CARE HOMES FOR OLDER PEOPLE
St Anthonys Residential Home 126 Sutton Road Erdington Birmingham B23 5TJ Lead Inspector
Brenda O’Neill Key Unannounced Inspection 3rd September 2007 09:15 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 Anthonys Residential Home DS0000016780.V349383.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 Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Anthonys Residential Home Address 126 Sutton Road Erdington Birmingham B23 5TJ 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) 0121 373 7900 0121 382 7911 Mr Tim Kelly Mrs Isabel Smith Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 17 Service Users who are over 65 years of age and fall within the category of old age. One named person under the age of 65 years of age at the time of admission can be accommodated and cared for in this home. 19th May 2006 Date of last inspection Brief Description of the Service: St Anthony’s residential home offers residential care for eighteen older people. The home is a large detached two storey property which has been extensively renovated, extended and decorated to a high standard. The home is situated close to local amenities and public transport. The rooms are all suitably furnished and equipped to meet the needs of the occupants. The decor throughout is homely. St Anthony’s provides a total of fifteen bedrooms consisting of twelve single and three double bedrooms, which are situated on both the ground and first floors. There is an attractive dining room, two lounges and a dedicated smoking area. All bedrooms and communal areas have access to a call system. Whilst none of the bedrooms have en suite facilities there are ample assisted bathing and toilet facilities to meet the current needs of the people living in the home. The home has vertical lift access to the first floor. There is limited parking at the front of the home. The inspector was informed that the fees at the home at the time of the inspection ranged from £406.78 to £428.14. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was carried out by one inspector over one day in September 2007. During the course of the inspection a tour of the home was undertaken, the files for two of the people living in the home and two staff were sampled as well as other care, staff and health and safety documentation. The inspector spoke with the manager, the proprietor, two staff members and six of the people living in the home. Prior to the inspection a completed Annual Quality Assurance Assessment was returned to the Commission that gave some additional information about the home. Some questionnaires were sent out to the people living in the home and some of their relatives, seven of these were returned and all the comments received about the service were very positive. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes a person whose knowledge about social care services comes directly from using them. What the service does well:
Evidence gathered throughout this inspection showed that the people living in the home felt they were offered a good service and they all appeared quite happy. The expert by experience commented: ‘St Anthonys residential home is well worthy of the title Care Home’. Clearly people wanting to move into the home were encouraged to visit the home before going to live there. Comments received included. From the expert by experience ‘Prospective new residents are encouraged to visit daily over a period of weeks to see how they feel and allow for Staff to assess requirements and integration with other residents. Thus keeping a happy balance.’ Comments from the people living in the home included ‘I came once a week to see if I liked the home. Isabel and staff were very good and the meals were lovely’ and ‘ I met the lady who runs the home and knew she was the one for me.’ Health care needs were being identified, followed up and monitored by staff. Clearly the people living in the home had access to health care professionals.
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 6 The expert by experience commented ‘There is a good liaison between doctors and district nurses, with prompt service being given by both to the residents, who have a choice of keeping to their own Doctor or joining a nearby practice which attends the home.’ There were no rigid rules or routines in the home and the people living in the home were clearly very content. There was a range of activities available for the people living in the home to participate in if they wished. Comments by the expert by experience in relation to activities were ‘Activities are provided in house throughout the week including specialised keep fit to music with a quiz. The Proprietor pays for and supports outside social activities throughout the year.’ Visitors were welcomed into the home at all times. Clearly the staff at the home kept in close contact with relatives and the people living in the home were also encouraged to do this. The expert by experience spoke to the people living in the home about visiting and she stated ‘Residents are free to entertain guests in their bedrooms, community rooms or garden.’ The expert by experience concluded that ‘Residents control their own lives from waking to bedtime, shopping or going into the community to socialise or for religious services, transport is provided by family, friends, ring and ride or taxi. All residents have full control/choice over their daily lives.’ Meals at the home were varied and nutritious. All the people living in the home that were spoken with were happy with the meals they were served. Their comments included: ‘We are given choice at meals.’ ‘If a meal is not liked something else is found for you.’ ‘If there is anything that can be applauded it is the question of meals. Every effort is made to suit the wishes of the inmates and the result is every body is happy about the meals.’ The expert by experience commented ‘Meals are of an excellent quality with tender meat and small cut vegetables, well presented and pleasing to eat. Making it easy for residents to feed themselves without assistance.’ The people living in the home were very comfortable in the presence of the staff and the manager which would give them the confidence to raise any concerns. The people living in the home were being cared for by a well trained stable staff team. Comments received about the staff team were very positive and included: ‘Everything possible is carried out to the highest standard.’ ‘Well staffed.’ ‘Treat people with dignity and respect.’ ‘Staff are very good.’ The expert by experience commented: ‘ All staff are friendly and respectful to residents.’
