Inspection on 19/05/06 for St Cecilia

This inspection was carried out on 19th May 2006.

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

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

Other inspections for this house

St Cecilia 26/01/09

St Cecilia 17/01/08

St Cecilia 13/03/06

St Cecilia 04/08/05

St Cecilia 31/01/05

St Cecilia 15/07/04

St Cecilia 23/02/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE St Cecilia 29 Nelson Road Branksome Poole Dorset BH12 1ES Lead Inspector Jo Palmer Key Announced Inspection 10:00 19th May 2006 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 DS0000004074.V291543.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. DS0000004074.V291543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Cecilia Address 29 Nelson Road Branksome Poole Dorset BH12 1ES 01202 767383 01202 767383 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 Robert John Eshelby Ms Carolyn Gwendoline Hazell Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13) DS0000004074.V291543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person (as known by the CSCI) under the age of 65 may be accommodated to receive care. 13th March 2006 Date of last inspection Brief Description of the Service: St Cecilia is registered to provide care for up to thirteen older people over 65 years of age with mental health needs. The home is detached and situated in a quiet tree lined residential street. There is easy access to the shops and amenities of Westbourne. Accommodation comprises of six single rooms on the ground floor four of which have en-suite facilities and a further six rooms on the first floor, one of which is a double room. There is a bathroom and WC on both the ground floor and the first floor. The second floor is not occupied and is currently being refurbished. There are secluded gardens to the rear of the property and a tarmac drive at the front of the home with trees, shrubs and a seating area. The current level of fees for personal care and accommodation at St Cecilia is £472 based on the local authority rate of payment for care services. DS0000004074.V291543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection on 19th May 2006 lasted for five hours and forty-five minutes. Carolyn Hazell, registered Manager was present and assisted with the inspection; Robert Eshelby, Registered Provider was also available for most of the day. The inspector also spoke with four residents, two members of staff, examined relevant records and took a tour of the premises. Christine Main, the Commission’s pharmacy inspector visited St Cecilia on 9th May to inspect the home’s systems of medication management, her findings are included in this report. This was a ‘key’ inspection where the home’s performance against the key National Minimum Standards was assessed along with progress in meeting requirements of the last inspection. A pre-inspection questionnaire was sent to the manager in order that certain information could be provided; information from the questionnaire will inform sections of this report alongside evidence gathered during the inspection visit. Questionnaires were also sent to the home prior to the inspection to be distributed to residents, relatives and visiting health care professionals, these were sent at short notice and unfortunately, just one was returned at the time of writing the report. Any further responses received will inform the next inspection. What the service does well: As a home caring for older people with mental health needs and dementia, admissions are arranged on the resident’s behalf, usually under a care management arrangement with the local authority that has a contract with home. Information about the care and services provided at St Cecilia’s is available to the local authority through their contract monitoring arrangements. A ‘Welcome Pack’ is available in the entrance of the home for relatives and residents informing them of the home’s structure, care arrangements, accommodation and services. The local authority provides the home with pre-admission information and care plans in order that an assessment of the suitability of St Cecilia’s for meeting the residents needs can be made. Continuous documented assessment and review of care plans ensures that an informed staff group can meet resident’s needs. Most medicines checked were given as prescribed and recorded. The medication policy does not contain enough detail to instruct staff in some DS0000004074.V291543.R01.S.doc Version 5.2 Page 6 procedures for handling and administering medicines and needs improving to protect residents. Staff relations with residents were good and it was evident that they were treated respectfully. Social care at St Cecilia’s is provided in accordance with individual resident expectations and assessments identify social, leisure and recreational preferences; due to the nature of the residents mental health needs, many are unable to engage in sustained levels of activity although they are supported in making decisions about their daily routines. Meals are provided in a sociable environment that meets residents individual dietary requirements and tastes. There have been no complaints about St Cecilia since the last inspection although a complaints procedure is available to residents and their visitors; other procedures are in place in accordance with recommended guidance concerning issues of adult protection. St Cecilia offers clean, comfortable, homely accommodation where resident’s health and safety is assured by regular safety checks of equipment and assessments of any potential