CARE HOMES FOR OLDER PEOPLE
St Anne`s Rest Home Grange Lane Burghwallis Doncaster DN6 9JL Lead Inspector
Marina Warwicker Key Unannounced Inspection 6th February 2008 10:30 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 Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Anne`s Rest Home Address Grange Lane Burghwallis Doncaster DN6 9JL 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) 01302 700 319 01302 708 752 NONE www.stannesresthome.org.uk Hallam Diocesan Caring Service Gail Nelthorpe Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th March 2007 Brief Description of the Service: St Ann’s Rest Home is situated in the village of Burghwallis to the north of Doncaster. The home is a grade 2 listed building with parts dating back to the 11th century. Many original and interesting features remain throughout the building. Bedrooms vary in size and shape and accommodation is provided on a number of levels. There is a passenger lift and a chair lift to the different levels. The home is set in large grounds on the edge of a quiet hamlet. The nearest shops can be found in the next village. The home is owned and managed by the Diocese of Hallam Trust. The home has no specific admission criteria relating to faith. However, a Mass is said daily and the residents have the option of attending. The home is registered to accommodate 30 residents needing personal care and support. Information about the home can be found in the statement of purpose and the service user guide. These documents are available from the manager. The manager said that the weekly charge was £386.00 and that there were no additional charges other than those for hairdressing, private chiropody treatment, toiletries, newspapers and magazines. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes.
An inspection of this rest home was carried out on Tuesday 5th February 2008 between 10.30 am and 3.30pm. The staff, management and the people using the service were not informed of the visit and therefore it was unexpected. Five people who use the service were consulted and seven staff were spoken with. A further nine people using the service, six relatives and three professionals who come into contact with the people were contacted by post to obtain feedback about the service. Comments received from the surveys have been included in the body of the report. Any comments received after the publication of this report will be shared with the management of the home. Time was spent observing and chatting with staff and the people using the service. The manager was present during the inspection. The premise was inspected, which included bedrooms of people using the service, the communal areas and the service areas such as the kitchen and the laundry. Samples of records such as the care plans, staff recruitment and training files were checked. I would like to thank the people who live at St Annes, their relatives, all staff who took part and the manager for their contribution towards this process. What the service does well:
The manager and the staff were friendly and helpful to the people living at the home and also to those who visit the home. Comments were received that the staff made the most of the resources available to them and often worked extra shifts to cover for shortages. There was a relaxed and homely atmosphere in the home. People using the service described the staff as friendly and helpful. The people also commented that their family and friends were made welcome by staff when visiting the home and that they were able to visit without restrictions.
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The following are some areas identified during this inspection process where the service needs to make improvements; so that the people living and working at the home are safe and receive appropriate care and support. The people have been admitted to the home without care needs assessments. This has resulted in care staff being unable to plan care for the specific needs of individuals. To avoid this, no one must be admitted to the home before their care needs have been assessed by a suitable trained person and the manager of the home has been consulted to confirm that the home wis suitable to meet the identified needs of the individuals. The care plans were not updated and therefore did not reflect the ‘present needs’ of the people living at the home. Therefore to deliver the correct health, personal and social care, the present needs of the individuals’ must be identified and records updated by the staff. Since the care plans had not been reviewed at the home there were no records of any changes to the individuals’ care needs. To correct this, the people using the service must be involved in their care reviews and the staff must review the care plans at least every six months. The care plans needed details of all the identified needs of the people together with specific details about the care to be provided by staff. The decisions about the care must be based on the risk assessments completed by the staff. The manager needs to promote and maintain access to the appropriate primary health care teams, so that the people using the service and the staff are able to receive appropriate advice and support. Furthermore the care staff needed training and updating in identifying those who are at risk of developing pressure sores, becoming incontinent, those who were prone to dehydration and malnourishment so that the staff are able to take appropriate actions to prevent illnesses and promote health.