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 7 The home was very well managed by a manager who set very high standards and expected the staff to follow them. The home was well maintained, safe and comfortable and all the people living in the home that were spoken with were satisfied with their environment. What has improved since the last inspection? What they could do better:
Care plans needed to reflect the current needs of the people living in the home to ensure they received person centred care. To ensure the people living in the home and the staff were fully safeguarded the manual handling assessments needed to include specific details about the equipment and methods to be used. Any challenging behaviours and issues of pressure care needed to have management plans in place for staff to follow to ensure the people living in the home were safeguarded. Some improvements were needed in the management of medication to ensure it could be guaranteed that the people living in the home received their medication safely and as prescribed. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 8 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 Anthonys Residential Home DS0000016780.V349383.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 Anthonys Residential Home DS0000016780.V349383.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, 2, 3, and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available, and pre-admission assessment process ensured that people considering living in the home had enough information to make an informed choice about living at the home, and know that the home could meet their needs. EVIDENCE: There was an information pack available for any people wishing to move into the home to help them decide if the home could meet their needs. The file for one person admitted to the home since the last inspection was sampled. It was evident that a social worker had been involved in the admission process as there was a care plan drawn up by them. The home had undertaken their own pre admission assessment also and this covered all the required areas. It is recommended that the home obtain a copy of the full assessment undertaken by the social worker to ensure they have as much
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 11 information as possible about any people wanting to move into the home. Clearly people wanting to move into the home were encouraged to visit the home before going to live there. Comments received included. From the expert by experience ‘Prospective new residents are encouraged to visit daily over a period of weeks to see how they feel and allow for Staff to assess requirements and integration with other residents. Thus keeping a happy balance.’ Comments from the people living in the home included ‘I came once a week to see if I liked the home. Isobel and staff were very good and the meals were lovely’ and ‘ I met the lady who runs the home and knew she was the one for me.’ The file sampled evidenced that people going to live in the home were issued with a statement of terms and conditions of residence at the home and this had been amended as required at the last inspection to include the room number to be occupied. St Anthonys Residential Home DS0000016780.V349383.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, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments needed to be improved to ensure the current needs of the people living in the home were evident to staff and all identified risks had management plans in place. Health and personal care needs were met with the additional support of visiting health care professionals. Management of the medicines in the home needed to be improved to ensure the safety of the people living there. EVIDENCE: The care plans, risk assessments, daily and health care records for two of the people living in the home were sampled. One of these individuals had lived at the home for a considerable amount of time the other for a few months. The care plan files included personal profiles which gave details of the individuals’ history and the circumstances leading to their admission to the home. Included in the files were details of the individuals’ preferences in
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 13 relation to their daily lives, general assessments of their physical condition and physical health. It was clear from one of the care plans that the individual was quite independent and able to direct his own care but would ask for help when needed. The care plan was being reviewed monthly and six monthly. It was clear the individual had been present at the six monthly review and had commented he thought his care was excellent and did not want any changes. The other care plan was for a person who had dementia and was very dependent on the staff for her care. She had been in the home for a considerable amount and it was evident when reading the monthly evaluations that her condition had deteriorated. Any changes had been noted in the evaluations but had not been updated onto the care plan. These changes would be lost amongst the many evaluation sheets and needed to be entered on the care plan to ensure it always reflected the current needs of the individual. Clearly staff who had worked at the home for a considerable amount of time knew the individual’s needs however new staff needed this information available to them also. This was discussed with the manager at the time of the inspection and also that where people are not able to direct their own care there needed to be specific details of the assistance they required. This individuals’ care plan stated ‘help needed’ newer staff would not know what help or assistance was needed unless it was specifically detailed. There were risk assessments in place on both files sampled for manual handling, falls, personal risks, mental health, behaviour, physical health and nutrition. Some of these needed to be further developed and have management plans in place for any identified risks. For example, one of the falls risk assessments put the individual at a high risk of falling and stated ‘in case of fall if no apparent injury use at least 2 staff’ but it did not state what the two staff were to do. Any moving and handling instructions needed to be clearly detailed so that staff were clear of how to move people safely. It also stated on one of the files that the person could display some challenging behaviour when staff were trying to assist with personal care. There was no management plan in place for staff to follow detailing how they were to manage this behaviour when it did occur. One of the files sampled evidenced that the district nurse was visiting the individual on a regular basis due to some pressure areas however there was no care plan in place for the management of the pressure areas in the home, for example, did the individual have a pressure cushion or mattress whilst in the home. Clearly the individual did have some equipment for managing her pressure areas but again this needed to be detailed in the care plan so that staff were aware it must be used. It also appeared this individual was being turned at night and there were no handling instructions for staff to follow in relation to this. Daily records gave some details of the personal care needs of the people living in the home being met. Comments by the expert by experience included, ‘All