hazards. The home was free from offensive odours, was a satisfactory temperature and was well lit and ventilated. Staff employed are all in the role of carer although take on additional tasks such as laundry and domestic tasks and catering. An additional care staff member has recently been rostered onto the morning shift specifically to prepare and serve the midday meal, this therefore no longer detracts from care staff time with residents. Management arrangements for the home are good with the registered manager being well supported by the registered provider and senior care staff, each senior member of staff has specific tasks for which they take responsibility such as fire officer, housekeeping officer and medication officer, Carolyn Hazell, the manager carries out staff supervision and oversees all other aspects of the home’s management and administration. Quality assurance audits are in place to ensure the home continues to meet its expressed aims and objectives; this could now be developed however. What has improved since the last inspection? There were many requirements made as a result of the last inspection raising concerns about this home. However, evidence was available at this inspection in the form of written records and documentation that the areas identified were no longer of concern. Areas identified where improvements have been made include the following: DS0000004074.V291543.R01.S.doc Version 5.2 Page 7 • • • • • • • Medicine allergies are now recorded on the Medicine Administration Record (MAR) charts written in the home and the charts are usually checked for accuracy and countersigned. The complaints procedure has been update to include information about the Commission and the Adult Protection policy has been amended. Builders rubble has been removed from the rear garden The temperature of the home was satisfactory The registered provider has submitted a report as requested under regulation 26 Fire safety equipment is checked and maintained Hazardous substances used for cleaning are monitored by use of appropriate data specification records 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. DS0000004074.V291543.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 DS0000004074.V291543.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 4 Quality in this outcome area is good; this judgement is made using available evidence. The home’s Welcome Guide provides detailed information about the care and services provided at St Cecilia. The admissions process is such that all residents have a pre-admission assessment and care management plan provided by the funding local authority prior to admission, where such information has been inadequately provided, the registered manager ensures that assessment information is gathered before offering the resident admission to the home. An emergency admission policy has been formulated since the last inspection, in all instances, all residents receive written confirmation from the home that based on the information provided, St Cecilia can meet their needs. EVIDENCE: St Cecilia provides a ‘Welcome Pack’ for new residents and their relatives; copies of this are available in the home’s entrance. Information provided includes detail of the care and services provided, it has been recommended however that this makes reference to the fact that as the home does not have DS0000004074.V291543.R01.S.doc Version 5.2 Page 10 a passenger lift, residents with mobility difficulties can only be accommodated on the ground floor. St Cecilia holds a contract with the Local Authority for all but one of its rooms, as such, the Borough arranges all admissions and residents contractual arrangements are agreed with them at the time. All residents are however issued with a letter from the home confirming that based on the assessment, the home can meet their needs, this letter also details a statement of the Terms and Conditions of Residency at St Cecilia. Care files for two residents were examined; both held assessment information and care plans provided by the local authority although one of these was for a home care arrangement that the authority had previously tried to arrange. This resident had been admitted to the home on an emergency basis following a crisis at home and pre-admission assessment information had been unobtainable. A recommendation of the last inspection that an ‘Emergency Admission’ policy was produced and made available for staff reference has been addressed, policy guidance is now available indicating how appropriate information must be obtained prior to agreeing to the admission. Carolyn Hazell, registered manager was able to demonstrate that St Cecilia will not take residents where, following assessment, it is evident that the home cannot meet their needs. Two such assessments were seen and the reasons for refusal documented. Assessment information available for both recently admitted residents demonstrated that the person’s personal care needs, mental and physical health and general welfare had been considered in order to make a decision regarding the home’s suitability. DS0000004074.V291543.