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 7 The daily routines, leisure and social activities needed to be flexible and varied to suit the expectations, preferences and capacity of the people living at the home. There needs to be a record of the people’s interests, preferences and dislikes so that the staff are able to offer suitable activities. All staff working at the home needed to be competent in dealing with allegations of abuse or neglect. The staff must know the homes policies and procedure on safeguarding adults. Although this is a grade 2 listed building it needs to comply with the requirements of the local fire service and environmental health department to make it safe for the people using the service. The responsible individual needed to produce a programme for the maintenance, essential redecoration, renovation and refurbishment work to be completed to ensure that the home is safe and comfortable for the people who live in the home. The responsible individual and the manager need to ensure that the people are safe and not at risk of tripping or falling over when accessing the communal and private areas of the home. The registered manager needed to ensure that a fire risk assessment of the whole of the home environment is carried out, so that the management could take appropriate action to prevent fires and also be prepared to deal with any unfortunate incidents of fire. The management must provide aids, hoists and adaptation to the baths and toilets to meet the needs of those who live at the home. All parts of the home must be kept clean and free from offensive odours. This could be achieved by employing adequate number of domestic staff on each shift. The number of care staff on each shift needed to reflect the assessed needs of the people using the service, the size and the layout of the home. The manager must employ care staff, domiciliary staff and the catering staff in sufficient numbers so that the people are able to receive appropriate care. The registered manager needed to review the application form, the recruitment process and update the documents according to the current employment laws. The manager must ensure that all staff have completed their learning needs analysis so that she is able to identify the gaps in their training. The management needed to ensure that the training and development programme for the staff supported the requirements of the service setting so St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 8 that the staff were trained for their work role (specific jobs they are to perform). The registered manager needed to undertake training in general management skills. As part of this the responsible individual on a regular basis must support and advise the manager so that she is able to fulfil her role. The quality assurance systems needed to be based on seeking the views of the people who use the service and those who provide the service (i.e. the staff), so that the management were able to measure how successful they were in meeting the stated purpose of the home. The people involved in this process must receive feedback so that they feel that their views had been listened to and comments appreciated by the management. The registered person must ensure that all staff receive supervision at least 6 times per year. This process needed to be used to find out whether the staff were competent and confident to do the jobs they had been employed to carry out and how the manager was able to appraise, offer direction and organise training opportunities according to individual needs. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 9 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 Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people who wish to use the service and their representatives are able to get the information in the form of a service user guide. However, the service user guide is in need of bringing up to date so that the people are able to find out the facilities available, the quality of care provided and therefore able to make an informed decision about the suitability of the service. EVIDENCE: People using the service and the staff were consulted. One person said, “I have some information about the home in my room. It has been kept in a file. I am not bothered either way.” Staff said that the information was available to those who come to see the home and that the manager had copies of the service user guide. During the tour of the accommodation we saw copies of the service user guide in some of the bedrooms. During our conversation the manager said that the information was in need of updating.
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 11 We checked three care plans. There was no evidence of the people having had needs assessments prior to admission. This has not been a practice at the home. However, the manager showed us a set of needs assessments she had carried out before accepting a person for respite. The information recorded was relevant, useful and helped with planning of care for the person during his/her stay. Two relatives informed us that they were happy with the way the staff showed them around and offered them the opportunity to ‘test drive’ the place before moving in permanently. Some of the people had used the respite facilities at St Annes and were satisfied with the arrangement and therefore chose to move in permanently. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 & 11 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Most individuals feel that they would like to be involved in decisions about their lives. But the daily routines and the staffing arrangements made it impossible for them to play an active role in planning the care they receive and support. The health and personal care that people receive is not always based on their present individual needs. The principles of respect, dignity and privacy are put into practice by the care staff. EVIDENCE: Three care plans were checked. The people receiving the service were consulted and the staff were interviewed. The responses to the surveys were also considered. Most of the people were able to decide what support and care they wanted. Some of their views were that due to ‘chaotic nature’ of staffing