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 14 residents were well groomed, hair and nails well attended to. Clothes were well fitting and colour co-coordinated. Hairdressing is available in house weekly.’ Staff needed to be mindful that they recorded exactly what was happening in the home, for example, one of the daily records stated ‘quite aggressive teatime’ with no explanation of whether this was verbal or physical aggression and what had led them to this conclusion. Another of the records showed that one of the individuals had some bruising but there was no evidence that this had been explored. This was discussed with the manager and she stated this detail was in the handover book. It was discussed that this information needed to be on the individual’s records and not in a communal recording book. This would ensure information could be tracked and also ensure the confidentiality of the person. Health care needs were being identified, followed up and monitored by staff. Clearly the people living in the home had access to health care professionals including doctors, district nurses, chiropodists, opticians and dentists. Staff needed to be mindful that they recorded the outcome of any health care appointments so that all staff were aware of the information, for example, one of the records stated ‘results from scan’ with no explanation as to what these were. The inspector spoke with a visiting doctor and he was very positive about the care being offered at the home. He stated that whenever possible the people living in the home were taken to see him and he knew that if he was called out it was essential. The expert by experience commented ‘There is a good liaison between doctors and district nurses, with prompt service being given by both to the residents, who have a choice of keeping to their own Doctor or joining a nearby practice which attends the home.’ Medication was administered via a 28 day monitored dosage system. A random audit of the system was undertaken. The medication had not been booked in on the MAR (medication administration record) chart when received in the home. The inspector was informed that any unused medication was always returned to the pharmacist at the end of the 28 day cycle therefore it should have been possible to undertake an audit on the basis of the amount of medication detailed on the boxes and blister packs. Several discrepancies were found where the amounts of tablets remaining in boxes did not correspond with what had been received and what had been administered. The manager needed to audit the staff on a regular basis to establish their competence for administering medication. The blister packs were being appropriately administered. One of the people living in the home was self administering their medication and there was a risk assessment in place for this. The manager stated she did do compliance checks on this but did not make any records. It was strongly recommended that written records of compliance checks were kept. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 15 It was noted that the medication was kept upstairs and taken downstairs in a laundry basket when it was to be administered. It was strongly recommended that a drug trolley was obtained so that all medication could be kept in it and transported when necessary. The people living in the home were treated with respect and their rights to privacy upheld. Staff were very polite and interacted well with the people living in the home. Individuals could spend time in their bedrooms without being disturbed if they wished. Double bedrooms had appropriate screening in place. Individuals were asked if they wanted locks on their bedroom doors and if so these were fitted. Assistance with personal care was offered discreetly. All the people living in the home that were spoken with were very happy with the care they were receiving. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home were able to exercise choice and control over their daily lives. Social contact and the activities they chose to participate in, promoted their individuality and independence. The people living in the home received a wholesome and varied diet that met any special dietary requirements. EVIDENCE: There were no rigid rules or routines in the home and the people living there were clearly very content. The inspector arrived at a busy time of day and the home was calm and relaxed. Some of the people living in the home were still having breakfast, others had finished and some were still getting up. There was a range of activities available for the people living in the home to participate in if they wished. Activities documented for August included skittles, games afternoon, keep fit, video evening, keep fit and a meal at the local pub. Staff were recording if the people living in the home had participated in the activities and if they had enjoyed them. The range of activities offered was discussed with them on a regular basis. It was also evident from daily
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 17 records that individuals also pursued their own leisure interests, for example, going out for a coffee, visiting the shops, reading and watching television. The expert by experience commented in relation to activities included: ‘Activities are provided in house throughout the week including specialised keep fit to music with a quiz. The Proprietor pays for and supports outside social activities throughout the year.’ One of the people living in the home commented ‘we have exercises for hands, legs and feet fortnightly, occasionally taken out for coffee, big outing once a year, the hairdresser comes weekly.’ Visitors were welcomed into the home at all times. Clearly the staff at the home kept in close contact with relatives and the people living in the home were also encouraged to do this. The expert by experience spoke to the people living in the home about visiting and she stated ‘Residents are free to entertain guests in their bedrooms, community rooms or garden.’ The manager stated that when any of the people living in the home are in hospital if their relatives live a long way off they could stay at the home so that they are able to visit the hospital easily. The expert by experience was specifically asked to look at what choices and control the people living in the home have over their lives her conclusions after spending a considerable amount of time with the individuals were, ‘Residents control their own lives from waking to bedtime, shopping or going into the community to socialise or for religious services, transport is provided by family, friends, ring and ride or taxi. All residents have full control/choice over their daily lives.’ Meals in the home were varied and nutritious and it was clear after having a cup of tea at breakfast time and lunch with the people living in the home that staff were well aware of their likes and dislikes. For example, at breakfast some individuals had toast, some bread and butter some with the crusts off others with them on and so on. The inspector and the expert by experience had lunch with the people living in the home and the meal was very well cooked and presented. It was pleasing to note that the crockery was of very good quality, condiments were available and people were encouraged to be as independent as possible by helping themselves to gravy and such like. The expert by experience commented ‘Meals are of an excellent quality with tender meat and small cut vegetables, well presented and pleasing to eat. Making it easy for residents to feed themselves without assistance, squash or water is offered with the meal. Some residents have their meals served in their room. Tea/Coffee with biscuits is readily available at any time if requested. Family and visitors are encouraged to take meals when visiting, thus giving residents a feel of offering their own hospitality.’ The people living in the home were clearly very happy with the meals served at
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 18 the home and commented: ‘We are given choice at meals.’ ‘If a meal is not liked something else is found for you.’ ‘If there is anything that can be applauded it is the question of meals. Every effort is made to suit the wishes of the inmates and the result is every body is happy about the meals.’ St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home had access to a complaints procedure and issues they raised were listened to and acted on. EVIDENCE: The complaints and adult protection procedures were not viewed at this inspection as they have been seen at previous inspections and were found to be comprehensive. No complaints had been lodged with the Commission since the last inspection. There were four complaints in the home’s complaints register all of which had been raised by the people living in the home. These were all about environmental issues, for example, the bushes in the garden being overgrown and the toilet door sticking and all had been addressed appropriately. The people living in the home were very comfortable in the presence of the staff and the manager which would give them the confidence to raise any concerns. Comments received from the people living in the home and their relatives about raising complaints included: ‘I would complain to Isabel. (Manager)’ ‘I would speak to Isabel.’ ‘I have a document giving me the procedure if I need it.’ ‘Never needed to raise any concerns.’ ‘It is rare for there to be justified complaints.’
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 20 No adult protection issues had been raised at the home and the majority staff had received training in adult protection issues. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 21 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, 20, 21, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. St. Anthony’s provides the people living there with a safe, comfortable, homely and clean environment in which to live. EVIDENCE: A tour of the home was undertaken. The home was very well maintained, safe and comfortable. The home has an ongoing plan for refurbishment and redecoration. The people living in the home were clearly very comfortable and those spoken with stated they were very happy with the environment. There was ample communal space at the home with two lounges and a dining room all of which were nicely furnished and decorated. The expert by experience commented ‘All Community rooms are warm and well furnished with plenty of clear walking area and well lit. There are two lounges for residents to use, one used as a quiet room for reading and quieter pursuits the
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 22 other for television and social activities.’ There were adequate numbers of toilets throughout the home. The people living in the home had a choice of either having a bath or a shower. Both the bathroom and shower room were fully assisted facilities. The shower room had been refurbished and both rooms were very pleasant. The expert by experience stated about the toilet and bathing facilities ‘Bathrooms and toilets were very clean, warm, well lit, with ample equipment for easy use by residents’. The aids and adaptations throughout the home met with the needs of the people living in the home and included, hand and grab rails, shaft lift, ramps and emergency call system. The majority of the bedrooms were seen during the tour of the home and these were all nicely furnished and decorated. All the bedrooms had had new curtains and carpets and decoration were upgraded whenever necessary. Clearly the manager and the proprietor did all they could to ensure the occupants of the rooms had all they needed. For example, the owner of the home provided televisions in the bedrooms. The majority of the rooms had a lockable facility for personal effects and people living in the home were asked if they wanted a lock on their doors. All the rooms seen were personalised to the occupants’ choosing. The home was clean and hygienic throughout. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home were being cared for by a well trained stable staff team. The recruitment procedures were robust and safe guarded the people living in the home. EVIDENCE: There had been little staff turnover at the home since the last inspection and many of the staff had worked at the home for a considerable amount of time. This ensured good continuity of care for the people living in the home. Comments received from the people living in the home and their relatives showed that relationships with the staff and the service offered at the home were good. These included: ‘Everything possible is carried out to the highest standard.’ ‘Well staffed.’ ‘Treat people with dignity and respect.’ ‘Staff are very good.’ The expert by experience commented: ‘ All staff are friendly and respectful to residents.’ Copies of the rotas were taken and these showed that the staffing levels were appropriate for the needs of the people living in the home at the time of the inspection. The manager’s hours were supernumery to the care rota and the