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good; this judgement is made using available evidence. Care plans provide sufficient detail for staff to be aware of resident’s health and welfare needs and how to meet them; care needs are reviewed appropriately. Most medicines checked were given as prescribed and recorded. The medication policy does not contain enough detail to instruct staff in some procedures for handling and administering medicines and needs improving to protect residents. Resident’s rights to privacy are supported through care delivery, relationships with staff and confidential record keeping practices. EVIDENCE: Resident’s needs are assessed and reviewed appropriately in relation to all health and welfare needs. St Cecilia is provided with a care management care plan from the local authority for each resident, this is used for information prior to and on admission, the registered persons then ensure that a care plan DS0000004074.V291543.R01.S.doc Version 5.2 Page 12 is written specifically appropriate to the resident’s needs whilst living at St Cecilia. Care plans examined detailed how needs are to be met in relation to personal care, physical and mental health and social care. It was evident that resident’s needs are considered individually and care plans reflect personal choices such as their preferred time of waking, daily routines, likes and dislikes. A requirement was made at the last inspection concerning appropriate care planning for diabetic care; it was evident during this visit that for one resident with diabetes, an appropriate care plan was in place instructing staff on how to manage the condition, information was also available from the residents GP outlining the surgeries expectations of the home care staff in relation to diabetes. A requirement was also made following the last inspection that risk assessments were in place for residents to ensure their nutritional needs and the risks of falling had been identified. Carolyn Hazell confirmed that all residents had a risk assessment with regard to their susceptibility to falls although a format following health and safety guidelines has now been added to provide a more complete assessment. Nutritional assessments are now in place for each resident and the home records, where possible, the resident’s weight. One resident was unable to be weighed due to mobility problems although it was evident from assessment that there were no concerns about this person’s nutritional state. Carolyn Hazell also confirmed that residents with continence difficulties are assessed six monthly by a district nurse in relation to their continence care needs, one resident who was identified as having had specific problems had been referred to and assessed by a continence specialist. Care plans regarding continence care were in place for staff guidance. Daily records are written by staff for each resident, these provided a detailed report of the resident’s daily routines, lifestyles and any significant health or welfare problems. Care plans and daily records are written in a manner that uses easy to understand language and is respectful of the resident’s needs and how they are managed. Four residents were spoken with and although all had difficulty engaging in meaningful dialogue for a sustained period, they confirmed that staff are kind and helpful, they all confirmed they were warm enough and the food was good. All four spoken with were happy with the level of activity in the home; a member of the local clergy had visited that morning to conduct a brief service and although residents could not identify what other activities took place, they expressed no concerns about inactivity or boredom. One comment card returned from a relative stated ‘the quality of care (relative) receives is of a high standard and gives us peace of mind’. Christine Main, the commission’s pharmacy inspector visited St Cecilia on 9th May and reported the following: DS0000004074.V291543.R01.S.doc Version 5.2 Page 13 The home has a medicines policy but it did not provide guidance for staff on some aspects of the handling and administration of medicines and needs reviewing and updating (see guidance provided). No residents were selfmedicating. Staff handwritten the Medicine Administration Record (MAR) charts and medicine allergies are now recorded. Contrary to good practice guidance from the Royal Pharmaceutical Society staff pre-dispense medicines from the pharmacy labelled supply into cassettes a week in advance. The cassettes were only labelled with the resident’s name and were stored in a different place to the labelled medicines so staff giving medicines could not easily confirm that what they were giving was in accordance with the doctor’s directions on the medicine label. Staff record the date of opening a new pack of medicines to provide an audit trail but this was not easy to follow because of filling the cassettes. The contents of the cassettes checked agreed with the MAR chart and with the labels on the medicines except for one. The manager explained that she thought that this medicine was labelled incorrectly but had not checked. At the full inspection she said that she had followed this up and the dose had not changed so what they were giving was correct. The MAR charts were signed to confirm the medicines given but there were some gaps for the morning of the visit and one dose of a new vitamin medicine had not been given. When a choice of dose was prescribed staff sometimes did not record the dose they gave. The manager said that the pharmacy had agreed to provide medicines in monitored dosage blister packs and that she had provided the necessary information to set this up. She is also planning to get a new metal cupboard for medicines and this must be fixed to the wall. The home does not have a Controlled Drugs (CD) record book and advice on obtaining one was provided. Six of 10 staff, who give medicines, have done a medication course and the manager said that others have been trained in the home and assessed as competent. DS0000004074.V291543.