CARE HOMES FOR OLDER PEOPLE
St Bernards Cranoe Road Hallaton Market Harborough Leicestershire LE16 8TZ Lead Inspector
Linda Clarke Unannounced Inspection 19th October 2005 10:15 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 Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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 Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Bernards Address Cranoe Road Hallaton Market Harborough Leicestershire LE16 8TZ 01858 555271 01858 555332 elainefarrell@aol.com 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 Hallaton Manor Limited Vacant Care Home 41 Category(ies) of Past or present alcohol dependence (41), Past or registration, with number present alcohol dependence over 65 years of of places age (41), Past or present drug dependence (41), Past or present drug dependence over 65 years of age (41), Dementia - over 65 years of age (41), Learning disability (6), Learning disability over 65 years of age (6), Mental disorder, excluding learning disability or dementia (41), Mental Disorder, excluding learning disability or dementia - over 65 years of age (41), Old age, not falling within any other category (41), Physical disability (33), Physical disability over 65 years of age (33) St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. The minimum age of admission to the Home for persons falling within category MD is 50 years of age. No person falling within categories PD or PD(E) may be admitted to the Home when there are 33 persons in total of the combined categories already acc. The minumum age of admission to the Home of persons falling within any of the categories PD, A, D or LD is 55 years of age. To be able to admit the person of category PD named in variation applicated number 37503 received on 29th July 2002. No person falling in categories LD(E) or LD may be admitted to the Home when there are 6 persons in total of the combined categories already admitted To be able to admit the named person of category A named in variation application number 39453 dated 17th October 2002. 7th July 2005 Date of last inspection Brief Description of the Service: St Bernard’s is a care home providing personal care and accommodation for upto forty one older persons, who may have additional care needs which may include mental disorder, dementia and past or present alcohol/drug addiction and Learning Disability. The home is a converted large country house, which is situated in beautiful countryside approximately one mile from the village of Hallaton. Accommodation is on two floors that can be accessed via stairs or a passenger lift. The majority of the rooms are single occupancy, many of them with en suite facilities. There are a variety of lounges and a dining room, with a separate facility for those residents wishing to smoke. The home has ample gardens and outside areas. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced Inspection that took place between 10.15am and 4.15pm. When undertaking Inspections, the Commission for Social Care Inspection focuses on the outcomes of individuals staying in the home. To support this, four residents were ‘case tracked’. This means that the care records and care plans of residents were checked; the residents were spoken with where possible. Three completed relative/visitor comment cards were received, results of which are reflected within the Inspection report. The Registered Person and Manager contributed to the Inspection. Opportunity was also taken to look around parts of the home. What the service does well: What has improved since the last inspection?
The Community Staff Nurse, has undertaken risk assessments on all bed guards and protective covers. Environmental improvements continue to be made, with blinds being ordered for communal rooms, and painting taking place at the time of the Inspection. Policies and procedures have been reviewed. Designated care staff are on-call at all times. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 6 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 Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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 Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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: Standards within this section were not Inspected on this occasion. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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): 7 and 8. Residents are looked after well in respect of their health and personal care, poor moving and handling practices may put residents at risk. EVIDENCE: The care plans and records of four residents were viewed, care plans were in place and regularly reviewed. The Registered Person and the Inspector spoke as to the development of care plans, and it was agreed that care plans would revert back to how they use to be presented. The development of care plans will then reflect individual care requirements, reflecting a holistic approach to care inclusive of physical, mental health and recreation care. The Inspector observed on a brief tour of the home, one example of poor practice in relation to moving and handling of a resident, this was brought to the Managers attention, who spoke with the care staff, and confirmed that the member of staff had received training in moving and handling. The Inspector spoke with the visiting Community Staff Nurse who confirmed that she had observed some poor practice. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 10 The District Nurse confirmed that risk assessments have been undertaken for all residents requiring the use of beds sides, and all but one are protected, the remaining bed guard remains uncovered at the request of the individual resident. The Registered Person and Managerial staff should be vigilant and monitor care staff to ensure good moving and handling practice. The Inspector spoke with the Community Staff Nurse, who stated that she is confident in the delivery of care offered by care staff within St Bernards, and that she is contacted appropriately to support residents with their health care. Three completed relative/visitor comment cards were received, which are issued by the Commission for Social Care Inspection as part of the Inspection process. All indicated an overall satisfaction with the care provided. One relative/visitor comment card contained an additional comment: ‘It appears to me to be a very well run home with friendly caring staff’. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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): 12, 13 and 15. Residents experience a homely life style and visitors are encouraged to visit. EVIDENCE: The records of residents whose files were viewed, supported that individuals have accessed community resources, which included visits to Market Harborough, visits by friends and relatives. The revision of care plans and the detail of information within daily records was discussed with the Registered Person and Manager; a holistic record would mean that resident’s participation in activities and recreational pursuits would be recorded, along with any decisions they made. One gentleman spoken with said he had visited a Mosque in Leicester on several occasions, and that he’d been out to Market Harborough and Leicester shopping. A second gentleman said he didn’t go out, as he didn’t wish to. One lady said she enjoyed sitting in the extensive grounds. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 12 Another lady spoke of a recent visit from her daughter and went onto speak of her shopping trips into Market Harborough. The Registered Person and Manager said that entertainers visit the home, however the frequency of these visits is not recorded nor resident participation. One lounge area provides a pool table for the benefit of residents and a computer is also located in this room. The Inspector sat with residents for a short time during the lunchtime meal; and noted that choices were available for all courses. Meals were of a good portion size and contained fresh produce. Those residents who required assistance with their meal were supported in a sensitive manner, promoting their dignity and choice. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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): EVIDENCE: Standards within this section were not Inspected on this occasion. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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): 19, 20 and 24. A comfortable and safe standard of accommodation is provided for the resident’s. EVIDENCE: The Registered Person continues to make environmental improvements, as evidenced on the day of the Inspection, with decorators working in the home. St Bernards has various communal facilities, consisting of three separate lounges and a dining room; in addition to this a dedicated area for residents wishing to smoke is also provided. Soft furnishings are of a good standard; the Registered Person confirmed that she has ordered blinds for the tall windows in the communal areas. The Inspector, accompanied by the resident, viewed her bedroom, the room was decorated to a good standard, and had been personalised by the resident. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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): 27, 29 and 30 Recruitment practices are not in all occasions robust, which has the potential to place residents at risk. Staff at St Bernards are trained and employed in sufficient numbers to meet the needs of residents. EVIDENCE: The staffing rota indicated that there are five or six members of care staff on duty in the morning, with four to five being on duty in the afternoon/evening, there are two waking night staff, which are supported by on-call staff. Three completed relative/visitor comment cards were received, which are issued by the Commission for Social Care Inspection as part of the Inspection process. All indicated that in their opinion there were always a sufficient number of staff on duty. A significant number of care staff are recruited from overseas, with accommodation being provided on the top floor of the home, independent to residential accommodation of residents, it is these staff who on a rota basis provide additional on-call cover. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 16 The staff files of the five staff on duty at the time of the Inspection were viewed, three were found to contain all relevant documentation including a Criminal Record Bureau disclosure. The two remaining care staff files however did not contain all necessary documentation, such as a completed application form, two written references, nor did they contain verification of their identity and Criminal Record Bureau clearances. The Registered Person is to ensure that resident’s welfare is protected when recruiting staff, by ensuring that all documentation is in place prior to the commencement of employment. The staff files were also viewed with regards to training. Staff had accessed a variety of courses, which included First Aid, Infection Control, Challenging Behaviour, Catheter Care, Dementia Care, Fire Training and Huntingdon’s Disease. It is recommended that care staff responsible for the administration of medication access an ASET course in ‘The Safe Handling of Medicines and that all staff access training in alcohol and drug dependency, which the home if registered to provide care for. The Registered Person did state that she had tried to access training in the area of drug and alcohol dependence, but with no success to date. Positive interaction was observed between residents and care staff. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 17 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): Records were in place detailing resident’s financial arrangements. EVIDENCE: The Inspector discussed with the Registered Person as to how Quality Assurance was monitored by the home, the Registered Person is currently working on a document and questionnaires, which will be circulated to residents, relatives and professionals as appropriate. The Inspector was unable to view staff and resident meeting minutes as part of Quality Assurance as these documents were not on the premises at the time of the Inspection. Therefore compliance of this standard could not be ascertained. Information regarding resident finances was detailed within individual resident records, and for some residents a Power of Attorney was in place.
St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 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 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X X X 3 X X STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? 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 OP8 Regulation 13(5) Requirement The Registered Person to ensure that service users safety is maintained and promoted by the adoption of correct moving and handling procedures. The Registered Person to ensure that recruitment practices of staff safeguard the wellbeing of residents. Timescale for action 01/11/05 2 OP29 17(2) 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP30 OP30 Good Practice Recommendations It is recommended that staff responsible for the administration of medication attend and attain an ASET award in The Safe Handling of Medication. It is recommended that all staff access training in alcohol and drug dependency. St Bernards DS0000001825.V258347.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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