Inspection on 16/10/06 for St Bernard`s Residential Care Home Ltd

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Bernard`s Residential Care... 21/01/09

St Bernard`s Residential Care... 28/03/06

St Bernard`s Residential Care... 31/10/05

St Bernard`s Residential Care... 04/03/05

St Bernard`s Residential Care... 06/09/04

St Bernard`s Residential Care... 15/03/04

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

CARE HOMES FOR OLDER PEOPLE St Bernard`s Residential Care Home Ltd 76 St Bernard`s Road Olton Solihull West Midlands B92 7BP Lead Inspector Monica Heaselgrave Key Unannounced Inspection 16th October 2006 10:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Bernard`s Residential Care Home Ltd DS0000004541.V311013.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 Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Bernard`s Residential Care Home Ltd Address 76 St Bernard`s Road Olton Solihull West Midlands B92 7BP 0121 708 0177 0121 707 6434 info@stbernardscare.co.uk 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) St Bernard’s Residential Care Home Limited Miss Ann Coombs Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28th March 2006 Brief Description of the Service: St Bernard’s provides 24-hour care for 28 service users, who are 65 years or older. It is situated in a residential area in Solihull. The house is approached via a private driveway with off road parking to the front, and extensive landscape gardens providing beautiful views from all aspects of the property. There are twenty-four single and two double bedrooms, the majority of which are fitted with en-suite facilities, which provide a good degree of privacy for service users. All bedrooms are lockable. All rooms are furnished to a high standard and provide spacious accommodation in which service users can bring their own furniture. A private telephone line can be arranged in bedrooms. An Email facility run by the home, is also available to service users. There is a passenger lift to access each level of the property, and ramped access to the front and rear. Grab rails are fitted in communal areas to provide support to service users. A call system is provided in all rooms in case assistance is required. There are three communal bathrooms these have facilities suited to those people who require assistance. Facilities meet the needs of service users living at the home. The home has hoisting equipment available for service users who have decreased mobility. An accessible well maintained garden area with outdoor seating is provided. There are three lounges and two conservatories. Each is comfortably furnished. A separate laundry, hair salon and treatment room are also available. St. Bernard’s has ample space in which service users can enjoy a range of both indoor and outdoor activity. The house retains many of its original and elegant features, which service users, are particularly pleased with. Inside the home, the reception area has notice boards, which display information about forthcoming events and other articles that may be of interest. The current charge for living at the home is £500:00 per week depending on the size of the room. Additional charges include chiropody, hairdressing, aromatherapy, day centre, toiletries and newspapers/magazines. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day lasting approximately eight hours, enabling the morning, lunchtime and evening routines to be observed. Prior to the inspection the inspector received a pre inspection questionnaire completed by the home. The inspector also received comments from service users, visiting professionals and relatives via questionnaires; these provided details of their experiences of the care and service provided. A number of service users were spoken with individually and the care delivered to service users was observed. A review of all information that the commission held since the previous inspection, was undertaken, considered and included in this report. Three service users were case tracked, to see how well their needs were met. This included looking at their care file, daily records, and the facilities available to them. Records relating to the recruitment, training, supervision, and work patterns of staff were examined. Medication records and stocks were sampled. Three care staff, the manager, and a visiting professional were spoken with. A tour of the building was undertaken and bedrooms were sampled to ensure they met with service users needs. Examination of the procedures in place to protect the health and safety of service users was undertaken. This included seeing certificates relating to the maintenance and servicing of equipment. What the service does well: There is good information to service users to help them make a choice about moving in. The needs of service users are explored before they take up residence, this means that the staff can plan carefully about how they will meet service users expectations and care needs. Service users do enjoy a range of stimulating activities, and comment favourably about what is available. Meals are varied, well balanced and nutritious which encourages service users to maintain a healthy diet. Service users, benefit from a particularly beautiful house in a nice location. There are landscaped gardens which service users access in good weather. The house is spacious and most rooms have en suite facilities, which add to the privacy of service users. The maintenance and upkeep of the house is given high priority and this ensures service users live in a comfortable and well-maintained environment. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 6 There is a consistent, stable staff group who are competent in meeting the needs of the service users. Service users describe the staff as very caring, and responsive to their needs, and this means they are comfortable with the people who support them. Both service users and relatives were complimentary of the care that is offered. What has improved since the last inspection? What they could do better: Where service users are at risk due to significant health care needs or specific support they require, a risk assessment must be carried out to show how these risks can be minimised, this must include any particular equipment that can be provided to minimise the risk and make the service user more comfortable. This information must be incorporated into their care plan so that staff have all the information they need to assist service users in a safe manner. The practices for the recruitment of staff need to improve. It is important that new staff complete a full application form and that a history of employment is explored and recorded to ensure that staff are suitable to work with vulnerable people. The absence of these checks could potentially put service users at risk. Staff supervision must be consistently maintained to enable staff and managers to monitor care skills, and give direction to staff. A clearer delegation of roles and responsibilities is needed within the management team. This will improve those areas of the care practice that have been identified as having shortfalls, and ultimately mean that service users receive a consistently high standard of care that meets with their needs. Please contact the provider for advice of actions taken in response to this St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 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 Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 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, 2, 3, 4, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is excellent information available to help service users make a choice about moving into the home. The comprehensive and well-established assessment and admission procedures ensure that the needs of service users are known, and met, and that service users know what to expect from the home. EVIDENCE: The information available to service users has been updated and now provides excellent information to prospective service users in a format suited to the needs of older people. Both the homes Statement Of Purpose and Service User Guide provide comprehensive detail regarding what to expect from the service, and these are particularly well written. Each Service User has a copy of the homes contract. These have also been improved since the last inspection, and now meet with requirements. The manager and staff team have an excellent system in place for welcoming and informing prospective service users. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 10 This includes giving them copies of these documents for them to read at leisure, and verbally explaining the process and procedures to them, should they decide to live in the home. Service users spoken with, confirmed that this experience has been very positive, and that they are happy with the information provided for them, which has enabled them to make an informed choice. The inspector received several completed questionnaires from service users confirming that they had sufficient information prior to them moving in. There is an excellent and well- established, pre- admission assessment process. This includes the service user, their family, and any relevant professionals involved with the care of the service user. Home visits are undertaken to support this process. Trial visits have been a regular feature prior to moving in. A particularly admirable feature noted, is that the Statement Of Purpose gives specific information about the need to ensure that familiar faces are on duty, throughout the admission, to welcome the service user and their family. It’s also acknowledged that a number of preliminary visits might need to take place at a pace dictated by the service user, and his or her needs. Service Users spoken to described this experience, positively. Records seen confirm that a comprehensive assessment of need is undertaken, and developed into a Care Plan. Three care plans were sampled. It was disappointing to see that these lacked significant key points, which could prevent staff from knowing how to support individuals with aspects of their care. It was positive to note that the bedrooms offered to the service users who were case tracked, were in line with their assessed needs to allow more space for a person who required mobility aids. Some pressure relieving aids were also seen to support those who were at risk of developing pressure sores. The service users’ spiritual and cultural needs are assessed and staff does make efforts to ensure that these needs are met. Service users that wish are assisted to go to local religious services or see the visiting clergy. St. Bernard’s does not provide intermediate care. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of gaps in planning could mean that service users health and social care needs are not met, and may prevent service users receiving individualised care. Good practice in respect of medication administration ensures service users receive their medication in a timely and safe manner. Service users are treated with respect and are clearly happy in the company of staff. EVIDENCE: Care plans are developed for all service users the three files examined had a plan of care generated from the initial assessment. The files of those service users case tracked showed that there were a variety of health care needs identified. These included the management of continence, diabetes, weight monitoring, risk of falls, manual handling needs and poor tissue viability, which could give rise to pressure sores developing. It was concerning to note that a tissue viability assessment had not been undertaken for one person and that the risk of developing pressure sores and St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 12 the action to be taken to minimise this risk, was not incorporated into the care plan, so that staff know how to respond to this need. There had been no assessment of any aids that might reduce the risk of pressure areas, and the bedroom viewed did not have a pressure relieving mattress this could potentially place the service user at risk. A second file had no care plan and this person had needs in relation to diabetes, manual handling, and a risk of falls. No risk assessments had been undertaken for any of these areas to show how this person was to be supported in a safe manner. A third file for a service user identified as at risk of developing pressure areas, had no risk assessment or mention of these concerns in the care plan. One service user had a risk assessment for falls, but this was out of date and had not been reviewed. In summary whilst some assessment information had been gathered and utilised to develop a care plan for daily living, there was little correlation between the assessment