Inspection on 02/06/08 for St Brelades

This inspection was carried out on 2nd June 2008.

CSCI found this care home to be providing an Excellent service.

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 Brelades 08/11/06

St Brelades 23/01/06

St Brelades 18/07/05

St Brelades 15/03/05

St Brelades 21/06/04

St Brelades 12/01/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Brelades 5/6 Beacon Hill Herne Bay Kent CT6 6AU Lead Inspector Chris Woolf Unannounced Inspection 2nd June 2008 09:00 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 Brelades DS0000023555.V365565.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 Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Brelades Address 5/6 Beacon Hill Herne Bay Kent CT6 6AU 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) 01227 375301 01227 740293 stbrelades@btconnect.com St Brelades Retirement Homes Limited Mrs Catherine Margaret Anne Chuck Care Home 37 Category(ies) of Dementia - over 65 years of age (36), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (36) St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. LD (E) is restricted to one person whose date of birth is 20/10/1934. Admissions are restricted to those Service Users whose category is DE(E) 8th November 2006 Date of last inspection Brief Description of the Service: St Brelade’s is a care home that provides personal care and accommodation for 37 older people with dementia. The home only provides care for women. It is owned by St Brelade’s Retirement Homes Limited who also own another home next door. The home is located on the seafront and close to Herne Bay town centre with all of its amenities and facilities. It consists of two large houses joined together. Thirteen of the single rooms and seven of the shared rooms have en suite toilet facilities. There is a patio area to the front of the house and a garden area to the rear. The current fees for the service at the time of the visit range from 421.02 to £550.00 per week. Information on the Home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is stbrelades@btconnect.com St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. Information for this report has been gained from various sources. These include an Annual Quality Assurance Assessment (AQAA) completed by the home; Comment cards received at the time of the Annual Service Review from 12 relatives/advocates and 12 members of staff; and a site visit to the service that lasted 7 hours 45 minutes. We (the Commission) also looked at the information gained at a Thematic Inspection held in September 2007. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. This thematic inspection looked at the quality of care people with dementia experience when living in care homes, and focused on ‘dignity’ as an important part of people’s quality of life. A separate short report was produced of this inspection. The site visit was unannounced. This means that neither the home nor the clients knew that we were going to visit. During the site visit we talked with the clients. We also talked with 4 visitors to the home and with most of the staff on duty including the Clinical Manager and the training organiser/ administrator. The Registered Manager was present for the majority of the day and made herself available to give us all of the help that we required. We observed the interactions between staff and clients, and the lunchtime meal being served. We also looked at a variety of records including care plans, staff recruitment files, training records, medication records, complaints records, menus, and the homes quality assurance records. The people who use this service prefer to be called ‘clients’ and this is the term used to describe them throughout the report. What the service does well: The home has a clear mission statement and philosophy of care promoting holistic and individual person centred care which takes into account each client’s diversity and equality needs. The home has gained the local authority coveted ‘Scores on Doors’ 5 diamonds for food hygiene. The home is clean and comfortable with a friendly and welcoming staff team. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 6 The home has strong links with both the local G.P. and the specialist Psychiatrist and Community Psychiatric Nurse. What is done well is best summed by quoting from relatives and advocates comments:‘I would just like to reiterate that St Brelades is an exceptionally caring home. They welcome and involve relatives and friends and try to make it as much like a family home as possible. We have nothing but praise for their care and professionalism’. ‘If all care homes reached the standard of this one, we should have an end to the media criticisms we hear so often’. ‘Thank goodness there are care homes like St Bs’ ‘Im sure I couldnt find a better place for my mother’ ‘They always take care of her personal appearance and hygiene. The home is clean, tidy and free from unpleasant odours whenever you visit’. ‘They are in constant contact with me, and seek my views on the care provided’. ‘I would like to thank the staff for doing what is a difficult job at times’. What has improved since the last inspection? A more accessible care planning and assessment system has been introduced including better identification of risks and more holistic recording of individual needs. The home has been focusing on individual activities to give clients a sense of meaning. Environmentally, two more special beds have been purchased for the comfort of clients with substantial physical needs. Window security has been improved. A new dishwasher that washes and sanitised crockery and cutlery has been installed. The abuse and whistle blowing policies have been improved as have staff supervision and training in these subjects. More staff have completed NVQ’s, and the clinical manager has completed her St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 7 Registered Managers Award. Following comments made by relatives/ visitors on last years quality assurance questionnaires some improvements have been made to staffing levels on public holidays when there are many more visitors. 