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 Unannounced Inspection 28th March 2006 09:40 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.V287726.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 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 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.V287726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: St Bernards 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, some with en-suite facilities. All are lockable. There are three communal bathrooms with hydro hoists to assist service users. 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 lounges and two conservatories. Each is comfortably furnished. A separate laundry, hair salon and treatment room are also available. The house retains many of its original and elegant features, which service users, are particularly pleased with. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a weekday, between 09.40 hours and 13.00 hours. The inspector met with the manager, assistant manager and two care staff. A number of service users were spoken to individually. Observation of the daily routine was made, to include the arts and crafts session. Service users were also observed utilising the beauty salon, and a group of service users went out for tea at Henley. A tour of the premises was undertaken. A number of records were inspected to include assessments, care plans, medication, and service users finances. Training records and staff rotas were also inspected. This is the second of two inspection visits. Both reports should be read in conjunction, particularly given that the first inspection visit covered the majority of the areas assessed. What the service does well: What has improved since the last inspection?
St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 6 The manager and her staff team have continued to maintain high standards of care and service delivery. At the previous inspection new systems in care planning and record keeping had been introduced. At this inspection these were well established. Records were up to date and well maintained, enabling an easy audit trail. Recommendations made at the previous inspection, had been followed up. A ‘snug ‘area for service users has been created, and the dining room table relocated to ease access for service users. The quality assurance system is now established, the views of service users and their families have been sought, and the manager is intending to publish the results of service user surveys to demonstrate how well they meet the aims of the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 7 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.V287726.R01.S.doc Version 5.1 Page 8 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): EVIDENCE: Five of these standards were assessed at the last inspection in October 2005. All were met. St. Bernards does not provide intermediate care. This standard is not applicable. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 9 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): 9, 11 The arrangements for the management of medication are good, there are clear procedures supported with staff training that ensure medication is administered safely to service users. There are procedures in place that support the preferences of service users at the time of their death. EVIDENCE: At the previous inspection standards 7, 8 and 10 were assessed and met. During the inspection medication records and storage were examined. Staff had a good understanding of the residents medication needs. Training records indicated that staff had received accredited training in medicine safety. Medication records were in good order, signed and included a photograph of each service user. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 10 A record of medication ordered and received was maintained, which enabled staff to monitor that correct medication was received prior to administering it to service users. Medication was seen to be stored securely, in two trolleys secured to the wall. The present system for storing controlled medication was discussed. The manager is purchasing a separate controlled drugs cabinet, and at the time of inspection a secure storage area for this to be fitted, was identified. The stock of medication is large for the current storage trolleys. The over spill of medication is secured in a separate locked facility, however this was discussed and agreed that this should be relocated to the new storage facility identified, in this manner all medications, and equipment necessary to the management of diabetes, and dressings, can be secured and located in one area. Service users care files were sampled and showed that staff monitors the well being of service users on medication, and call the G.P. if concerns are evident. There is a system for the regular review of medication, ensuring the health care needs of service users are promoted. There is a good system in place to ensure that at the time of their death, service users and their families are assured that their choices and preferences are respected. Care files sampled showed that this information was explored and recorded at the point of admission. Staff had experience in this area and are competent. A policy to guide staff in this area was also seen. Staff training records showed training had also been undertaken. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 11 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): Not assessed. EVIDENCE: At the previous inspection these standards were assessed and met. The standards were not assessed at this inspection, but it was noted that this continues to be a very positive area of practice. During the inspection some service users were having their hair done in the ‘beauty room’, a small salon type room that is enjoyed by both male and female service users for hairdressing and manicures. The inspector also spent time observing the ‘arts and crafts’ session that was in progress, and it was evident from the comments made by the service users, that they enjoyed this regular activity, which is provided by an outside session worker. A third group of service users were preparing to go to the tea rooms at Henley, a planned activity for a small group, with staff support. Over the two visits this year it has been positive to note that service users at St. Bernards have a variety of activities on offer, which they choose, and are
St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 12 planned and displayed to prompt service users. Some service users particularly enjoy the more ‘busy’ or ‘active’ life that can be offered. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 13 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): 17 Service users legal rights are protected, staff endeavour to explore these choices and record them on care files to ensure the legal status of the service user is respected. EVIDENCE: At the previous inspection two of these standards were assessed and met. 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. One service user confirmed that staff support her in contacting her solicitor when she needs to. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 14 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): Not assessed. EVIDENCE: At the previous inspection these standards were assessed and met. A tour of the premises demonstrated that housekeeping standards remain high. The inspector observed staff in the process of doing the laundry and tidying rooms, these staff have designated domestic tasks which ensures care staff are always available to provide care to the service users. There is a good definition of staff roles and deployment of staff, which ensures that the maintenance of the premises does not impact on the care to the service users. The communal areas and those bedrooms sampled were exceptionally well maintained, clean, tidy, odour free and decorated and furnished to a high standard. To some of the service users spoken to, this aspect of the home was important. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 15 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): Not assessed. EVIDENCE: At the previous inspection these standards were assessed and met. At this inspection staffing levels were assessed, rotas sampled indicated that four care staff, one senior, and an activities worker cover each morning shift. The staff seen on duty matched the rota sampled. In addition to this, the cook and housekeeper who ensure that standards relating to food and cleanliness are maintained were also on duty. 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. Staff training records show that ninety percent of the team have NVQ level 2, and many are undertaking level 3. 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.V287726.R01.S.doc Version 5.1 Page 16 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): 35 The arrangements in place for managing service users money are good. This ensures they can undertake this for themselves, or that for those who are unable, their interests are safeguarded. EVIDENCE: Service users financial interests are safeguarded; service users control their own money except where they may lack capacity. 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. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 17 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. At the previous inspection, it was recommended that the location of the small table in the lower lounge, be kept under review, and risk assessed to ensure it did not pose a risk to service users accessing their seats. The manager has relocated this to the conservatory area, where service users can utilise it more safely. The vacant spot is now a nice ‘snug’ area with armchairs and small table where service users are comfortable. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations It is recommended that the controlled drugs cabinet be relocated to the designated area. Any overspill of medical supplies/dressings should be stored in this area. St Bernard`s Residential Care Home Ltd DS0000004541.V287726.R01.S.doc Version 5.1 Page 20 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
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