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 24 home also employed domestic and catering staff. The home had also employed a member of staff to undertake administration tasks. The recruitment files for two staff employed since the last inspection were sampled. The files included all the required documentation, with the exception of one CRB check which was faxed to the inspector after the inspection. In both cases more than two references had been obtained. The information received prior to the inspection stated that all staff had completed their NVQ level 2 which is to be commended. New care staff were undertaking induction training as specified for Skills for Care and records of this was kept on site. There was evidence on site that staff undertake a variety of training including, manual handling, safe handling of medicines, infection control, continence promotion, first aid and food hygiene. It was recommended that the home have a training matrix that details all the training staff have undertaken with dates and when they are due for an update. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 25 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, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensured the smooth running of the home with support from the owner. The health and safety of the people living in the home and the staff were very well managed. EVIDENCE: The manager had worked at the home for many years. She was clearly a very experienced and committed manager who set very high standards and expected them to be followed by staff. She knew the people living in the home very well and was very much a ‘hands on’ manager. She was very receptive to all the comments made by the inspector about the care plans, risk assessments and medication system. The inspector was left in no doubt that any requirements made would be met. The manager had completed her
St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 26 Registered Managers Award since the last inspection and regularly updated her training along with staff. The owner of the home was a regular visitor and was known by the people living in the home. There was a quality monitoring system in place at the home. Audits of the standards in the home were undertaken on a regular basis. The people living in the home were listened to and their views taken into consideration in relation to the running of the home. The owner of the home was also involved with the quality management process. The information received prior to the inspection stated the home were hoping to involve staff more in the quality monitoring in the home over the next twelve months. The home was managing some money on behalf of some of the people living there. The records for this were sampled. All income and expenditure was detailed with receipts obtained for all expenditure. It was recommended that wherever possible there should be two staff signatures for any expenditure and that the hairdresser should sign the receipts issued. There was a small discrepancy in one of the cash balances checked however this was to be looked into straight away. Health and safety in the home were very well managed. Staff had received training in safe working practices and protective clothing was available as needed. The only health and safety issue raised in the environment were some worn kitchen surfaces however this was already scheduled to be addressed. The information received prior to the inspection detailed that all the required servicing of equipment was up to date. Accident and incident recording and reporting were appropriate. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 27 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No. 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 OP7 Regulation 15(1) Requirement Care plans must reflect the current needs of the people living in the home. This will ensure the people living in the home receive person centred care. Moving and handling assessments must include specific details of the methods and equipment to be used for any tasks staff are to undertake. This will ensure the people living in the home and the staff are safeguarded. There must be management plans in place for staff to follow for any challenging behaviours. Timescale for action 31/10/07 2. OP7 13(5) 20/10/07 3. OP7 13(4) 20/10/07 4. OP8 12(1)(a) This will ensure the people living in the home are safeguarded. There must be detailed plans in 20/10/07 place for the management of any pressure areas individuals have. This will ensure the people living in the home are safeguarded. All medication received into the
DS0000016780.V349383.R01.S.doc 5. OP9 13(2) 20/10/07
Page 29 St Anthonys Residential Home Version 5.2 home must be entered on the MAR chart to enable a full audit trail. Regular staff drug audits must take place to assess staff competence in medicine management. Appropriate action must be taken when discrepancies are found. Written records must be kept of the compliance checks for people self administering their medication. This will ensure the people living in the home receive their medication safely and as prescribed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations It is strongly recommended that a copy of the social workers assessment is obtained prior to the admission of any people to the home. This will ensure the staff at the home have comprehensive information about the individual. Staff should ensure that daily records are exact and detail exactly what has happened in the event of any incidents. The outcomes of any health care visits should be recorded so that all staff are aware of the current situation with the individual. It is strongly recommended that a drug trolley be obtained for the storage and transporting of medication. Personal details about the people living in the home should not be recorded in a communal book. It is recommended that the home has a training matrix that details the dates and training undertaken by all staff
DS0000016780.V349383.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. OP8 OP8 OP9 OP10 OP30 St Anthonys Residential Home 7. OP35 and when they are due for an update. It is recommended that wherever possible two staff sign for any expenditure made on behalf of the people living in the home. The hairdresser should sign the receipts issued. St Anthonys Residential Home DS0000016780.V349383.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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
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