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good; this judgement is made using available evidence. Social, cultural and leisure activities provided by the home are consistent with the resident’s abilities to engage. Residents are supported in maintaining contact with their friends and family and in making decisions about their lives in the home and it was evident that a caring staff group provided choices in daily routine and level of activity. Residents are provided with a variety of appetising meals that meet their individual tastes and dietary requirements. EVIDENCE: A written schedule of activities, or ‘activities programme’ was not examined although it was evident from discussion with residents that they were satisfied with the level of activity in the home. Care records also demonstrated the extent to which residents engage in social or leisure activity in the home and with visits from friends and families. Some residents have varying degrees of dependency and complex needs and many are unable to make decisions and choices about their daily lives although it was apparent that staff provide choices with regard to daily routine and level DS0000004074.V291543.R01.S.doc Version 5.2 Page 15 of activity. Residents were observed in the lounge area and with a continual staff presence there was a supportive, relaxed and friendly atmosphere. Meals are provided to residents in the dining room of the home where a large ‘farmhouse’ style table enables them to eat together in a sociable setting. A menu details what meal is to be served each day and although residents do not directly have a choice of meal, their likes and dislikes are known and an alternative would be offered where it is known that the resident does not like the meal of the day. Following a recommendation of the last inspection, the registered manager confirmed that giving a choice of meal in advance is problematic as residents are either unable to make an informed choice or would forget their choice once made. The last inspection also made the recommendation that residents are provided with cruets and sauces on the tables and a fruit bowl and drinks available throughout the day. The manager confirmed that few residents would be able to independently manage cruets and sauces and it was considered best practice for staff to continue to offer condiments to those residents who wanted them. On arrival for the inspection at 10.00am, all resident had a glass of water beside them and morning coffee was provided, a fruit bowl was on the table from which residents could help themselves although Carolyn Hazell said this practice would stop as one particular resident had a tendency to eat all the fruit, fruit would be offered throughout the day from the kitchen. Care staff do the home’s catering and the last inspection made the recommendation that a cook was employed to free up care staff time. Since that time, additional care staff hours have been utilised, there are now four members of staff on duty in the mornings, one to cook, two to care and the manager. (See also staffing section of report) Care staff also provides the evening meal although this does not take so much preparation time as it consists of a lighter meal or sandwiches. All care staff involved in catering have obtained foundation certificates in Food Hygiene, six staff are booked for an update of this training. Mrs Ruth Eshelby has a higher diploma in Nutrition and Mr Eshelby confirmed that the menus have been designed around sound principles of nutrition and calorific value. DS0000004074.V291543.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in this outcome area is good; this judgement is made using available evidence. Any person wishing to complain is directed through a written procedure detailing how their concerns will be addressed, they can therefore be confident that their complaints will be listened to and taken seriously. Resident’s rights are upheld through appropriate representation with their affairs. Procedures for responding to suspicions of abuse are held in accordance with Department of Health guidance, meaning that any allegations of abuse can be managed effectively. EVIDENCE: A complaints procedure is in place informing complainants of the correct channels for making their concerns known, the procedure gives the name and contact details for the Commission addressing a recommendation of the last report. Complainants are also directed to the host local authority, a recommendation of the last report that the procedure identify Dorset Care and Health and the local primary care trust has been withdrawn as St Cecilia is not under the control of Dorset Care and Health (Dorset County council social Services) and is not a nursing home. The recommendation was made in error. There have been no complaints since the last inspection, record form (RF16) was seen that is referred to in the home’s policy for complaints, this record format serves as a log of complaints should any be received, a requirement of the last report that a complaints register is held is withdrawn. DS0000004074.V291543.R01.S.doc Version 5.2 Page 17 Carolyn Hazell confirmed that all residents have representation with their affairs by relatives, solicitors or their care managers to protect their financial and legal interests. St Cecilia has available for staff a copy of the local authority guidelines on managing and reporting any allegations of abuse or poor practice. Additionally the home has it’s own policy which has been amended since the last inspection to inform staff of the appropriate procedures and to refer them to the local authority guidelines. Four of the nine care staff employed have received training in adult protection although Carolyn Hazell confirmed that this needs up-dating and other staff need to attend (See also standard 28) DS0000004074.V291543.