information and care plan. The plan of care lacked significant key points; and did not in all cases set out in detail the action that needed to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. These concerns were discussed with the manager and some immediate requirements were made to ensure the safety and wellbeing of service users. At the time of writing this report, the Commission had received confirmation that the requirements made in relation to the concerns detailed in this report, had been addressed within two days. This area will be monitored on subsequent fieldwork visits to the service to ensure that continued compliance. Service users with cognitive impairment are referred to specialist services to help meet their needs. Care plans did not however demonstrate how these needs would be met. Good dementia care looks at both strengths and weaknesses. Staff had received training in dementia care, and this is positive. The manager needs to improve the social/background profiles for service users so that staff know the values preferences, and lifestyle of the service user they are looking after, and can plan for this in a positive manner. It was positive to see that where concerns are noted staff seek medical advice, this ensures the health care needs of service users are met. Records showed that health professionals such as the G.P. district nurse, dentist and consultants offer clinical advice as to how needs should be met. The district nurse was spoken with at the time of the visit and offered positive comments as to how staff follow clinical advice given, and follow the plan of care designed by the district nurse, she felt that staff manage these needs well. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 13 The lounge and communal areas were staffed consistently through the inspection ensuring service users who are vulnerable to falls, or confused had the support they needed to keep them safe and comfortable. The medication administration records (MAR) were kept well. There were no gaps in signing for medication. There was a photograph of each service user to assist with identification. The storage of medication was secure making it safe for service users. The home had a copy of medication administration policies and procedures and showed that they were aware of what they contained. Regular audits are carried out to ensure that all medication is given out correctly and signed for this ensures that any errors made can be picked up quickly and rectified. Staff who administer medication have received appropriate training to do so. The daily records of one service user showed that there were concerns with administrating medication this had not been reported to the G.P. for advice. This concern was discussed with the manager and an immediate requirement was made to report the concerns to the G.P. for advice and follow up. Staff had good knowledge of the care routines of service users. Observations showed that staff know who needs assistance and in what areas. There was good support to assist service users moving around the home, and accessing the toilet areas. Service users were spoken to in a kind and consistent manner. Personal hygiene needs were attended to; service users appeared well cared for, appropriately dressed and comfortable. Some service users described aspects of their personal care they maintained independently, they were happy with these arrangements. The arrangements for, and facilities available to service users for personal care ensure that the privacy and dignity of service users is both protected and promoted. Staff provided a good insight into individuals’ routines demonstrating that these are known and respected. Service users described their preferred routines regarding bathing, and were particularly positive that they had use of en-suite facilities, which provided privacy. Some use the communal bathrooms, which are fully equipped to assist people who have difficulties, whilst maintaining their dignity. Service users confirmed that they have access to a phone in private, and handle their own mail and private affairs. Where this was not possible, arrangements were seen to be in place for these to be handled independently from the home, but with support to the individual to contact their solicitor, or representative. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.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 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. The activities on offer meet the expectations, and interests of service users, who do enjoy a meaningful lifestyle. However records do not reflect this. Service users are supported to maintain contact with their families and friends. Service users exercise decisions over their daily lives ensuring they maintain some independence and individuality. The dietary needs of service users are well met, they benefit from meals that are well presented, wholesome and varied. EVIDENCE: St. Bernard’s has a designated activities worker who arranges a programme of events designed to provide interest and stimulation. It is nice to note that individual staff who have a particular interest and skill in supporting service users in these events, are encouraged to take a leading role in providing activities for service users. A programme of weekly activities was on display in the foyer. This was varied and included regular exercise classes, music afternoons, quizzes and art and craft sessions. Service users said that activities are a regular feature, as is entertainment, celebrations and parties. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 15 Those service users spoken with particularly favoured a music and mobility session. Service users said there is a visiting library, and magazines and papers can be ordered and delivered on request. Those records sampled showed there is assessment information which included looking at the identity of a person, their faith, specific difficulties they experience, and any particular social or cultural interests the person has. Some of the entries read, ‘ Is a widow, of Christian faith,’ and another said ‘Has a particular interest in Africa.’ It was particularly positive to see that where individuals have conditions that may prevent them from articulating their interests, this is considered, for instance one assessment stated,’ In relation to autonomy struggles to make needs known due to speech.’ It is positive to see that the particular interests of service user are explored. Care plans specify the routines people preferred, and the social and recreational activities, and interests service users have, for instance, ‘Likes to read newspapers and books’. Unfortunately the daily records looked at for the previous month, lacked any detail that would allow staff to monitor whether these things were being offered or taken up by service users. There was no accurate means of monitoring whether service users were engaging in activities, and this was particularly sad as from other sources it was evident that a great deal of positive social activity is made available, and a lot of effort and time is put into supporting service users in this area. Staff do themselves a disservice by not recording the good things that they do. Several people were able to describe flexible routines in relation to getting up and retiring to bed, personal care, and routines personal to them. This was also seen to be the case at the time of the visit. It was positive to see that service users were enjoying meaningful activities, some service users were relaxing in their rooms, or chatting in the lounge, some were having their hair done in the salon, and a group preparing to go out to lunch. Contact with family and visitors is known and respected. Staff have supported service users in maintaining contact and relatives said that staff had provided snacks and refreshments and a private room. Meals in the home, featured highly in service users estimations. A number of service users commented very favourably, upon the quality and variety of food. At lunchtime service users were seen to choose where they ate their meal, either in the lounge, dining room or their own bedroom. Service users said they are given choices, and can request food or drinks in between. The menu was on display in the foyer. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 16 Service Users were seen to have appropriate support to eat their meals, and food and fluid intake is monitored where concerns are evident. The meal on the day was nicely presented with service users saying the portions were to their liking. The questionnaires returned to the Commission included very favourable comments from service users in relation to the meals provided. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 17 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, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives were confident that their concerns would be taken seriously, and all have access to the complaints procedure should they need to make a complaint. The home showed that they are able to protect vulnerable service users in their care. EVIDENCE: The Commission has not received any complaints about this service. Service users spoken to were clear that they would speak to the manager if there were a problem. Relatives were happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. Each service user had a copy of the complaint procedure in their bedroom, and the details of how to contact Commission should they wish to register a concern. Where the service user has dementia and possibly could not advocate for themselves family or representatives had this information. A compliments book is maintained which enables visitors to comment on the care delivered, the entries were positive. The monthly regulation 26 visits showed that compliments and complaints are audited, this is a good means of quality assurance and another means of the service being able to obtain the views of people in order to make any improvements. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 18 The financial arrangements for the majority of service users are not handled by the home. Most service users have arrangements with their family, solicitors or Power Of Attorney to protect their interests. Those spoken with were happy with these arrangements. Two service users currently part manage their personal allowances. Records of service users personal allowances were sampled, and demonstrated that all transactions are recorded and receipted. Money held by the home for the service users was audited and tallied with the records seen. Service users have secure facilities in which to maintain their money or valuables. Inventories of possessions are maintained on file. Service users commented that they have assistance to make a shopping list and staff will undertake this for them. They were happy with these arrangements. The care records of service users were sampled, and where applicable these clearly recorded their legal status, including any restrictions regarding their financial concerns. The manager has experience in liaising with families and or persons who have power of attorney. Service users can participate in the civic process if they wish, and are enabled to vote in elections either via postal votes, or attending polling stations. The pre inspection questionnaire completed by the manager prior to the inspection stated that Adult Protection Procedures and Whistle Blowing procedures were available, and recently reviewed, to ensure they are in line with current good practice. These were not examined at this visit. Staff training records showed that most staff had received training in how to recognise abusive situations and how to respond to them, this ensures they can safeguard service users. Staff interviewed during the visit had a good awareness of what to do in such circumstances. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 19 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, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users live in a safe, well- maintained and comfortable environment. They have the range of equipment necessary to support their care needs, and benefit from high standards of cleanliness and hygiene. EVIDENCE: St. Bernard’s is a large elegant house, which retains many of its original features. It is spacious, enabling service users to access all parts without difficulty. There is a passenger lift to access all floors, and ramped access to the front and rear gardens. The décor and furnishings are tastefully in keeping with the elegance of the house. Service users are positive about their surroundings, many have their own possessions around them, which is made possible, by the good size of many of the bedrooms seen. Service users said they were happy with the décor and St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 20 furnishings in their rooms, which are lockable providing them with security for their possessions. Bedrooms are equipped with en-suite facilities, and communal bathrooms are adapted and fitted with aids and equipment to assist those service users who may experience difficulties. The bedrooms of two service users’, who are at risk of developing pressure areas, did not have pressure-relieving mattresses. One had a chair cushion but this was compromised with a towelling cover over it. The specific requirements of these service users must be in line with their tissue viability assessment and the necessary aids provided to them. An immediate requirement was left with the manager to action this. Corridors and communal areas are fitted with grab rails to assist service users. A call system is installed which enables service users to determine when they need help. An assessment of the premises has been undertaken and the services of the Occupational Therapist have been enlisted to ensure service users have the equipment required for specific needs. There are several communal areas and two conservatories, which enable service users to determine to what extent they socialise with others. The lighting is domestic and creates a soft homely atmosphere. Radiators are covered to prevent burns, and window catches are evident to prevent injury from falls. There are dedicated facilities for hairdressing, a treatment room and laundry area. The facilities offer a good degree of privacy to service users, as they can have their hair done out of view, and have their own en-suite for personal care, and engage in small group activities of their liking. The environment is safe, comfortable and continues to be well maintained. Since the last visit five bedrooms have been redecorated and newly carpeted, and the hallways and landings have also been redecorated, this ensures that the environment for service users is kept in a very good state of repair and is comfortable. Maintenance standards are clearly given a good degree of priority, and service users themselves consider this an area that is important to them, and enjoy the benefits of a beautiful home environment. There are extensive landscaped gardens to the rear, which service users can access and enjoy without difficulty. All areas of the home were found to be clean, and odour free. There are dedicated staff to undertake cleaning and laundry with good infection control procedures in place. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to the service. There is a well-established staff team, which ensures continuity of care for service users. Recruitment procedures were not consistently followed and this could put service users at risk. Staff training is structured to ensure staff acquire the skills and knowledge to support service users in a competent manner. EVIDENCE: Staffing levels were assessed and rotas sampled these indicated that five care staff, one senior, and an activities worker cover each morning shift. The staffing compliment is good and ensures that service users have the support with their care needs as well as there being good opportunity for staff to plan activities for service users to engage in both in and outside of the home. The staff seen on duty matched the rota sampled. In addition a cook and housekeeper are employed who ensure that standards relating to food and cleanliness are maintained. The service also has the benefit of an administrative worker. The pre inspection questionnaire submitted to the Commission by the manager showed that 61 of the team have NVQ level 2, and twenty staff holds a current first aid certificate. There continues to be good awareness of the needs of service users, and staff are competent in the roles they undertake, which ensures that service users are in safe hands. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 22 The recruitment files of two staff were sampled. Both evidenced two references and CRB clearance. There was an application form this was poorly completed in pencil with no previous employment history or previous qualifications. The second file had a completed application form and history of employment. The manager must ensure that all the checks necessary for the safety of service users are undertaken prior to staff taking up post, this includes exploring previous employment history and any gaps, and ensuring a completed application form is submitted and retained. Staff training and induction continues to follow the Skills for Care targets. This will further ensure that staff, have the skills and knowledge to meet the assessed needs of services users accommodated. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 23 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, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of service users care and money was thorough and protected them. Systems to monitor the service being delivered and the assessment of risk was not always consistent and this means that problems with the service may not be identified and acted upon quickly enough to prevent potential harm to service users. EVIDENCE: The manager is experienced in the conditions that affect older service users. She holds the NVQ level 4 in management and care and the Registered Managers Award. She has several years of experience in caring for older persons, and managing a staff team. Service users speak positively about their inclusion in events within the home. The inspector received ten completed questionnaires from service users and St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 24 relatives these showed they were satisfied with the care standards this service provides. Relatives felt that their concerns are listened to and that they are made welcome and kept involved. Observations made of the care practices, and routines demonstrate that the home is well run, by a capable manager. Service users and staff spoke positively of the ethos of the home. There are many platforms in which service users felt they could contribute to the way the home is run, this included service user meetings, Key Worker sessions, and a quality assurance system. A news letter has been published to inform service users, families and visiting professionals of events within the home, and this included information obtained from service users about