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 13 arrangements at the home they were often unable to plan and get support from the staff to carry out their daily activities. The individual care plans were not comprehensive and they did not reflect the individuals’ present needs. The care plans checked by us did not have the details of the health, personal and social care needs of the individuals nor did it have the actions to be taken by the care staff to meet the identified needs. The manager and the care staff were informed of our findings. There was an undisputed agreement that the documentation did not reflect the needs of the people and that the daily records were inadequate. The staff were concerned that the documentation they were using was not user friendly and seen by them as pieces of paper they had been told to fill in. There had been ongoing problems with the care plans records. These were some of the comments received from the care staff. “The care plan is in bits and I feel its too much paperwork. In reality it did not help the residents.” “There is no useful information in the documentation. Nothing tells us what we should do. It is there and we need to write when something happens.” “Can we have a care plan that includes what the person wants, what we feel that they should get and how we are going to provide the care?” “Care plan reviews! What is that all about? Isn’t it supposed to be done with the resident? Well that doesn’t happen here.” We observed the staff interaction with the people. The staff were friendly and communicated with the people in a respectful manner. They were seen maintaining the peoples’ dignity whilst helping them. During the interviews the staff gave several examples of the ways in which they respected people’s dignity and privacy. They said that they respected people’s privacy by knocking on the doors before entering the bedrooms, making sure the people had their own clothes to wear, when delivering personal care getting permission from the person and not exposing them unnecessarily whilst giving a wash. The staff said that they had not received any formal palliative care or end of life care training. However, some staff have had experience of looking after and supporting people during death. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people who use services are on the whole able to make choices about their life style, and they are sometimes supported to develop their life skills by the care staff. The social, cultural and recreational activities offered at the home by and large did not meet the expectations of the individuals using the service. EVIDENCE: The manager said that the people were offered a variety of activities and that they employed an activities co-ordinator who worked part time. However, people said that they would prefer to go out on short trips and that the minibus did not have facilities for wheelchairs. During our visit those people who came to the communal area were all sat around in the lounge in a circle. The lounge looked very basic and the people looked bored. There were no records of the individual’s interests, preferences and their capacity to be involved in the leisure and recreational activities in and outside
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 15 the home. Some of the people were not aware of the type of activities offered at the home. The relatives and the staff said that the people were able to receive visitors and the visitors were always made welcome. The staff at the home encouraged people to exercise control over their financial affairs, and when needed, advocates were introduced. In a number of the bedrooms the people had some of their own possessions to make the rooms look and feel personalised. We observed lunch and ate the same food as the people living at the home. The food was tasty and there was a choice of food offered to the people. The people said that the food was always good and that they have had a meeting with the cook where they were able to put forward their suggestions. The manager said that the cook had started collating information on the likes and dislikes of the people living at the home so that she is able to consider the options when putting together the weekly menus. The lunchtime was unhurried and the people were given sufficient time to consume their meals. We saw the cook being involved in the serving of the meal, which helped the cook monitor how the people received the meals. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people who use the service are able to express their concerns and have access to a complaints procedure. In general the people living at the home are protected from abuse and neglect. EVIDENCE: The manager and the staff said that the people had access to the home’s complaints policy. One of the people said that s/he was happy to speak to the manager and the staff rather than going down formal lines. The manager said that they maintained records of all formal complaints. We did not check these records on this visit. Five care staff were spoken with and three staff files were checked. Out of five, three staff have had training on safe guarding adults. The staff interviewed said that they knew what types of actions were abusive and that they would report any incident to the manager, but they were not confident of the formal policies and procedures. Those staff files checked had evidence of satisfactory criminal record bureau checks having been obtained by the home before employing the staff. This ensures that people are protected by rigorous recruitment checks.