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. The summary of this inspection report can be made available in other formats on request. St Brelades DS0000023555.V365565.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 Brelades DS0000023555.V365565.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, & 4. Standard 6 is not applicable in this home Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective clients and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The home has good assessment processes. The AQAA confirms that ‘All clients who are admitted to St Brelades suffer with moderate to advanced dementia, so it is usually a relative or advocate who looks around the home. At this stage they are also given written information about dementia and a copy of the home’s statement of purpose’. Before admission to St Brelades, a pre admission assessment is completed wherever the prospective client is living at the time. This is carried out by a St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 10 senior manager who collates as much information as possible from the client, relatives, and health and social care professionals, regarding all aspects of physical, psychological, therapeutic, social, diversity needs and family history. Where clients are Care Managed a copy of the joint assessment is also obtained. One visitor confirmed that assessment took place before admission and one said no. Another visitor explained, “Mother came for respite and stayed, but we had a lot of information given to us before she came in”. All clients have a contract. For private clients this is incorporated in the statement of purpose and for funded clients it is with the local authority. This home does not offer the facility of intermediate care, which is a specialised service with intense rehabilitation aimed at enabling clients to return to their own homes. St Brelades DS0000023555.V365565.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that clients receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The report of the Thematic Inspection noted that ‘The home needs to ensure that clients and or their relatives/representatives are involved in the person centred care plans and sign up to their preferred methods of care’. Evidence was seen during the site visit of relative involvement in care planning and discussions were also held with the clinical manager about how this is best achieved not only on admission but also on a regular basis. Relative comments about involvement in care plans included, “They tell me now, I did St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 12 have an issue but it has been resolved”, and ‘They are in constant contact with me, and seek my views on the care provided’. The home has recently changed their care planning to a more accessible system. Individual person centred care plans are prepared for each client based on their pre-admission assessment, and agreed with the client, their relatives and any other interested parties. Each care plan includes details of physical, mental, social, cultural and diversity needs. They also include a variety of assessment tools including monitoring nutritional needs, and promoting continence; and a variety of risk assessments including moving and handling, skin integrity, and person centred risks. Staff comment cards included, ‘Care plans are updated on a regular basis according to service users needs and changes, and we as carers are given verbal input on a daily basis’, and ‘The clients needs are documented in their records as well as medical notes, life history and menu preferences. For ladies who are more dependent their nutritional and fluid intakes are documented along with a flow chart. In each of the kitchens there are forms showing which ladies are under/over weight with guidelines on the appropriate action that should be taken to rectify this’. The home promotes and maintains the clients health. A Clinical Manager is employed. She is a registered nurse in mental health who has also achieved her Registered Managers Award (RMA). She gives guidance and support to all carers in clinical issues and liaises with other health professionals and relatives. She has responsibility in assessing, planning and evaluating the delivery of care to the clients and in ensuring that the documentation and procedures are in place for recording clients needs and risks. Community nurses organise pressure relieving equipment, beds, and chairs to promote tissue viability. The home liaises with the continence nurse to ensure that the correct pads are supplied to maintain the comfort and dignity of those clients who need assistance to promote their continence. A chiropodist visits the home weekly. Annual optical health checks are organised for all clients who wish to be tested. Clients who need to attend hospital whether for a routine appointment or as a result of