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good although could be improved by addressing the good practice recommendation made. This judgement is made using available evidence including a visit to this service. St Cecilia is clean and well maintained and routine maintenance schedules ensure residents health and welfare through regular checking and servicing of equipment and maintenance of the accommodation and grounds. Accommodation and facilities provided meet the current residents needs. EVIDENCE: Mr Eshelby and Ms Hazell were able to evidence by means of a written schedule, planned and completed maintenance of the premises and servicing of equipment, Mr Eshelby confirmed that the schedule has been in place for some time, a requirement of the previous inspection in respect of this is withdrawn. The previous inspection also made the requirement that some builder’s rubble was cleared from the rear gardens; this has been addressed. DS0000004074.V291543.R01.S.doc Version 5.2 Page 19 At the time of inspection, the premises were safe, clean, free from unpleasant odours and well maintained and residents were able to move freely about the home. The rear gardens were accessible by means of a ramp although no residents were taking advantage of the garden due to the cold weather, one resident spoken with confirmed that she enjoys the gardens and the home’s conservatory seating area. Ms Hazell confirmed that as part of the home’s maintenance plan; additional handrails were to be fitted to the sloping areas of the garden. There are sufficient numbers of bathrooms and toilets around the home for resident use and four ground floor rooms benefit from en-suite facilities. Bath seats are provided to assist residents when bathing, there are no mechanical bath aids and Ms Hazell confirmed that this type of equipment had not been necessary for the residents accommodated, all of whom were able to use the baths with the seats provided. Ms Hazell demonstrated an awareness of the need to ensure at the pre-admission assessment stage of considering a resident for admission to the home that St Cecilia provided the necessary equipment to meet resident’s mobility needs. A recommendation of the last inspection is however repeated with regard to ensuring that the correct aids and adaptations are made around the home following assessment of the premises by a qualified occupational therapist. Contact details for two local occupational therapists were provided who may be willing to undertake this assessment. The last inspection made the recommendation that a passenger lift is installed. Discussion with Mr Eshelby confirmed that this would be impractical as there is not sufficient space in the home to install a lift shaft. Although it was evident from examination of one pre-admission assessment for a resident who was refused admission as they were unable to access the first floor room that was available, it has been recommended that reference is made in the home’s Service User Guide (Welcome pack) to the fact that the home cannot accommodate persons with mobility difficulties above the ground floor level. Residents bedrooms visited were clean, well furnished and personalised to varying degrees with ornaments, pictures etc. Mr Eshelby confirmed that he is in the process of renewing some of the vanity basin surrounds in some rooms where these have become old and shabby looking. Registered for thirteen, ten residents were accommodated at the time of inspection, vacant rooms had been redecorated and there was evidence of other, on-going decoration around the home. The home was a satisfactory ambient temperature for the time of day and weather conditions, a thermometer in the lounge area read 21°C. The majority of residents spend their day downstairs in the home’s communal areas; some of the first floor bedrooms were cooler as windows had been opened to provide ventilation. A new boiler system has been installed in the last year and all radiators were working effectively, the registered manager confirmed that at the time of the last inspection, there had been a fault with the heating system DS0000004074.V291543.R01.S.doc Version 5.2 Page 20 that had been repaired following the visit. All hot water outlets have thermostatic valves in order to regulate the water temperature to prevent accidental scalding. All radiators are guarded for this same reason. Residents spoken with confirmed they were warm enough in the home and comfortable. The home was hygienically clean and appropriate hand washing facilities are provided for staff. The laundry area was not assessed although Mr Eshelby confirmed that this contains one machine with sluicing programme and capable of reaching high temperatures, and one dryer, this area is due for redecoration later this year. Residents were observed to be wearing appropriate clothing that was clean and presentable and bedding in residents rooms was noted as satisfactory. DS0000004074.V291543.