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The lack of maintenance of the building, the physical design and layout of the home does not enable people who use the service to live in safe, wellmaintained and comfortable surroundings. The environment hinders the independence of those who use the service. EVIDENCE: The tour of the premise, feedback from the people living at the home and the staff working at the home raised serious concerns with regards to the layout and the state of maintenance of the home. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 18 There had not been any recent involvement from the fire service and the environmental health service to establish whether the building complied with their requirements. There was no fire risk assessment of the building, which exposes the people using the premise at risk of harm in the event of fire. Although the manager informed us that there were plans to renovate and refurbish the home there were no definite programmes or records of completed work available at the home. The staff feedback highlighted the lack of aids and adaptations available for the people living at the home. Two relatives supported this statement and added that an assessment of the disability access around the premise and the environmental adaptation would be invaluable for this home. Such an assessment would draw attention to the work needed to ensure the people were able to access the areas of the home safely and maintain their independence. The rooms were of different sizes and shapes. The people had made their bedrooms as comfortable as they could. Some areas and rooms emitted stale/urine smell and the manager was made aware of this. The premise was cluttered and appeared ‘rundown’. There were wheelchairs and other equipment around the communal areas. The staff and the manager said that there was a lack of storeroom facilities. This made the home unsafe for the people. The manager said that the laundry room was to be refurbished and additional washing equipment was to be brought in. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. On the whole the staff working at the home are trained and have the skills they need to care for and support the people who use the service. However, the staffing numbers are low and when deciding on the numbers of care staff and domestic workers, the management are not taking into account the needs of the people, the size and layout of the home. EVIDENCE: The people’s needs were unable to be met by the lack of staff on each shift. We reached this conclusion since the ratio of care staff to people needing care was not determined according to the up to date assessed needs of the individuals. In addition there wasn’t adequate domestic staff during our visit. Instead of two domestic staff there was one and the other domestic staff was carrying out hairdressing duties. We were told that in the evenings and at the weekends the care staff were expected to run the laundry and do the catering. These were some of the comments received by us. “We should have four care staff, a laundry assistant and two domestics everyday. But what we get is three care staff and one domestic and if there
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 20 was another domestic they end up working in the laundry or doing other chores.” “ Why can’t the management recruit more care staff? It is a small homely place. I don’t think that they try hard.” “Why can’t the kitchen staff serve breakfast and tea? Often residents complain when they want to have their breakfast and we are too busy getting other residents ready in the morning. Residents don’t know that just three of us are trying to see to ‘twenty odd’ of them.” “We have told the management team about our problems when they come each month to do their audits. They all listen sympathetically and nothing happens afterwards.” Those staff interviewed said that they had either completed NVQ level 2 or were waiting to commence the training. Three staff recruitment files were checked with the help of the manager. The following were the findings and they were shared with the manager. • The application form did not ask for a full employment history. Therefore the management did not know what the candidates had done before and where they had come from. • The documentation did not include evidence that the person is physically and mentally fit for the purpose of the work, which they are to perform. There was no declaration of fitness by the employees. • One file had a recent photograph as a proof of identity but the others did not. • None of them had a statement of Terms and conditions / contract. We were told that the management were aware of this but had not responded. • None of the files checked had evidence of a face to face interview, the records of the interview and who made the decision and when to employ the staff members. Therefore we were unable to confirm whether there had been individual interviews. • All three staff had evidence of a satisfactory criminal record bureau check. • Names and contact details of the next of kin of the employees were not available and we suggested that the above details were helpful if an accident or incident happened at work and that the manager needed to contact the employee’s representative. Three staff training files were checked and the following gaps were noted and the manager was made aware of them. Not all the staff had attended the mandatory training on the following topics. Health & safety, fire safety, infection control and safeguarding adults. However, the staff have attended other training such as moving & handling, food safety and first aid. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 21 During this site visit we determined that the care staff would benefit by having the following training i.e. tissue viability, continence care, nutritional intake of older people, end of life care and managing pain. So that the staff are able to monitor, prevent and seek help from the appropriate professionals and support to the people living at St Anne’s. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is based on openness and respect for the people who use the service. However, there is a lack of leadership and unreliable monitoring of the quality assurance of the home. The systems did not protect the health, safety and welfare of the people who and the staff at the home. EVIDENCE: The registered manager has been in charge of the home since 2002. She is an experienced carer who has progressed to be the registered manager. We found that there was a clear line of accountability within the home and with the external management of the home.