an urgent admission are always accompanied by a carer day or night and they support the client for as long as they are needed. Advice is sought when necessary from speech therapist or a dieticians. In order to provide more robust clinical support the home has a medical contract with a GP practice and a doctor visits weekly to give general medical guidance and support. She also reviews the medication and general health of those clients registered with her surgery on a regular basis. Clients are welcome to select their own GP, and the home liaises with whichever practice the client is registered with. All medical examinations are conducted in the St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 13 privacy of the clients room. Following the appointment of a new Consultant Psychiatrist he now runs a clinic at St Brelades every three months accompanied by a Community Psychiatric Nurse (CPN). All clients on medication specifically for their mental health are now reviewed and evaluated at these reviews and this is documented in their records. A relative commented, ‘I attend meetings with other care professionals involved in my Mothers care, (psychiatrist) and have been pleased at the decision making processes regarding medication’. A client commented, “They look after me extremely well”. Relatives comments about the care provided by the home included, ‘My Mothers care at the home has been excellent’, ‘I feel the standard of care is excellent, I consider I was very fortunate to find a home with such a high standard of care and dedicated staff’. ‘She is looked after, both physically and emotionally’‘, and ‘Our mother can be quite challenging! And we know the staff at St Brelades are more capable of dealing with her calmly and kindly than we ever could’. Staff said, “We look after the ladies well”, and “They are well cared for”. The home uses the Boots monitored dosage system of medication. Receipt, storage, administration, recording, and disposal of medication all meet with the requirements of the Royal Pharmaceutical Society. All staff that administer medication have received appropriate training. Policies and risk assessments are in place for self-medication where this is appropriate. The report from the thematic inspection included, ‘Staff also need more understanding of how to treat clients with respect by giving choices as well as not just carry out tasks without interaction with the clients they are working with’. On the day of the site visit it was observed that clients were treated with respect by the staff; their dignity was upheld, and their privacy was respected. The AQAA states, ‘The conduct of the staff in respecting clients privacy, dignity and in promoting choices in their daily lives is enshrined in St Brelades mission statement, philosophy of care, staff descriptions, staff inductions and in all aspect of staff training. They are evaluated on their understanding of these principles and ability to express this in their interaction with the clients’. Visitor comments included, “Yes, they definitely respect her privacy and dignity”, and “Yes, they look after her privacy and dignity as much as they can”. Staff said, “We definitely pay attention to their privacy and dignity”, and “Their privacy and dignity is looked after very well”. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients are able to make choices about their life style. Social, cultural and recreational activities meet clients expectations. Clients receive a balanced and nutritious diet. EVIDENCE: The report of the thematic inspection identified that at that time ‘no meaningful activities were observed especially for the clients’ with advanced stages of dementia’. The homes AQAA indicates, ‘We recognise that although structured group activities are important they only meet the social needs of a minority of clients at St Brelades. We have been looking at focusing on individual activities which give clients a sense of meaning and a greater feeling of worth’. It also says, ‘The individual plans give guidance on clients particular hobbies and interests and activities they enjoy. Further information is supplied by clients themselves and in more detail by families on a Life History form which gives a greater sense of a clients identity. An appreciation of a clients St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 15 past helps staff to reminisce with clients and to give the client a sense of their unique identity and self esteem’. Staff use the times when they are with the clients performing personal care tasks as an opportunity to be able to interact and engage on a one to one with the client. A staff member said, “Everything we do from the time we get them up until the time they go to bed is an activity in itself”. Structured activities are organised for the clients and manicures and hairdressing are also popular. There are opportunities for clients to engage in group activities such as entertainment shows, musical exercises, coach outings and religious services. In addition individual clients enjoy activities that give them a greater sense of individual achievement and belonging such as folding laundry, dusting and polishing, gardening and baking. The home provides a selection of current magazines which are used as a discussion point between the clients and the staff. During the evening the night staff use the first hour of their shift as a social time, with food and drinks on offer to those who want them. Two members of staff have recently attended NAPA (National