their experiences and opinions of the service offered. This is an excellent achievement for St. Bernards’ and one they wish to continue with in order to improve service delivery to the service user. Staff meetings are well established and provide a good sense of direction for staff in undertaking their role and responsibilities. Formal supervision has not been as consistent. At previous visits to the service it was recommended that the task of supervising staff be shared amongst the senior team. This has not been yet taken place, and there are still lengthy gaps evident on those files sampled. It is important that regular staff supervision takes place in order to provide staff with a platform in which their practice can be appraised as well as providing a sense of direction in their work. Since the last inspection there has been further developments in updating training for staff. The manager has purchased the TOPPS training package, all the training records have been updated and a training matrix implemented in line with TOPPS requirements. These developments will ensure that staff have, the opportunity to develop their skill in meeting the needs of the people accommodated. Statutory records were well organised, and well maintained. Records of service users’ finances held at the home meet the standard. Records relating to the depositing of valuables in the home for safekeeping are robust. All the records seen balanced with the amount of money held. The home kept individual receipts for all spending of money. Regular financial audits are carried out in order to safeguard service users’ money. There are appropriate arrangements to ensure the health and safety of both service users and staff. Appropriate maintenance and inspection certificates for all appliances were seen. Visits are taking place by the Registered provider on a monthly basis copies of these reports were available at the home. The arrangements for ensuring safe working practices are relatively good, staff have received appropriate training in these areas but this could be St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 25 compromised by the lack of including the outcome of risk assessments in care plans, for instance, manual handling, diabetes, medication, tissue viability assessments and use of pressure relieving equipment had not been incorporated into service users care plans.This could potentially place service users at risk. During the visit an immediate requirement report was left with the manager about the things that she needed to take action on, in order to safeguard service users. The use of dedicated staff should ensure that all have delegated roles and that tasks are deployed and covered appropriately, however some aspects of this seem not to be working, for instance the staff supervision is not on target and as stated previously care planning and management of risk have not been kept up to date. The manager informed the inspector that the senior team are undergoing a re organisation so that specific roles and responsibilities can be designated, it is anticipated that once these changes have been implemented that those areas of practice that have some shortfalls, will be more quickly picked up and acted upon to ensure the wellbeing of service users. The manager must ensure that members of the management team are clear in their tasks and that more effective delegation takes place in order to ensure seniors are monitoring the care practice, and identifying shortfalls to be rectified. In this manner the wellbeing of service users will not be compromised. St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 26 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X 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 3 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 2 St Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 27 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 Timescale for action 18/12/06 2 OP7 3 OP7 4 OP7 5 OP9 The responsible person must ensure all service users have a care plan that identifies their needs and the action to be taken to meet these needs. Care plans must be regularly reviewed. 17(1)(a) 3 The responsible person must (m) ensure that tissue viability assessments are carried out, and the outcome of these incorporated into the care plan. This is an immediate requirement. 17(1)(a) 3 The responsible person must (m) ensure that the care plan details how the needs of service users who have diabetes are to be met. This is an immediate requirement. 13(5) The responsible person must ensure that manual handling risk assessments are carried out and the significant findings of these incorporated into the service user care plan. This is an immediate requirement. 13(2) The responsible person must ensure that an immediate referral to the G.P. is made to DS0000004541.V311013.R01.S.doc 18/10/06 18/10/06 18/10/06 18/10/06 St Bernard`s Residential Care Home Ltd Version 5.2 Page 28 6 OP12 16(2)(n) 7 OP22 12(1)(b) 8 OP29 19(5) (b) 9 OP36 18 (2) 10 OP38 24(1) (a) & (b) follow up concerns in relation to administrating service user medication. This is an immediate requirement. The responsible person must ensure that each service user has a care plan that specifies their social and recreational activity interests. Daily records must be maintained to demonstrate what activities service users engage in. The responsible person must ensure that service users at risk of pressure sores have the equipment and aids necessary to reducing the risk. This is an immediate requirement. The responsible person must ensure that all the necessary checks are undertaken when recruiting care staff. This must include a full and complete application form and a work history. The responsible person must ensure that all staff receive formal, recorded supervision on a regular basis. The responsible person must ensure there is a system that ensures the significant findings of risk assessments are specified in service user care plans. That there is a system for reviewing at appropriate intervals and improving the quality of care. 16/12/06 18/10/06 16/12/06 16/12/06 16/12/06 St Bernard`s Residential Care Home Ltd DS0000004541.V311013.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 Bernard`s Residential Care Home Ltd DS0000004541.V311013.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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