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Inspection on 17/12/07 for St Bridget`s Residential Home

Also see our care home review for St Bridget`s Residential Home for more information

This inspection was carried out on 17th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff at St Bridget`s have created a very homely and comfortable environment for the residents to live in. The manager says that they try to create `a very happy home for the residents.` The home is clean and smells fragrant throughout. Before anyone is offered a place at the home a thorough pre admission assessment is carried out, usually by the manager. After this is done the home then writes to the person who has been assessed with the outcome of the assessment letting them know if the home can meet their needs. Prospective residents and their supporters / families are welcome to visit the home before making the decision to move there. Daily notes are kept about what care is given to individual residents along with other things that happen at the home. Residents` health needs are well met by the home working with community health professionals. Residents themselves confirm that they are well cared for and feel that they are treated with respect and dignity. Residents are free to, and encouraged to spend their days as they choose. Current residents who have expressed a view have said that they are happy with what is on offer at the home. Residents are able to see visitors when they wish and make decisions about how they spend their days within the constraints of a residential care home setting and their own abilities. Meals are wholesome and varied and planned around the likes and dislikes of residents. The complaints procedure reassures residents that their views are important to the home and that any complaints they, or their supporters raise will be properly investigated. The adult protection policy demonstrates the home`s commitment to providing a safe environment for residents that is free from abuse. The home has a good, experienced, committed manager. Sufficient care staff are employed to meet the current needs of residents. Staff have access to the basic training that they need to do their jobs well. Criminal Record Bureau disclosures and POVA checks are completed for all staff employed at the home, and proof of the person`s identification is obtained. This goes toward protecting residents from unsuitable staff working there. The manager and some of her staff have worked at the home for a long time. This stability is good for the staff as they are used to working together and for residents who benefit from having the same people looking after them.

What has improved since the last inspection?

The home has got recent photographs of all but 2 residents as required by law to protect them e.g. from anyone mistaking their identity or for use should they go missing. One of the recommendations made by environmental health, in respect of the kitchen, has been addressed.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE St Bridget`s Residential Home 42 Stirling Road Talbot Woods Bournemouth Dorset BH3 7JH Lead Inspector Debra Jones Key Unannounced Inspection 17th December 2007 11:00 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 Bridget`s Residential Home DS0000003985.V356700.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 Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Bridget`s Residential Home Address 42 Stirling Road Talbot Woods Bournemouth Dorset BH3 7JH 01202 515969 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) Mr Anthony Howell Mrs Denise Simpson Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: St Bridgets Residential Home has the capacity to care for ten older people all enjoying single rooms. The home is set in a large 1930s converted house, in a quiet residential area of Bournemouth - Talbot Park - close to shops and other local amenities. The home is over two floors - ground and first - and there is a passenger lift. There are a variety of aids around the building to allow residents to move about more independently. One bedroom has an ensuite. There are four communal toilets and two baths - the more popular one has a mechanical bath seat. The weekly charge currently ranges between £363 and £442. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place on 17 December 2007. Debra Jones, inspector, carried out the visit and was accompanied by an Expert by Experience. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting the requirements and recommendations made previously. Both the registered provider, Mr Howell and Mrs Simpson, the registered manager were available to assist the inspector in her work. The inspector and expert by experience were made to feel welcome in the home throughout the visit. A tour of the premises took place and a variety of records and related documentation were examined, including care records. The expert by experience spent time talking with residents in their bedrooms and in the lounge. Residents were very positive about their experience of living in the home and praised the care they received. Five requirements and 9 recommendations are included in this report. A number of these have been carried over from previous inspections. Mostly they relate to the environment and some have a direct impact on the safety of residents at the home. Responsibility for addressing these lies firmly with the proprietor, Mr Howell. Some good practice suggestions were discussed with the manager at the inspection and these are referred to in the summary below, intended to encourage improvement. Prior to the visit the home submitted their completed annual quality assurance assessment (AQAA) to the Commission. This gave information about the service and its performance. This document was helpful in the planning of the inspection. The home also sent out comment cards on behalf of the Commission. Three were returned by residents, 2 by relatives, one by a GP and 3 by members of staff. These are some of the comments they made. ‘This residential home is providing outstanding care!’ (a GP) When asked what do you feel the home does well? Relatives who responded said ‘Everything – could not ask for any more.’ ‘Create a friendly family atmosphere.’ A member of staff said ‘we always give personal attention; offer choice of food. Nothing is any trouble.’ When asked how do you think the care home can improve? A relative said ‘There is nothing to improve in my opinion.’ St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 7 The home has got recent photographs of all but 2 residents as required by law to protect them e.g. from anyone mistaking their identity or for use should they go missing. One of the recommendations made by environmental health, in respect of the kitchen, has been addressed. What they could do better: The home reported in their AQAA that they are planning some improvements to bathrooms and to put new carpet in the lounge in the next 12 months. It would be good if the room that the resident is to occupy is put on the terms and conditions they are issued with when they move into the home. Residents would benefit from their care plan including a section on medication; having information about the use of creams, where appropriate and about how staff are to support the care given by health professionals. Changes to care plans also need to be dated. The home must obtain a controlled drugs cupboard ready for the next time that any such drugs need to be held in the home. The home should not remove any medicines from their original packaging until they are going to be given out. The home should also document the medication audits they carry out and keep sample signatures of staff so anyone can tell who has given the medicines. It would be good if there was a written programme of maintenance and renewal of the premises, with time scales for action, that included the outstanding areas of concern noted by the Commission and the fire service. It would also be good if the building / premises was / were assessed to ensure that the facilities were right for the people living there. The radiators and pipe work that need covering to protect residents from burns must be covered or guarded appropriately. The home must put suitable systems in place to respond to the moving and handling needs of residents, this might be to obtain suitable equipment. It would be good if all staff had statements of terms and conditions. It would also be good if more care staff had an NVQ level 2 qualification in care. This would make care staff more knowledgeable about the job they do and potentially improve the quality of care delivered to residents at the home. Where staff have got other qualifications the home should obtain proof that they are equivalent to the NVQ level 2. The home must get recent photographs of all the residents as required by law. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 8 Requirements and recommendations made by other authorities such as the fire and rescue service, in respect of upgrading the building for fire safety, and environmental health, in respect of the kitchen, must be addressed. In addition to the 5 requirements and 9 recommendations made in this report the following good practice suggestions are made that the home are urged to adopt and act upon. The home is encouraged to • Actually record a detailed history of falls where this has been identified in a pre admission assessment. • Obtain the clinical triggers available on the CSCI website in respect of continence, dementia, falls and nutrition. • Provide training in nutrition for the elderly for those involved in designing menus and preparing food for residents. • Ensure that rosters are clear about who is in charge when the manager is not on the premises and who cooks the evening meal. Also full names of all staff should be noted. • Record more information about fire drills e.g. time of day, who took part and how long the exercise took. 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 Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough pre admission procedure is in place and assessments are undertaken to ensure that only residents whose needs can be met by the home are offered places there. EVIDENCE: Files for two residents who had recently moved into the home were reviewed. Both files contained pre admission assessments. One resident had been assessed at the home they were staying in whilst the other came to St Bridget’s with a relative and was assessed there. One resident was noted to have had a history of falls but the actual history was not recorded. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 11 After the assessments were completed and the manager was sure that the home could meet the needs of the residents they were issued with letters confirming this. Files also contained contracts / terms and conditions of residents. These did not have the room that person was to occupy on them. Of the three residents who returned comment cards all said that they had enough information before they moved to the home in order to decide if it was the right place for them. They also remembered that they had received a contract. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their health and personal care needs met. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care plans are well written and reviewed / updated every month. They clearly set out individual care needs and how they are to be met. Plans are clear about what residents can do for themselves and what staff need to assist them with. All care files include risk assessments, manual handling assessments and falls assessments. Care plans seen had been reviewed recently. Where appropriate social services take the lead in reviewing residents and copies of their reviews were held on residents’ files. Specific written plans as to the medication needs of residents were not in place. Some daily records referred to staff using cream on a resident, why this was and how it should used, where and how often was not in the care plan. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 13 One resident whose file was reviewed was being visited regularly by a District Nurse. There were clear notes about the nurses visit and of the reasons for their visit i.e. to change dressings. The daily notes did not indicate when or why the nurse had been called in and the care plan did not include any information about the wound, dressing or what staff were to do in respect of supporting the care being given by the nurse. Some changes to the care plan were not dated so it was not clear as to when changes had occurred and if they were still current. All residents spoken to at the visit said that they were well looked after. When asked ‘do you get the care and support you need?’ All three residents who returned comment cards prior to the visit replied ‘always’. When asked ‘do the staff listen and act on what you say’ all who replied said ‘yes.’ The two relatives who responded by comment card said that the home ‘always’ gave the support or care to their relatives that they expected or agreed and met the needs of their relative. They also said that they were kept up to date with important issues. Daily notes support and evidence the delivery of care to residents. These records give a good picture of the daily lives of residents, the care that is delivered to them by staff in the home and by visiting community health professionals such as GPs, district nurses and chiropodists. A separate record is also kept of such visits. The GP surgery that returned a comment card to the Commission said that the home communicated clearly, worked in partnership with them and that staff demonstrated a clear understanding of the care needs of residents. They also said that the home took appropriate decisions when they could no longer manage the care needs of residents. All of the residents who returned comment cards said that they ‘always’ received the medical support they needed. A number of residents need aids to help them get around or live more comfortably. These were in evidence at the home e.g. pressure-relieving mattresses, zimmer frames and raised toilet seats. Wheelchairs are also available for use. No residents are currently administering their own medication. Medication at the home is only administered by staff who are trained to do this by the manager and are considered to be competent in carrying out this task. Medicines and dressings were tidily stored in appropriate places. No controlled drugs are currently in use and no medicines are being kept in the fridge. Some medication administration records (MARs) were reviewed. These were up to date and properly completed as to the medicines received and administered. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 14 A sample signature sheet, of the way that staff administering medicines sign their name was not in place. The home does not audit and document their medication administration system. Any allergies known were clearly recorded, and where there were none known this was also noted. Where handwritten entries had been made to the printed records these were not always signed and countersigned by competent people to confirm the accuracy of the entry. The home has a system for returning unused medicines to their pharmacist and appropriate records are kept. Some residents are prescribed medicines to take ‘when required.’ In all cases Mrs Simpson said that residents are able to make the decision as to when they want these medicines. Most medicines arrive in the home in a monitored dosage system. A sample spot check was done of some temazepam tablets that were not in this system e.g. tablets that had been sent to the home in boxes. The total number agreed with the records, however the tablets were being removed from their original packaging into bottles, which is not good practice. The home does not have appropriate storage for controlled drugs. The GP surgery that returned a comment card to the Commission prior to the inspection said that in their opinion residents’ medication was appropriately managed in the home. Staff were seen to be treating residents in a respectful and dignified way during the course of the inspection and were polite and courteous. The GP surgery that returned a comment card to the Commission confirmed that they are always able to see their patients in private. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some activities are available for residents to participate in should they choose to. People are generally encouraged to make choices about their life style and to maintain contact with their family and friends. The meals in this home are wholesome and varied and are served in a pleasant environment. EVIDENCE: Residents are able to do what they like and spend their days as they choose. Some residents like to spend their days in the lounge, others in their rooms, reading or watching TV. Some residents are able to go out on their own while others are more dependent on visitors taking them out. Some residents maintain their contact with the church. Newspapers can be arranged and the library service visits. The home have an activities person coming to the home for an hour and a half every other week who does musical movement and plays games with residents. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 16 Some games are generally available and sometimes staff play bingo with residents who are interested. Of the three residents who returned comment cards one said that it was ‘always’ the case that there are activities arranged by the home that they can take part in; one said ‘usually’ and the other said that this was true ‘sometimes.’ Residents are able to have visitors when it suits them. The visitors’ book confirmed the number and range of visitors to the home. The relatives who returned comment cards said that the home helped their relatives keep in touch with them. Residents at this home are well able to make their choices and opinions known to staff and are in control on how they live their lives at the home. Most have the support of families or supporters / solicitors to help them with their affairs. During the visit staff offered residents choices, for example where they would like to sit. The relatives who replied by comment card said that they felt that the home supports people to live the life they choose. The lunch on the day of the visit was chicken pie with mashed potato and carrots and peas, with fruit and cream for afters. In addition to the meals, fruit and fruit juices are on offer throughout the day. Food records show that there is a variety of food on offer and residents are able to make choices and have their preferences accommodated. The dining area is at the end of the lounge and the dining table overlooks the garden. About half the residents usually come to the dining area to eat their lunch; others have stated a preference to eat in their rooms. Prior to the inspection 3 comment cards were received from residents. All said that they ‘always’ liked the food. All staff involved in the preparation of food have up to date food hygiene certification. Staff have not had training in nutrition for the elderly. St Bridget`s Residential Home DS0000003985.V356700.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a complaints procedure. Policies and staff training in abuse protect residents from harm. EVIDENCE: The home has a satisfactory complaints policy and system for dealing with complaints. No complaints have been received by the home or by the Commission in the last 12 months. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Three residents sent back cards. All answered ‘always’ to this question. In respect of knowing how to make a complaint they all said yes ‘always’. The relatives who returned comment cards said that they would know how to make a complaint if they needed to. When asked if the service had responded appropriately if you or your relative have raised concerns about their care? One said ‘always.’ St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 18 The home has an adult protection policy. Abuse awareness is covered in National Vocational Qualification and during induction programmes. Prior to any members of staff commencing employment at St Bridget’s the Protection of Vulnerable Adults list is checked to ensure their suitability. Since the last inspection visit the home has not made any referrals to the Protection of Vulnerable Adults list. St Bridget`s Residential Home DS0000003985.V356700.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, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. St Bridget’s provides a homely environment but the progress remains slow in making sure that the home is truly safe for residents to live there. EVIDENCE: The home is registered for 10 people and has 10 bedrooms. Since the last inspection visit 2 bedrooms have been redecorated. Residents are able to bring personal possessions and furniture into the home should they wish to, and most have. One bedroom has an ensuite. Some residents have commodes in their rooms. Communal bathrooms and toilets are readily accessible around the home. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 20 All rooms have emergency call bells in them for residents to summon help if they need it. Call bell cords are long enough for residents to be able to reach them from wherever they usually lie or sit. It was noted at the last inspection visit that some radiators in the home are guarded. Others had been identified as posing a potential risk to residents and were yet to be covered. In the meantime furniture was being placed in front of them or other methods employed to minimise the risk of burns. This was still the case at this inspection. No major works are planned at the home but the manager again said she was hopeful that this year will see the refurbishment of one of the communal bathrooms. A relative commented that a new carpet in the hallway would give a better impression on arrival at the home. The kitchen has been redecorated since the last inspection visit. An assessment of the whole premises has not yet been undertaken by suitably qualified persons as recommended in previous reports. Appropriate washing machines are in place to manage residents’ laundry. On the day of the visit the home was clean and there were no unpleasant odours. Two of the three residents that returned comment cards said that the home is ‘always’ fresh and clean, the other said it was ‘usually.’ St Bridget`s Residential Home DS0000003985.V356700.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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient, adequately trained staff are on duty at all times to meet the needs of the residents. The procedures for the recruitment of staff are robust and provide a framework to offer protection to people at the home from unsuitable workers being employed there. EVIDENCE: Staffing rosters are in place that show who is on duty and when. Rosters show all staff on duty, their full names, with the exception of the cleaner, and their designations i.e. what job they do. It is not always clear from the roster who is in charge of the home when the manager is not on the premises or who is cooking the evening meal. Two care staff are on duty during the day between 8am and 8pm. They also do the cooking. The manager is usually in addition to this. There is a cleaner at the home five days a week. At night two people are available, one awake and one sleeping in. Residents were asked are the staff available when you need them? All three who responded said this was ‘always’ the case. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 22 The relatives who returned comment cards thought that the staff at the home had the skills and experience necessary to look after their relatives properly. Out of the 9 care staff employed at the home 2 have a qualification at NVQ level 2 in care or above. The Department of Health target is that 50 of care staff should have level 2 in care. The manager said that five care staff at the home qualified as nurses in their home country. Staff files are kept that demonstrate the recruitment process in action and most documents required by law that relate to staff are on file. Since the last inspection visit only one new member of staff has been appointed at the home to be a cleaner. Their file was reviewed. The file contained the required proof of identification, POVA 1st check and Criminal Record Bureau disclosure certificate obtained prior to them starting work at the home. Two references were on file. The file also contained information about the person’s health. The file did not contain a full employment history. It was good to see that the induction programme developed by Skills for Care was being used. It remains the case that staff are not issued with statements of terms and conditions. An overview of staff training is kept showing when staff have had training and when refreshers are due. It was clear from these records that staff are getting the basic training and updates they need to do their jobs. In the last year there has been fire, infection control, moving and handling, health and safety, food hygiene and emergency aid training. Three members of staff returned comment cards to the Commission prior to the inspection visit. All said that they felt they were given training which was relevant to their role, that helped them to understand and meet the individual needs of people and that kept them up to date with new ways of working. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well organised and the care, contentment and safety of residents is at the heart of the daily management and running of the home. However, the progress of meeting the requirements made by the fire service in respect of the overall safety of the building is slow and puts at risk the health and safety of people in the home. EVIDENCE: Mrs Simpson is the registered manager. She is an experienced manager and has worked at the home for the last 15 years. Mrs Simpson is committed to providing a good service to the people living there. She keeps herself up to St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 24 date by attending refresher courses with staff and recently completed a course in palliative care. Prior to this inspection visit the home completed an annual quality assurance assessment (AQAA), which they submitted to the Commission for Social Care Inspection. This identified what the home feels they do well and sets out their plans for improvement over the next twelve months. The home sent out and made available comment cards for the Commission as requested before this visit. Comments came back from 3 residents, 2 relatives, a GP and 3 members of staff. All were generally positive about the home. In addition the home has sent out their own questionnaires over the course of the year (2007). These were given to residents and relatives. All were very positive about the home and there were no suggestions as to how the management could improve the way the home is run. A range of policies and procedures underpin the care delivered at the home. The home confirmed that most were last reviewed in 2007. The manager reported that the home does not hold any money or valuables for any residents. All records asked for at the inspection were made available. At the last inspection this was with the exception of photographs of residents. It is now the case that the home has recent photographs for all but two residents, one of whom was moving into the home during the inspection visit. An up to date insurance certificate was on display along with St Bridget’s registration certificate. The home’s fire risk assessment was seen. This was written in 2007 and has been submitted to the Dorset Fire and Rescue Service (DFRS) as requested. DFRS visited in November 2007 and have made requirements of the home in respect of fire safety that will have to be addressed, including modification of the fire risk assessment. The Proprietor said that he was currently in the process of getting estimates to carry out the work necessary to improve fire safety at the home. General fire records were in place. An external company carries out regular checks of the fire equipment. Internal checks are being carried out and records showed this. Fire training and fire drills are taking place. Records are made of these events. At the last visit it was suggested that the home noted on these reports what time of day the exercise was carried out and how long it took. The time of day was noted on the latest report. The recommendations made by the Environmental Health Officer about the kitchen have been addressed in part i.e. there are now diffusers on the St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 25 fluorescent strip lighting. A rack to drain and store the chopping boards has still not been fitted. Information submitted prior to the inspection visit confirmed that equipment and facilities are being appropriately maintained e.g. the emergency call bell system. Accident records were looked at. Since the last inspection visit in February 2007 there have been 29 accidents. Twenty-one happened at night, between 8pm and 8am and involved residents being found on, or falling to, the floor. Seven resulted in the paramedic service being called out to assist residents off the floor who were unable to get up themselves. The home does not have equipment to assist residents from the floor e.g. any form of hoist. Given the recorded high number of accidents reported at night of this nature such dependence on the emergency services is not an appropriate way to manage this issue. St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 x x 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x 2 1 St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard OP9 OP25 Regulation 13 13 Requirement The home must have a controlled drugs cupboard. The programme of covering / guarding or replacing with low temperature surfaces all radiators and pipe work, assessed as posing a risk to residents, must be completed. (Previous timescale of 1 August 2005 not met) Suitable equipment must be in place to support the safe moving and handling of residents. There must be a recent photograph of every resident in the home. (Timescale of 01/04/07 not met). Adequate arrangements must be in place to comply with the requirements of the Fire and Rescue Service. (Timescale of 31/12/04 not met). Timescale for action 01/04/08 01/02/08 3. OP22 13 01/02/08 4. OP37 17 01/02/08 5. OP38 23 01/04/08 St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 28 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 OP3 OP7 Good Practice Recommendations Terms and conditions given to residents should include the number of the room they are to occupy. • • • All care plans should include a section on medication. Care plans should be clearer about why and how creams are to be used. Where residents have support from external health professionals e.g. district nurses treating wounds, care plans should include this, as well as how the home is to support the treatment of the person between visits. Changes to care plans should be dated, so it is clear when changes occur and what is current. A sample signature sheet (how staff sign the medicines record) for medication should be introduced. The home should record their medicine audits. Handwritten entries to medication records should always be signed and countersigned by competent people. Tablets should not be removed from their original packaging until they are administered to residents. • 3. OP9 • • • • 4. OP19 A programme of routine maintenance and renewal of the fabric and decoration of the building should be produced and implemented with records kept. Where a timescale has been set for compliance with any standard relating to the physical environment of the home, a plan and programme for achieving compliance should be produced and followed with records kept. It is recommended that an assessment of the premises is undertaken by an occupational therapist or another suitably qualified person. 5. OP22 St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 29 6. 7. OP29 OP28 It is recommended that all staff employed at the home have statements of terms and conditions of employment. It is recommended that the home ensures that 50 of care staff attain NVQ level 2 by the end of 2005, or where appropriate the home obtains proof of equivalence. It is recommended that all the recommendations made by the Environmental Health Authority be carried out. The home’s quality assurance system should include other stakeholders such as care managers, GPs and other healthcare professionals. 8. 9. OP38 OP33 St Bridget`s Residential Home DS0000003985.V356700.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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