CARE HOMES FOR OLDER PEOPLE
St.Cecilia 29 Nelson Road Branksome Poole BH12 1ES Lead Inspector
Tracey Cockburn Unannounced 04 August 2005 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 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.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Cecilia Address 29 Nelson Road, Branksome, Poole, Dorset, BH12 1ES Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 767383 01202 767383 Mr Robert John Eshelby Ms Carolyn Gwendoline Hazell Care Home 13 Category(ies) of MD(E) - 13 registration, with number DE(E) - 13 of places St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: One named person (as known by the CSCI) under the age of 65 may be accommodated to receive care. Date of last inspection 31 January 2005 Brief Description of the Service: St.Cecilia is registered to provide care for up to 13 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 6 single rooms on the ground floor 4 of which have en-suite facilities. A further 6 rooms on the 1st floor 1 of which is a double room. There is a bathroom and WC on both the ground floor and the 1st floor. Private accommodation on the 2nd floor is currently occupied by the registered provider. There are secluded gardens to the rear of the property. There is a tarmac drive at the front of the home and trees and shrubs with a seating area. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 2.5 hours in the morning of the 4th August 2005. The purpose of this inspection was to review the requirements and recommendation from the previous inspection and to see how the new registered manager was getting on. During the inspection care files were examined, residents and staff spoken to, policies and procedure seen, a tour of the premises took place and both the registered manager and registered provider spoken to. At the time of the inspection there were 12 residents in the home. 3 members of staff were on duty. What the service does well:
The service user guide for the home has been updated and now clearly states that the home provides specialist care to older people with dementia. This means that people who come to look round the home on behalf of a relative or friend will be clear on who the home is able to care for. Prospective residents and their families are encouraged to visit and look round the home and speak to the manager and find out if the facilities the home offers will be suitable. Every resident has an individual plan detailing their care needs and their preferred routines, likes and dislikes and recreational interests. This means that care staff have a good understanding of each resident and their needs. Residents in this home are in most cases not able to make decisions about their health needs, decisions are made in consultation with the residents representative. The home has established the social, recreational and cultural needs of their residents to ensure that they are providing activities which they would be interested in. Residents are able to maintain contact with the people they wish to. St. Cecilia’s provides a safe and well-maintained environment for its residents, with access to the garden. The home has sufficient washing and toilet facilities with the addition of all toilets being easily recognised for those residents who are no longer able to read, by being painted red. The registered manager has an excellent understanding of the needs of older people with dementia and encourages staff in developing their own knowledge. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,5 standard 6 is not assessed as the home is not registered to provide intermediate care. The home’s service user guide contains all the information a prospective resident or their representative needs to make a decision about whether the home can provide the service they need and want. The home encourages people to visit before making a decision to move in or not. EVIDENCE: Since the last inspection the service user guide has been updated to include information about the specialist nature of the service the home provide this makes it clearer to prospective residents that the home provides care for people who have a mental health problems specifically dementia. During the inspection relatives were visiting the home to view a vacant room. The manager was observed showing them around and explaining the homes philosophy, approach to care understanding of dementia care and the support they provide. The manager was observed being reassuring and thoughtful to the distress the relatives felt in having to make this decision about a loved one.
St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Individual plans of care set out the health, personal and social care needs of residents which means that care staff have a good understanding of the support that individual residents need. Residents receive support from health care professionals as soon as a problem is identified. This means that residents health care needs are met by people qualified to provide treatment and give guidance to staff. The home has a policy and procedure for dealing with medicines this is not always implemented leaving residents vulnerable. EVIDENCE: The care plans and assessments for 4 residents were looked at, including if care needs were addressed, how assessed needs were implemented and whether or not mental health needs were adequately covered. The care needs which were identified were consistent with the needs expressed in the original assessment. The care plan for one resident identified her routine on waking as staying in bed until 10am except on the days she attended a day centre. Care plans also identifies what residents like to do; sit in the garden, go shopping, watch TV. The care plan for one resident also identified that staff should be
St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 10 aware that this resident did not like his personal space to be invaded and that this can cause him distress. Care plans also identify how many pillows people like when they are sleeping, how many care staff they need to assist them with their personal care and how they like their personal care to be carried out. There were several pots of prescribed cream, which were found around the home at the time of the inspection. One pot of cream was found in a different bathroom to the name on the label and another pot of prescription cream was found in the dining room on a shelf by the radiator this cream was for someone who was no longer in the home. This was drawn to the attention of the registered manager who immediately removed the pot of cream from the dining room. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 There are systems in place in the home for identifying residents social, cultural and recreational interests, which means that they are able to stimulate residents memories with activities they may once have enjoyed. Residents are encouraged to maintain contact with the people they want so they can continue to be part of the community and keep in touch with the people who are important to them. EVIDENCE: The manager has completed assessments on each resident’s activities and interests. This has been part of a wider review of the key worker system in operation within the home. The activities assessment includes their mental health, memory, and cognitive ability. From this assessment there have been identified areas where the resident might benefit from 1:1 time with their key worker. The forms are kept in key worker files and enable the care staff to fully participate in the life of the resident, by ensuring that their relatives are kept up to date, the residents rooms are cleaned by them, cupboards tidied and care plans up dated. The registered manager has ensured that these assessments enable care staff to understand the state of each resident’s memory, whether or not they are able to talk, have partial speech or are not able to complete sentences. These