St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 23 The home did not have an effective quality assurance and quality monitoring systems. Although the manager informed us that there had been a residents’ meeting and the cook was also involved. As a result they were looking at the menus. The staff were not involved in the quality assurance monitoring. One comment was, “We don’t have any quality audits. I don’t have the time or any tools. I have seen staff groups being responsible for specific areas (like health & safety, equipment audits) but here nothing like that happens.” Part of quality monitoring should involve staff views of the running of the home. The feedback from staff confirmed that the management generally did not listen to their suggestions with regards to the practices at the home and if they did they were not valued. Some people commented that the care staff do their best under the circumstances and people were protective of the staff. The manager had carried out some staff supervisions. Not all staff we contacted have had supervision in the last six months. It was evident that although the manager was willing, she did not get the appropriate assistance from the management team and had not established links with the health and social care professionals to gain advice and help so that she was able to carry out her role effectively. Throughout this report we have discussed the issues relating to the health, safety and welfare of the people and the staff at the home and how it has been compromised by the unfortunate layout, poor standard of maintenance and the lack of staff employed on each shift by the home. St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 24 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 2 X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X 2 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 Requirement Timescale for action 25/03/08 2. OP7 15 No one must be admitted to the home before their care needs have been assessed by a suitably trained person and the manager of the home had been consulted and confirmed that the home was suitable to meet the identified needs of the individual. 29/04/08 The registered person must ensure that • The present needs of the individuals’ are reflected in their care plans so that the staff are able to deliver the correct health, personal and social care. • The care plans must be reviewed and the people must be involved in the decisions. • The reviews must be carried out at least every six months. • The care plan must detail all the identified needs of the person together with specific details about what care is to be provided by staff. The decisions about the care must be based on
DS0000007964.V350147.R01.S.doc Version 5.2 St Anne`s Rest Home Page 26 3. OP8 13,14 the risk assessments completed by the staff. Previous timescale: 28.02.06, 30/04/07 not met. The manager must promote and maintain access to the appropriate primary health care teams so that the people using the service and the staff are able to receive appropriate advice and support. Furthermore the care staff must be trained on identifying those who are at risk of developing pressure sores, becoming incontinent, those who are prone to dehydration and malnourishment so that their actions could be proactive and promote health. The daily routines, leisure and social activities must be flexible and varied to suit the expectations, preferences and capacity of the people living at the home. 25/03/08 4. OP12 16 25/03/08 5. OP18 12,13,17 6. OP19 23 7. OP19 13,23 There needs to be records of people’s interests, preferences and dislikes so that the staff are able to offer suitable activities. All the staff working at the home 25/03/08 must be competent in dealing with allegations of abuse or neglect. The staff must know the homes policies and procedure to deal with safeguarding the vulnerable people they are caring for. The building must comply with 25/03/08 the requirements of the local fire service and environmental health department. The management must seek advice from the appropriate authorities. The responsible individual must 25/03/08 produce a programme for the
DS0000007964.V350147.R01.S.doc Version 5.2 Page 27 St Anne`s Rest Home 8. OP22 16,23 maintenance, essential redecoration, renovation and refurbishment work to be completed to ensure that the home is safe and comfortable for the people who live there. Previous timescale: 31/05/07 The responsible individual and the manager must ensure that the people are safe and not at risk of tripping or falling over when accessing all parts of the communal and private areas. 25/03/08 9. 10 OP26 OP27 13 18 The management must provide aids, hoists and adaptation to the baths and toilets to meet the needs of those who live at the home. All parts of the home must be 25/03/08 kept clean and free from offensive odours at all times. The number of staff on each shift 25/03/08 must reflect the assessed needs of the people, the size and the layout of the home. The manager must employ care staff, domiciliary care staff and the catering staff in sufficient numbers so that the people are able to receive the appropriate care. The registered manager must review the application form, the recruitment procedure and update the documents according to current employment laws. 11. OP29 12,19 20/05/08 12. OP30 18 Staff must be issued with a contract or Terms and conditions of their employment so that their employment is legally binding and they have rights. The manager must ensure that 25/03/08 all staff complete their learning needs analysis so that she is
DS0000007964.V350147.R01.S.doc Version 5.2 Page 28 St Anne`s Rest Home able to identify the gaps in training. The management must ensure that the training and development programme supports the requirements of the service setting so that the staff are trained for their work role. The registered manager must undertake management training to support her job role. The quality assurance systems must be based on seeking the views of the people who use the service and those who provide the service so that the management are able to measure how successful they are in meeting the stated purpose of the home. However, the people involved in this process must receive feedback so that they feel appreciated and listened to. The registered person must ensure that all staff receive supervision at least 6 times per year. Previous timescale: 28.2.06, 30/06/07 not met. The registered manager must ensure that a fire risk assessment of the whole of the home environment is carried out. Previous timescale: 28.02.06, 31/07/07 not met. 13. 14. OP31 OP33 9 24,12 20/05/08 25/03/08 15. OP36 18 25/03/08 16 OP38 23 25/03/08 St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Anne`s Rest Home DS0000007964.V350147.R01.S.doc Version 5.2 Page 31 - 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!