Association for Providers of Activities for Older People) training and are now working with the manager on providing a revised training programme for the home. A relative comment card included, ‘My mother says she is bored - so would suggest more activities, yet she cannot remember what she has done so she might well be doing things we do not hear about. We would like her to get more exercise, before admission she was very active, this is not easy and when we take her for a walk she complains her legs hurt’. Staff said, “ We do activities every afternoon and Exercise class on Fridays”, and “We talk to the ladies on a 1:1 basis, do hands and nails, and I take them out for walks”. The religious beliefs of many clients are important to them. There are regular monthly services from the Church of England and Catholic clergy in which families sometimes participate. The clergy will also visit clients individually, particularly if they are unwell. A relative comment card included, ‘St Brelades arranged for our mother to be taken to the local Catholic Church every Sunday for the first two years she was there. When it became too stressful for her, they knew when to stop and she now receives holy communion brought into the home’. Clients are encouraged to maintain contact with their family and friends. During the summer months there are also monthly outings organised. Visitor comments included, ‘The staff are always welcoming. They are very patient with the residents, and take the time to do little things like painting nails. As there are six of us children ringing (mainly on a rota) they are very good at handling the volume of calls. The residents are taken out across the milder months on coach trips, and have entertainment throughout the year’, ‘Staff always make visitors welcome and always have time for the residents and visitors’ and ‘Preferably I like to sit with my Mother in private in the conservatory. However, she finds the seating uncomfortable, and so it is no longer possible to use that space. Most of the time we sit in the dining room, which is fine, but clearly not private. I think for many service users and their St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 16 visitors, comfortable chairs (with support) in the conservatory would make a real difference’. Clients have choices in all aspects of their daily life as far as their cognitive impairment allows. A member of staff said, “The have choices in menu, clothing, whether to eat in their own room or the dining room, whether to go out for walks, whether they want their nails done, what time they get up and go to bed, all sorts of things”. Visitor comments included, ‘My sister does like to go out walking but because she has angina they try to persuade her not to, As far as I could see, peoples wishes were respected’, ‘St Brelades allow our mother to continue to choose her clothes each day, explaining to us that it is important for her to have that control whilst she can - even if it means her looking bizarre on occasions!’, and ‘My mother wants to go home and get a job! But difficult to make that happen’. The home provides a varied balanced and nutritious diet. They have attained the coveted 5 diamonds for Food Hygiene ‘Scores on Doors’ from the local council. Food is freshly cooked on the premises. Current special diets include soft diet, diabetic, and gluten free. Healthy eating is encouraged and no deep fried food is served. Clients said, “The food is very good, the choice is good”, “Lunch was very nice”, and “I enjoyed it (lunch)”. Visitor comments included, ‘My mother likes the food’, ‘My Mother had an issue with the food. I went through the menus and indicated what she would not eat, and suggested alternatives. To my knowledge this was taken on board’, and ‘The food is good’. Staff commented, “The food is very good”, “I like the food”, “They get a nice choice of meals, all fresh vegetables”, and ‘We have a daily menu which allows choice of meals’. St Brelades DS0000023555.V365565.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients and their representatives are able to express their concerns, and have access to a robust, effective complaints procedure. Clients are protected from abuse. EVIDENCE: The home has a robust Complaints Procedure and copies are incorporated in The Statement of Purpose and Service Users Guide, and displayed in the hallway. A record is kept of all complaints made and includes details of any investigation and action taken. Even minor incidents or complaints are documented. The home say they aim to deal with any small issues before they become of major concern to anyone, and regard such comments in a positive way to improve services to the clients. The AQAA confirmed that 4 complaints were received in the previous 12 month period and that all were resolved within 28 days. Relatives commented, “We did have a few problems but they are now resolved. The last few months everything has been fine”, and “Yes, I do know how to make a complaint”. Relative comment cards included, ‘I have never had occasion to complain’, ‘When we have voiced concerns about our mother, we have always been listened to and our thoughts taken on board. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 18 These have not been issues of lacking care - more our mothers behaviour’, and ‘This situation has never arisen in the twelve years my sister has resided in the home’. Staff comment cards included, ‘Yes we have complaints procedure within the home which includes being aware of abuse and how to deal with a suspected situation we also have a whistle blowing policy. We also have a minor complaints policy, which may be about personal items being lost or missing’, and ‘We have a complaints procedure, minor complaints form, abuse policy, whistle blowing policy’. Clients in the home are protected from abuse. The home has clear and accessible abuse and whistleblowing policies in place. No member of staff starts work in the home until a satisfactory check of the Protection of Vulnerable Adults register has been received. All new staff receive training on abuse, protection, and whistle blowing during their induction. There have been no incidents reported to the Protection of Vulnerable Adults team. St Brelades DS0000023555.V365565.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables clients to live in a safe, clean, well-maintained and comfortable environment EVIDENCE: The home is well located for access to the town and local facilities. It is situated on the sea front and there are sea views from many of the rooms. The home gained 2nd place in the medical section of the ‘Herne Bay in Bloom’ competition this year. They have a programme of routine maintenance and renewal in place. A stair lift is available for access to the first floor, but clients living on the second floor need to have the mobility to climb the stairs to this level. On the day of the site visit decorating was taking place of the second St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 20 floor corridor. Some areas of damaged flooring were noted but the manager had already identified these and new flooring was on order. A deep clean of carpets had also been planned for a week after the site visit. This home operates a no smoking policy. The homes AQAA states that things that improvements during the last year include, ‘….. the security of windows so that that the restraints are more robust. Two more profiling beds have been purchased for the comfort of clients with substantial physical needs. In the kitchen we have recently changed to a commercial dishwasher under contract that washes and sanitises crockery and cutlery’. There are a variety of communal areas for sitting and dining and all are comfortable and homely. As previously mentioned a visitor commented about the seating in the conservatory and stated. ‘I think for many service users and their visitors, comfortable chairs (with support) in the conservatory would make a real difference’. The home is requested to take this into consideration. The home has a variety of both single and double bedrooms available, some with en suite facilities. Where a room is shared screening is provided to ensure privacy for personal care. Special beds are available for those clients with higher needs. Lockable facilities are available for rooms where required. Rooms are personalized to meet the needs of the individual client. When clients wish they are encouraged to bring in their own furniture to make their rooms even more homely and to give them more of a sense of belonging and ownership. The home has robust infection control procedures in place. The AQAA states, ‘In place is an Otex laundry system that is effective at eliminating Clostridium difficile and MRSA organisms using ozone rather than thermal treatments and this is effective on all its wash programmes. This eliminates the risk of infection from all washes and not just from foul or infected laundry cycle. All towels and flannels are washed after single use and most clothing is washed on a daily basis’ . All teams of staff are trained in COSSH and have their own copies of policies on health and safety which they are evaluated on. St Brelades DS0000023555.V365565.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the clients, and to support the smooth running of the service. EVIDENCE: Sufficient staff are employed on duty to meet the needs of the clients, with additional staff on duty at peak times of activity during the day. Trainee junior carers under 18years work under supervision in a support role only. Domestic and catering staff are employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the home is maintained in a clean and hygienic state. The homes AQAA states ‘Last years relative questionnaire showed that some relatives felt there were not enough staff on duty at the weekend (despite the staffing levels being exactly the same as in the week). At weekends, particularly on Sundays, on Mothers day, at Easter, or if there is a birthday party with a big family gathering, there are many more visitors. I have now increased the weekend staffing levels during these periods to enable the atmosphere to be more relaxed without the staff feeling under pressure’. A member of staff commented, “We have enough staff on duty and normally have spare as well”. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 22 The head of training, who has the responsibility for coordinating the NVQ candidates for the home, has achieved NVQ level 4 in care and the Registered Managers Award (RMA). Currently 75 of the care staff either hold or are working towards NVQ at Level 2 or above, with a high level having already achieved NVQ 3. The clinical manager is a registered nurse in mental health and has also achieved her RMA. Several of the senior staff are also NVQ assessors. Staff said, “I have NVQ 3”, “I have done NVQ 2 in catering”, and “I have my RMA”. The home has robust recruitment procedures based on equal opportunities and the protection of the clients. No new member of staff is employed until a satisfactory check of the Protection of Vulnerable Adults Register and two satisfactory references have been received. All staff are issued with a Statement of Terms and Conditions, a copy of the General Social Care Council Code of Conduct, and a copy of the homes whistleblowing policy. An enhanced Criminal Records Bureau and POVA check is also undertaken prior to appointment for ancillary staff such as hairdressers and musical exercise therapist. All carers employed by the home are female to reflect and respect the female client group. The homes AQAA states, ‘Staff come from a wide range of social backgrounds, and a few are also from ethnic minority groups and other faiths. At St Brelades staff are recruited for their skills and other criteria which are not based on discriminatory or prejudicial factors relating to age, gender (except carers), sexual orientation, religion, race or disability and this is part of our recruitment policy’. Staff at the home are trained to be competent in their role. The Head of Training and the Trainer/Administrator oversee the induction and ongoing certified training programmes of staff. All staff receive induction training to Skills for Care specifications when they first start working at the home and this includes mandatory training. Staff comment cards included, ‘‘We were given an induction package which involved a health questionnaire, fire awareness, manual handling, policies on adult protection, COSHH. Our mission statement Privacy, Dignity Choice, Rights and self fulfilment was discussed in depth with many examples on how to achieve this. The philosophy of care was discussed and emphasized through our training; we were given a moving and handling video, as well as being shown by an experienced member of staff. Our job description is clearly shown with an emphasis on working as a team, and ‘Yes my induction was very thorough covering many aspects of caring for the vulnerable i.e. care plans, confidentiality, appraisal, communication, bathing, washing, toileting, prevention of pressure sores, care of ill and mentally ill service users. Policies promoting the mission statement, i.e. recognising individuality, respecting and promoting privacy, dignity, choice, rights and selfdetermination. And when I first began my job and was mentored and supported exceptionally well’. Mandatory training is updated regularly although at present some certificates have lapsed. This was discussed during the site visit and a recommendation is St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 23 made regarding this. The report from the Thematic inspection included, ‘More training is required to ensure that staff understand differing types of dementia, and are aware of different methods of communication as well as providing meaningful activities for all levels of dementia. Staff also need more understanding of how to treat clients with respect by giving choices as well as not just carry out tasks without interaction with the clients they are working with’. All staff have either now received or are in the process of doing training in dementia. A member of staff said, “I did a Dementia course recently”. All staff who administer medication have received training, one commented, “I have done medication training”. Staff comment cards included, ‘I have been given training in Health and Safety, cross contamination, food and hygiene, and moving and handling. I only work one day a week and have been offered many other courses. The managers are constantly emphasising the need to treat each client as an individual, respecting their individual needs. Ways to do this and the previous information of the client’s previous daily routines are all documented in the care plan e.g. preferred time of getting dressed or religion. We are given information on different religions to help us meet the clients individual needs and regular religious ceremonies are held at the home to promote our philosophy of care we believe each person is an individual’ ’. A visitor comment card included, ‘Although there has been an increased level of staff turnover of late, the new staff are trained to a good standard and are well coached by senior and more experienced staff’. Visitor comment cards included, ‘From my experience all the care staff, right down to the youngest members, treat people with extreme kindness, care and respect’, ‘The staff are all super at dealing with these ladies. Our mother can be quite tricky at times and the staff handle her very well finding different tactics to help her when in a tizzy! ’, ‘… the staff who are known to the family have infinitely more experience than we have. Patience and kindness are essential for the staff at all levels, and I have never found this to be lacking’, ‘In terms of staffing, I have always, without fail found the staff to be friendly and professional. I have watched interactions between staff and service users, and have noted that service users are always treated with respect and dignity. I am sometimes aware that staff are very busy with numerous tasks, and that a long time can go by before residents are given any time for a chat or have anyone to talk to’, and ‘This is a specialist care home, with a highly trained staff, providing a high standard of service’. General comments from staff include, “I love it here”, “Its one of the better homes in Herne Bay”, and “I enjoy working here”. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, and has effective quality assurance systems. The health, safety and welfare of clients and staff is promoted and protected. EVIDENCE: The Registered Manager of the home has 30 years of experience of supporting clients with dementia and has been manager at St. Brelades since 1980. She is working towards completing her RMA, and has now completed all of the evidence ready for assessment. She is supported by an established St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 25 management team of a co-manager who is a registered general and mental health nurse, a clinical manager who is a registered mental health nurse and who has recently completed her Registered Managers Award (RMA), a training manager who has an NVQ level 4 in care and RMA, and many other senior carers who have achieved NVQ level 3 in care. Staff spoken to on the day of the site visit said, “I definitely get support from the manager. I only have to go to her with anything”, and “Yes I get support from the manager”. Visitor comments received included, “The management are very good, very approachable”, “I did have some issues, but Cathy always tries to say hello now”, and ‘I have been particularly impressed with the manager (Cathy) and with xxx (the clinical manager)’. Staff comment cards included, ‘There is always a manager available to talk to about and concerns I may have, we have regular appraisals as well as handover meetings, formal and informal meetings’, ‘We have handover meetings, appraisals, supervision sessions, any support or discussion we feel we may need is always accessible at any time’, and ‘Yes we have handovers at the start of shifts where we are given information. Our organisational structure includes operational managers, clinical managers, head of care, trainers, team leaders, anyone of these people can be given information verbally and documented in the service users care plans’. The manager was late in submitting the homes AQAA to us. However, when received, it was very comprehensive and contained all of the information that we required. The home has also developed their own quality assurance systems. Quality Questionnaires are circulated annually to clients’ advocates and issues raised are evaluated and appropriate actions are taken. The homes AQAA states, ‘Feedback is sought from relatives and visitors about services provided through anonymous user satisfaction questionnaires and through individual discussions with clients as well as evidence from their records. Together with feedback from staff meetings and staff discussions we are constantly striving to improve the quality of the services provided to the clients and this is achieved by careful planning, reviewing any actions and evaluating the outcomes and this can be evidenced in clients care plans’. Regular audits are undertaken on staffing, occupancy, food hygiene, risk assessments and trends i.e. complaints. Line management meetings and staff meetings are held as required. The home is a member of the Care Homes Association and holds Investors in People accreditation. Comments observed on Quality Questionnaires included, ‘I have no complaints whatsoever’, ‘All queries are dealt with no hesitation. I don’t feel ever that I am being a nuisance’, ‘Sometimes at weekends mum is less tidy and clothes are more dirty although midweek this is not a problem’, ‘ Overall I would say my mother is in the best place for her in her condition. She seems happy’, and ‘I can see she is being well looked after’. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 26 The only client monies held by the home are small amounts of ‘pocket money’ for those clients who like to have some cash to hand. Accounts for such items as chiropody and hairdressing are paid by the home and invoiced to the client’s representative. The homes AQAA says ‘Due to the clients severe cognitive impairment all clients have an appointed agent/advocate usually a relative or solicitor who manages the financial affairs of the clients. No-one at St Brelades is directly involved in the financial affairs of the clients but the manager can advise relatives on setting up an enduring/ lasting power of attorney or acting as receiver through the public guardianship service. Records and receipts are provided for the safekeeping of money and valuables on behalf of clients and there are secure facilities for the safekeeping of money and valuables on behalf of clients’. The health, safety and welfare of staff and residents is protected. All equipment is safe and regularly maintained. Accidents are properly recorded. Staff are trained in the mandatory health and safety related subjects although a recommendation has been made regarding this under the section on Staffing. All staff receive induction training which cover safe working practices. Environmental and care risk assessments are in place. All radiators are covered to protect the clients. The home is secure, there are keypad entries to the external doors, and window security has improved during the last year. The home has achieved the 5 diamond ‘scores on the doors’ from the local council for kitchen cleanliness and food hygiene. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 4 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 OP30 Good Practice Recommendations The home should ensure that all mandatory training, and training in Dementia and Protection of Vulnerable Adults is kept up to date and valid. St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Brelades DS0000023555.V365565.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!