St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 12 assessments also cover the person’s background, their education, and interests in classical music, opera and choral music. One resident likes to make things and during one to one time with their key worker they are able to spend time making crafts, which interest her. The registered manager was also explaining that she may be rearranging the lounge and dining area to be able to have smaller groups and encourage participation in different activities. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The homes complaints policy should give residents and their relatives confidence that their complaints will be taken seriously and action taken. The home has policies, procedures and training for staff, which should ensure that residents are protected from abuse. EVIDENCE: The home has a complaints policy, which is accessible to both residents and their relatives. There have been no complaints to the home since the last inspection and no complaints have been made directly to the commission. There has been one adult protection investigation; the home has not yet heard the outcome of this investigation. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,26 The home is safe and there is evidence that the environment is maintained to a good standard. The communal areas both inside and outside the home are accessible and safe which means that residents are able to wander where they want without risk. The home has sufficient and suitable lavatories and washing facilities for all the residents needs to be met. The home provides a clean, pleasant and hygienic environment, which gives a good impression to prospective residents. EVIDENCE: Since the last inspection there have been some changes to the home, the dinging room is less cluttered, the filing cabinets which were in the corner of the room have been moved into the new office at the side of the building. This means that there is more space round the dining room table for residents. There is also a small sun lounge leading from the dining room, which allows more light into the room and is another room which residents can sit in and
St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 15 look out over the garden. The bathroom on the first floor is in the process of being renovated and redecorated. The grounds both at the front and rear of the home are maintained tidy and assessable for residents. The home does not use CCTV. The home meets residents individual and collective needs, there is space to wander about safely. The living room in the home is smoke free, all residents sit together for their meals round a large farmhouse style dining table. The gardens are accessible for those residents who are in a wheelchair. There is outdoor seating and a small patio area, which is paved. The lighting in all the rooms is domestic in character. The furnishings in the lounge area consist of individual seats. The manager explained that the home is considering experimenting with changing the seating and seating arrangements, so that a variety of different activities can take place in small groups. All toilets in the home have the door painted one colour in this home it is red, this is so that residents can easily identify the toilets in the home. At present due to the renovation of one of the bathrooms there is only one bathroom in the home for residents use. Residents were not able to comment on whether this was a problem or not. The home provides specialist equipment when it has been assessed as necessary. There was evidence of a hoist in the home, grab rails in all toilets and chair raisers for some residents. The premises themselves have not been assessed. The manager explained that this is in the process of being done. At the time of the inspection there was initially a smell of stale urine in the home as the inspection progressed and the rooms were cleaned and bed linen changed this smell dissipated. The laundry area is accessed via a side door from the home. The equipment in the laundry room was in good working order. The home has policies and procedures in place for the control of infection and staff were observed using protective clothing whilst providing personal care. Rooms were clean. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Training practices have improved which means that staff are more competent to care for vulnerable adults with mental heath problems. EVIDENCE: All staff have been enrolled on the TOPSS induction and foundation training and will be starting in September. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,38 The manager expects high standards from all staff to ensure that residents receive the quality of service they deserve and pay for. The home has developed a quality assurance system which takes into account the mental capacity of residents, which means that they continue to work towards running the home in the best interests of the people who live there. Polices and practices of the home promote the health, welfare and safety of the residents and staff. This means that the staff have the information and guidance they need to provide a good service to residents. EVIDENCE: The registered manager has recently started her post and been registered by the commission. She has demonstrated that she is very capable and understands the standards and regulations. She has almost completed her Registered manager’s award.
St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 18 The quality assurance system in place means that the home has been able to produce an annual development plan a copy of which has been given to the commission. The manager actively seeks the views of the people who use the service and their representatives but also other people who visit the home on a regular basis. At the previous inspection there was no lock on the cupboard in the laundry room were cleaning products were stored this has now been rectified and the cupboard is now locked when not in use. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x 3 2 x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x 3 x x x x 3 St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The registered manager must ensure that all prescibed medication is stored correctly and only used for the resident to which it is prescribed. All medication must be returned to the pharmacy when a resident dies. Timescale for action Immediate 2. 9 13(2) 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 16 22 Good Practice Recommendations The complaints policy should be amended with the correct title of the Commission. The premises should be assessed by a suitably qualified individual such as an Occupational Therapist. St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI St.Cecilia D55 S4074 St Cecilia V229088 040805 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