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor, addressing the regulatory requirements will improve this. This judgement is made using available evidence including a visit to this service. There are sufficient numbers of staff on duty in the home each day and night to provide the level of care and support needed by residents. Staff employed have attended various training courses to equip them with the skills and knowledge needed to meet residents needs although this has been let down by a failure to ensure regular training up-dates. The registered persons have not ensured sufficient methods of ensuring that all staff are appropriately screened prior to taking up employment. An appropriate induction programme is in place to ensure staff receive proper training at the point of induction. EVIDENCE: Examination of staff rotas demonstrated that there are three care staff on duty each morning, two each afternoon and one each night with a second carer sleeping in/on call. Additionally, the manager is in the home at varying times throughout the week, supernumerary to care staff in a management/supervisory capacity. The post of the third member of care staff on the morning shift has been created since the last inspection; although engaged in care duties throughout the shift, the primary role of this member of DS0000004074.V291543.R01.S.doc Version 5.2 Page 22 staff is preparation of the midday meal leaving two carers to attend to residents needs. The breakfast meal is prepared by the night sleep in staff member and the evening meal is a lighter meal prepared by one of the two afternoon carers during the quieter period of the day. Information regarding the Residential Forum Staffing calculations has been sent to the manager for consideration should resident dependency levels increase. None of the present staff have a NVQ qualification in care, although all have attended various courses in appropriate care related subjects and health and safety matters. Many of these courses need up dating now to ensure staff remain abreast of current good practice. (See also standard 38) Carolyn Hazell is aware of the need to employ good staff recruitment practices and follows the home’s procedure in relation to obtaining relevant information about the applicant including their work history, qualifications (if any), identification and two references including one from the last employer. However, St Cecilia have experienced difficulties recently obtaining CRB* certificates which include the POVA* check. It is essential that the home overcome these difficulties and ensures that all staff are properly screened before starting employment, and that existing staff that have commenced employment have these checks carried out without delay. An induction-training programme is in place, a blank copy of which was seen and noted to be held in accordance with the National Occupational Training standards for care staff. No new staff have been appointed at St Cecilia’s to undertake this training programme, the last recruit had a certificate from her previous employer demonstrating that she had successfully completed all five units of the programme. * CRB & POVA - The Criminal Records Bureau check includes a check against the POVA list to ensure the person applying for the position has not been excluded from working with vulnerable people. DS0000004074.V291543.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to this service. St Cecilia is managed effectively and in the best interests of residents. Quality assurance programmes and audits are in place although would benefit from development to ensure controlled measurement of care and services provided in order that the home meets its expressed aims and objectives. Residents are safeguarded by good procedures for managing their personal financial affairs with the support of their families. Staff are supervised to ensure they maintain good working practices. The health and safety of residents is protected by procedures ensuring that equipment is checked and maintained and other potential hazards around the home are controlled although these are let down by the lapsed contract to check the safety of the home’s gas and electrical installations. DS0000004074.V291543.R01.S.doc Version 5.2 Page 24 EVIDENCE: Carolyn Hazell is registered with the Commission to manage the home on a daily basis with the support of Mr Eshelby and of senior care staff. Since the last inspection a third member of care staff has been rostered on to the morning shift to prepare the midday meal freeing up more management time for Ms Hazell. Quality audits are carried out although at random intervals, records of the audits demonstrated that aspects of the homes cleaning schedules, care practices, daily records and kitchen stock rotation had been audited; any corrective action needed was identified and the records demonstrated that this had been carried out; the audits have not lead to establishing a development plan. On 1st April 2006 a change in the regulation introduces a legal requirement for registered providers to produce an Annual Quality Assurance Assessment (AQAA), this will be introduced to care homes in autumn 2006. Although the Commission will introduce a set proforma to care homes, it would be considered good practice for Mr Eshelby and Ms Hazell to consider how well, in their estimation, they deliver good outcomes for residents at St Cecilia including the views of users, where improvements can be made and what action will be taken to respond to requirements and recommendations of the inspection. Ms Hazell confirmed that the home does not assist any of the residents with the management of their finances; the last inspection reported that one resident was having assistance with their finances although no records were kept. Mr Eshelby demonstrated during this inspection that records were held for this resident (who had since been discharged), records examined demonstrated robust and accurate