerable adult training provided by Bristol Social Services and Health which highlights the Local authority policy and procedure No Secrets in Bristol. A requirement for the manager and staff to attend further up to date training was made following the inspection. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 21 It was noted during this inspection that this training had not taken place. The manager explained that herself and another member of the management team had recently attended one of the multidisciplinary protection of vulnerable adult discussion groups organised by Bristol City Council Safe guarding officer but to date had not attended the training organised for managers. It was also noted that none of the staff had attended further up to date training in respect of the protection of vulnerable adults as required to. The Commission for Social Care Inspection receive regular notifications about residents’ welfare and health. Gaps in the recruitment process have improved considerably since the last inspection when serious concerns were noted. This improvement will be discussed in detail in the section on staffing. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 22 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): 19,20,22,23,24,25.26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from living in a safe, comfortable, homely environment. EVIDENCE: During the course of the inspection the inspector completed a tour of the communal areas and had the opportunity to view the garden space and several residents, rooms. The gardens of St Angels are very attractive and are well maintained. The inspector was informed that residents may access the gardens located at the front or rear of the house. It was noted that there is a lift facility and ramp facility for wheel chair users to use the rear garden and front gardens St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 23 The communal areas were found to be clean, smelt fresh and were well maintained. Records confirmed that arrangements for cleaning the home on a regular basis are very good. The member of staff who is responsible for the maintenance explained that minor maintenance work is dealt with immediately. However, the manager formally requests major work and records are maintained of the programme of work including refurbishment, decoration and safety checks. It was noted that the carpets in the stairs corridors and chapel and dining room have been replaced since the last inspection. It was observed on the day of the inspection that one of the two central heating boilers in the home was being serviced. The inspector was informed that a repair needed to take place for one of the boilers but the heating and hot water supply was not a problem as the other boiler was in good working order. Records confirmed that arrangements were in place for residents to have access to the equipment and adaptations they were assed as needing by health professionals. All residents’ rooms seen during this inspection were found to be safe comfortable and homely and residents confirmed that they could bring items of their own furniture if they chose to. The inspector noted that there were no environmental risk assessments in place, but during the visit no environmental concerns were observed on this occasion. One resident said: “In my experience of visiting residential care homes, the first experience is the smell. Many homes smell of urine. This is not the case with St Angela’s. The residents and the home are kept spotlessly clean”. Comments from relatives’ comments cards included: “The home is always very clean”. “The home is always fresh and clean”. “The home is always fresh and clean. The cleaner calls and works five days a week”. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 24 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels at night and during the day are satisfactory with a result that residents’ needs are met at all times The procedures for the recruitment of staff have improved considerably since the last inspection, which protects residents from risk of harm. The staff training programme is on the whole satisfactory. However, there are some gaps in specialist training with the result that residents’ mental health needs may not always be fully met. EVIDENCE: It was noted during this inspection that the staffing levels during the day and night met the dependency levels of the residents. The staffing levels at night increased to two staff in September 2005 following the requirements of the unannounced inspection conducted in June 2005. One member of staff carries out waking duties and the second member of staff carries out waking duties from 8.30pm until 11.30am, then sleep in duties until 5.30am and finally waking duties until 7.30am. The manager who lives in the Convent, which is part of the home, is also available in an emergency. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 25 There is a night staff rota in place and all night staff have been provided with a new contact outlining their duties. A formal review of night staff is carried out every three months. It was noted during this inspection that four members of staff including one agency member of staff make up the current night duty rota. During the inspection it came to the attention of the inspector after examining four staff files that the manager has improved the recruitment process and is now requesting all staff recruited by St Angela’s to have protection of vulnerable adults checks and criminal records checks before they commence working in the home. Serious concerns about the lack of this information were raised with the manager during the last inspection. It was noted that no permanent staff have been recruited since the last inspection but the manager and administrator demonstrated their understanding of the process. The manager has now made arrangements for all permanent staff including cleaners and volunteers to undertake a POVA/ criminal bureau check through the umbrella organisation responsible for checking this information on behalf of St Angela’s. Written information confirmed this and it was noted that the majority of checks had now been returned and were satisfactory. Two agency staff have been working in the home since the last inspection. The inspector noted that both of these agencies had organised POVA / CRB checks and the inspector saw evidence of the two agency staff experience and qualifications that the manager was keeping a record of. The sample of staff personnel files seen confirmed that staff receive induction training on appointment. They also receive regular training in the home on statutory subjects such as fire safety training, first aid, basic food hygiene and manual handling, and specialist training such as dementia care. It was noted that the majority of training is through a private company based in Birmingham and the training takes place within the home. The inspector discussed the benefits of having training with other providers of services and staff on occasions so that the opportunity to network and share ideas of good practice is increased. From the information seen the staff team are progressing very well with NVQ 2 training and two members of staff have NVQ3. Staff consulted during the training spoke very positively about the training provided in the home. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 26 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents and staff continue to benefit from an experienced manager who has begun to encourage an open style management approach. However, further attention to this change in management style is required to ensure that communication with staff and residents continue to improve. Support to care staff is still not satisfactory. There has been some deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staffs that are appropriately supervised. There are good systems in place to ensure that residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 27 Health and safety checks are not wholly satisfactory. Further attention must be given to staff training to ensure that the health, safety and welfare of residents and staff is promoted and protected at all times. EVIDENCE: The majority of residents and staff members spoke very highly of the manager and the support she provides to residents and the staff team. The management team has developed further since the last inspection. One of the sisters continues to deputise when the manager is away. Prior to the inspection conducted in June 2005 one of the carers was promoted to senior carer. This person is now a supervisor and a second carer has also been promoted to senior carer. Consequently the manager is now able to delegate some of her responsibilities to other members of the management team. Following discussion with the manager the inspector noted that the management team and staff team are currently going through a period of change, which has resulted in some tensions within the staff team. The manager explained that she was monitoring the situation very carefully and was providing support as necessary. Comments received from residents and relatives included: “It is all very well run by caring nuns and staff. I am very happy here”. “The manager has an insightful maternal art” “The manager is always available”. During the last inspection the inspector noted that staff meetings and formal supervision were planned to take place on a regular basis, which was a major improvement since the previous inspection in June 2005. However, it was noted at this inspection that staff meetings were not happening so regularly. The last meeting was January 2006 and prior to that it was September 2005. The inspector was informed that a meeting was planned for May or June 2006. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 28 There was no evidence of formal supervision of any staff including senior carer and supervisor having taken place since the last inspection. Staff confirmed this information during the inspection although indicated that the manager was always available if they chose to discuss something they were concerned about. There was evidence in place to confirm that staff from ethnic minority groups feel well supported and discrimination is not accepted in the home by the manager. Written evidence confirmed that the systems in place to safeguard residents’ finances and valuables were good. Staff and residents confirmed this information at the time of the inspection. The majority of health and safety checks including fire safety records were observed to be up to date and accurate. However, it was noted that there was no evidence of agency staff receiving fire safety training or being made aware of fire safety procedures at St Angela’s. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 29 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 1 X 1 3 2 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 3 2 2 2 St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 30 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 OP1 Regulation 5 Requirement All prospective and current residents and their representatives must be provided with a copy of the up dated services uses guide which must contain all information outlined in National Minimum Standards 1 and 2 The Statement of purpose and service users’ guide must be formally reviewed and up dated No person should be admitted to the home unless a suitably trained person obtains a full needs assessment. The needs assessment documentation in place in the home must be improved to assist in the collection of this information. The person undertaking the needs assessment must be qualified or receive formal training. Timescale for action 31/08/06 2. OP1 6 31/08/06 3 OP3 14(1)(a) 31/08/06 St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 31 This is an ongoing requirement from the last two inspection conducted in June 2005 and February 2006. A further extension has been given as there was evidence to indicate that improvement has started 4 OP5 14(2) All residents admitted to the home must be formally reviewed within 6 weeks of admission to ensure that their needs can be fully met All care plans compiled must be completed following a full assessment of needs. Daily running records must be improved Mental health training must be provided to all staff to ensure that residents emotional and mental health needs are met. This requirement has been on going since the last inspection 31/08/06 5. OP7 15 31/08/06 6 OP30 19 31/08/06 7 OP9 13(2) All medication administered must 11/06/06 be accurately recorded following consultation with the community pharmacist The storage arrangements for controlled medication and medication to be stored, as controlled medication must be improved as highlighted in National Minimum Standards 9. This is an ongoing requirement from the last inspection in February 2006. An extension was agreed, as there was evidence to confirm that arrangements had been put in place to meet this requirement. 31/07/06 8 OP9 13(2) St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 32 9 OP18 13(6) The manager and another member of senior staff must attend further specialist adult protection training for managers. All staff must also attend further relevant adult protection training This requirement is ongoing since the last inspection. An extension will be given as evidence in place confirmed that contact had been made with the Safe guarding adults coordinator Bristol Social Services and Health) 30/09/06 10 OP33 24 A Quality assurance system must 30/11/06 be set up in the home as outlined in NM Standard 33 Formal Supervision must be provided on a regular basis to all staff as outlined in NMS OP36 Robust arrangements must be put in place to ensure that all agency staff are provided with fire safety training and made aware of the fire procedures before they start working in the home. This information must be recorded. 31/08/06 11 OP36 18(2) 12 OP38 23(4) 31/07/06 13 OP37 17(2) Records that must be available 31/07/08 for inspection must be kept up to date and accurate St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 33 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 3 4 Refer to Standard OP1 OP10 OP36 OP30 Good Practice Recommendations The statement of purpose and service users guide must be reviewed at least annually or when any change to the service occurs Specialist training should be provided on equality and diversity for all staff. Staff meetings should take place on a more frequent basis and include night staff Staff training should be organised with out side agencies such as Social Services Training department to allow the staff members to broaden their experience and network with other services in order to share good practice. St Angelas Clifton Down Convent DS0000026518.V293611.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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