management of the residents funds. Staff receive regular supervision, records seen demonstrated the areas of discussion. it has been recommended that staff receive regular up-dates in areas of health and safety training and it is advised that Ms Hazell ensures that training needs are identified clearer through supervision to ensure training is up-dated as expected. Records are held in the home in accordance with regulations; the last inspection resulted in the requirement that Mr Eshelby undertake monthly inspections of the service as part of his responsibility under regulation 26. Since the last inspection, a report has been sent to the Commission demonstrating Mr Eshelby’s areas of inspection and discussion with residents and staff. Mr Eshelby is reminded that these inspections should be reported on monthly, the report will help Mr Eshelby to monitor and improve the quality of the service in ways that matter to the people using it. The report does not need to be sent to the Commission every month as a matter of routine but must be kept at least until the next key inspection. DS0000004074.V291543.R01.S.doc Version 5.2 Page 25 Examination of records of testing and maintenance of fire fighting equipment, alarm systems and emergency lighting demonstrated that these are undertaken at the required intervals. A record of fire drills demonstrates that these are carried out regularly and include evacuation of the premises. Following a requirement of the last report, a safety assessment has been carried out detailing areas where there are potential hazards around the home, the assessment was seen to reference guarding hot surfaces, water temperature regulation, window opening restrictions and removal of hazardous material (builders rubble) from the gardens. The last inspection also made a requirement regarding Control of Substances Hazardous to Health (COSHH), Ms Hazell confirmed this requirement was met and product analysis sheets were seen demonstrating safe use of all chemical substances used in the home for cleaning. The last inspection also resulted in the requirement that evidence is supplied confirming the safety of the gas and electrical installations, an engineer was present in the home on the day of inspection checking the gas installation, it remains a requirement however that certificates are sent to the Commissions confirming the home’s safety. Staff training must be up-dated in areas of Health and Safety including moving and handling, first aid, food hygiene and infection control, some staff employed last received training in these areas in 2001 and 2002, some staff are more up to date with training undertaken in 2003 and 2004. It is recommended that staff receive up-dates in all aspects of health and safety training and the registered persons ensure they take advice from the training provided on the recommended frequencies for training to be provided. DS0000004074.V291543.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 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 1 DS0000004074.V291543.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: Recording the administration of medicines at the time they are given and the dose if a choice is prescribed. There must be evidence that the home operates a robust recruitment system; new staff must not commence work without evidence of suitable CRB disclosure and POVA check. This requirement was first made at the inspection dated 13/03/06 and is repeated for the second time. Documentary evidence confirming the safety of the gas and electrical installations must be provided to the Commission. This requirement was first made at the inspection dated 13/03/06 and is repeated for the second time. Timescale for action 1 OP9 13(2) 30/06/06 2 OP29 19 30/06/06 3 OP38 13 30/06/06 DS0000004074.V291543.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. Refer to Standard OP1 Good Practice Recommendations It is recommended that the home’s ‘Welcome Pack’ inform readers that residents with mobility difficulties can only be accommodated on the ground floor, as there is no passenger lift. The home should follow guidance from the Royal Pharmaceutical Society including: a) The policy should be updated and should include provision for self-medication where appropriate (see guidance provided). b) The audit trail for medicines should provide robust evidence that medicines are given as prescribed and recorded and the home should self-monitor medication and the records to ensure that any problems are identified and corrected. c) The home should have a CD record book and appropriate storage for CDs. The premises should be assessed by a suitably qualified occupational therapist with a view to establishing the extent of any aids and adaptations required to assist access around the home as necessary. It is recommended that staff attend appropriate updates in their training in areas of good care practice. It is also recommended that at least 50 of care staff have attained NVQ level 2 by end of 2006. It is recommended that the registered persons consider establishing a development programme from their quality audits in line with the expectations of the Commission’s ‘Inspecting for Better Lives’ programme. It is recommended that staff receive up-dates in all aspects of health and safety training and the registered persons ensure they take advice from the training provided on the recommended frequencies for training to be provided. 1 2 OP9 3 OP22 4 OP28 5 OP33 6 OP38 DS0000004074.V291543.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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