Inspection on 10/08/06 for St Cecilia Care Home

This inspection was carried out on 10th August 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 Care Home 20/02/09

St Cecilia Care Home 15/02/06

St Cecilia Care Home 31/08/05

St Cecilia Care Home 10/03/05

St Cecilia Care Home 28/09/04

St Cecilia Care Home 11/02/04

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

CARE HOMES FOR OLDER PEOPLE St Cecilia Care Home 1 Hitchen Lane Shepton Mallett Somerset BA4 5TZ Lead Inspector Stephen Humphreys Key Unannounced Inspection 10th August 2006 09:30 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 Cecilia Care Home DS0000003288.V303213.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 Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Cecilia Care Home Address 1 Hitchen Lane Shepton Mallett Somerset BA4 5TZ 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) 01749 342809 01749 342809 Mr David Edwin Wills White Mrs Lynn Denise Ashwell Care Home 16 Category(ies) of Dementia - over 65 years of age (16) registration, with number of places St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user, under 65 years of age to receive periods of respite care, as detailed in application dated 23 February 2006. 15th February 2006 Date of last inspection Brief Description of the Service: St Cecilias is a detached two-storey house situated close to Shepton Mallet town centre. The service has provided specialist residential care for older people with dementia for about 3 years, having formerly been registered as a nursing home. Services are accredited, contracted and supported by Somerset Partnership NHS and Somerset County Council. The home provides a secure environment with an attractive, enclosed patio-style garden. This arrangement is to allow people living in the home to move freely around the home and garden in safety. Accommodation has been altered recently and is provided in single rooms. One room is shared with an attractive sitting room opposite for the couple to use. The space available allows service users to use a lounge or lounge/dining room downstairs and the garden. A wide variety of activities are available during the day and a specialist care development nurse (SCDN) visits to support the staff and service users two or three times a week. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of 2006/2007 period using the Commission for Social Care Inspection’s Inspecting for Better Lives methodology. The methodology. The inspection was unannounced and carried out over one day. Although the registered manager was not on duty she did come into the home to provide assistance to the inspector with regards to information. At the time of this inspection there were 14 residents in the home. The Inspecting for Better Lives methodology includes carrying out preinspection surveys of residents and other professionals involved in the home. The results of the surveys indicated that residents/ relatives and visiting professionals were satisfied with the service delivery in the home. Residents spoken to confirmed that staff are kind and respectful and the inspector observed staff interacting in a kindly manner. Lunch was observed and looked plentiful and appetising having been freshly prepared by the cook. The inspector had a brief discussion with the registered provider during his daily visit to the home. The registered provider indicated that he was considering to expand the number of bedrooms in the home in the near future. No relatives were spoken to during this inspection. The specialist care development nurse (SCDN) was in the home during the morning, monitoring the residents conditions and discussing care needs with the registered manager. The inspector was able to speak to her about the standard of care delivery. The Somerset Partnership and Somerset County Council have no concerns about the standard of care in this home. No concerns or complaints have been received by the Commission for Social Care Inspection since the last inspection. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: In discussion with the registered manager and the SDCN it was felt that the resident’s care plans could be more person centred and focussed on achievable outcomes. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Cecilia Care Home DS0000003288.V303213.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): 1,3 The quality in this outcome group is good. Residents and relatives are provided with detailed information about the home in a format suitable to their abilities. All residents receive a multi-disciplinary assessment before entering the home. EVIDENCE: Due to the variance of the resident’s cognitive abilities no one could confirm whether they made the choice to enter the home. Information in the form of a statement of purpose and service user guide in large print is available in the home to all who wish to read them. The statement of purpose and service user guide contains all the necessary information required to meet this standard. Initial assessments are completed by the specialist care development nurse (SCDN) or an appropriately qualified nurse or social worker and also go through an assessment panel. The manager or deputy will also visit and assess the prospective resident. Admission is then subject to the agreement of all parties involved, including the prospective resident and/or representative. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 10 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 The quality in this outcome group is good. Residents can be assured that staff will involve them as much as possible in the development of their care plan. Residents can be assured their health care needs will be met and that they will receive a wholesome diet. EVIDENCE: A sample of four care plans was reviewed in detail to include case tracking and a further four were reviewed for content. Each care plan was individual and showed a good balance between psychological and physical needs. The plans viewed showed that they had been reviewed regularly and evidence was seen which demonstrated that residents or their representatives had been involved in this process. The care plans showed evidence of response to changing needs. The home conducts written risk assessments to protect individual abilities and needs of residents. As the home provides personal care only the community nurses visit the service regularly to complete any nursing tasks. The care plans recorded the St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 11 health professional’s visits occurring on a regular basis including GP, podiatry and optical care. A good range of assessment tools with appropriate risk assessments including tissue viability, moving and handling and ‘slip, trip or fall’ and nutritional risk are recorded in the care plans. The resident surveys and professional surveys received were very positive in reply to the question “ do you receive the medical support you need”. Response to the question “do you like the meals in the home”, there was 100 response to always. The inspector discussed with the registered manager and the SDCN the benefits of having achievable outcome based care plans to be able to measure the quality of service delivery. The registered manager agreed to look at developing this further. The homes medication procedure was checked including observation of the administration of medicines. The receipt, storage, administration and disposal were all satisfactory. The controlled drugs were checked and counted. The drug fridge temperature is recorded daily using a max – min thermometer. There is a homely remedies policy signed by the GP for each residents. The pharmacy inspector from Mendip PCT carried out an inspection on the 5th June 2006 and found everything satisfactory. Respondents to the residents survey and observation of staff during the day confirmed that staff respect residents in all care situations. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 12 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 The quality in this outcome group is good. Resident’s can be assured that the home is run for their benefit with a wide range of social and leisure activities available. Family and friends are able to visit at any time. EVIDENCE: People who live at the home are able to maintain control of their lives and are enabled to be independent. The routines in the home are flexible with a focus on social care that benefits the individual and helps them to maintain their abilities for as long as possible. The social programme in the home includes trips out to interesting places in the community. The residents decide on the places to visit at their monthly meeting. The community bus is hired for trips to the coast, and other interesting places. On the day of this inspection the residents were venturing out in the evening to the Bristol balloon fiesta. The strong emphasis on social stimulation was evidenced from the entries made in the care plans. On the day of inspection staff were observed engaging residents in reading the newspaper and discussing world events. The articles were then used to reminisce about previous event. Staff were observed in one to one time with several residents during the day. Staff are mindful that St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 13 residents have short attention spans and therefore changed the emphasis of the activities in the delivery of person centred care. Respondents to the residents survey were positive about the activities provided in the home. Residents are encouraged and supported to handle a small amount of pocket money. The credit and debit records are kept in the individuals care plan. The service users guide includes information on how to contact the external advocate service provided by Age Concern. During a tour of the home the inspector was able to observe that residents had personalised their rooms. St Cecilia’s provides a four-week menu cycle, which showed a varied and well balanced diet. On the day of inspection the residents asked stated that the food provided was of a good standard. The menu demonstrated that fresh fruit and vegetables were provided on a regular basis. A choice of main meal was not routinely offered, however, those service users questioned stated that they could ask for an alternative if they did not like what was on offer. Meals could be taken in the main dinning area or in the resident’s room. The inspector observed the lunch being served. All the residents sat in the dining room all but two sat at tables of up to four residents. The tables were laid out with cutlery and condiments. Drinks were available. Staff were observed to serve the meals respectfully and sensitively offering support where needed. There was good interaction between staff and residents. Quite a few residents sat at table wearing a blue plastic apron. Staff offered these to protect the clothing however it may not be totally dignified. To enhance the homely ethos the registered manager should consider the benefits of staff having meals with resident’s to make meal times a social occasion. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 14 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): 16,18 The quality in this outcome group is good. Residents can be assured that there are robust procedures to ensure their protection and safety. EVIDENCE: St Cecilia’s has in place a satisfactory complaints policy a copy of which can be found in the statement of purpose and service user guide. No complaints have been received since the last inspection. Residents spoken to all said that they felt happy to bring up any issues to the management team if they were unhappy about any aspect of the support provided. Abuse awareness is part of the induction programme and NVQ training. Abuse awareness in dementia care is supported by the SCDN. The home uses the Somerset adult protection policy. The registered manager ensures through training, supervision and quality monitoring that staff comply with the policy and procedures to protect the residents. Staff files were checked to review the recruitment procedure. The files of recently employed staff contained CRB and POVA first disclosures. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 15 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): 19,26 The quality in this outcome group is good. Residents can be assured that the environment they live in is clean, warm and well maintained. EVIDENCE: During the inspection the inspector did a tour of the home including communal and resident bedrooms with permission. The communal rooms are homely and all the furniture and fittings appeared in good condition. At the entrance is a large notice board with an activities programme. The toilets and communal rooms are well sign posted with signage that is suitable to people with dementia and sight impairment. The stair carpet was showing signs of wear and tear and should be considered for replacement in the next budget year. Bedding and linen was clean well laundered and in good condition. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 16 There is a carpet grip with slightly raised screws across the corridor where the carpet has been joined. The registered manager must ensure that this is risk assessed and that the screws are driven home completely. In the kitchen the floor seals need replacing and the fly killer needs cleaning. The décor along with the garden and patio were pleasant and satisfactory. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 17 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 The quality in this outcome group is good. Residents can be assured that all staff are suitably trained and experienced in caring for people with dementia. The staff level is adequate for the number of residents in the home. EVIDENCE: Duty rotas were viewed as part of the inspection process and recorded that the service is adequately staffed. There are two night staff at all times. The staff on duty included 3 carers from 7.30 – 2pm then 3 carers from 2pm – 9pm and 2 waking night staff. There is always a cook and housekeepers on duty during the day. There is an on going training programme to provide NVQ qualifications. Staff spoken to during the inspection showed a strong commitment to training and seeking new ways to improve the lives of the service users. Staff files were viewed on the day of inspection and were found to contain the necessary documentation including evidence that Criminal Record Bureau checks have been received. In addition the ongoing commitment to NVQ training staff have undertaken a number of training opportunities relating to caring and supporting people with dementia. All mandatory training has been completed including abuse, fire, first aid, infection control, food hygiene, health & safety and moving and handling. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 18 Currently 66 of carers have completed the NVQ training at level two or above. All new employees complete an induction programme that meets the skills for life standards. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 19 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): 31,33,36,38 The quality in this outcome group is good. The registered manager is very experienced and committed to providing a high standard of service delivery to people with dementia. Records are well managed and stored securely. EVIDENCE: St Cecelia’s is well managed by Mrs Ashwell who has many years of experience in caring for older people with dementia. Mrs Ashwell stated that she felt confident in being able meet the aims and objectives of the home. Residents and staff said that they would be able to discuss any concerns with her and that appropriate action would be taken. All staff spoken to were positive and enthusiastic and find the manager approachable and supportive. All felt well supported and informed, with the opportunity to share in decision-making. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 20 The manager is supported by a committed deputy manager whom staff also indicated was a person that they can approach for support. The open door policy continues and staff meetings are held monthly. Staff continue to support each other if they find situations difficult and ‘time out’ is offered. One member of staff interviewed said “we are encouraged to take time out if needed”. The management team conduct a number of audits and quality assurance systems are in place to confirm the home is run for the benefit of the residents. This with the open door policy and the approachability of the management ensures the continued excellent standard of care and support delivered. Statutory records were reviewed these included the accident records, hoist records and fire safety. All were well maintained and equipment was serviced in line with good practise. Staff confirmed that they have regular formal supervision with the registered manager and notes of the meetings are kept on file. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 13(4) (c) Requirement The registered provider must ensure the carpet gripper screws are replaced or driven home to ensure the safety of staff and residents. Timescale for action 30/08/06 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 OP7 OP15 Good Practice Recommendations The registered manager should develop the individuals care plan to be more outcome focussed and achievable. The registered manager should consider making meal times a social occasion and include staff to take meals with residents. St Cecilia Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Care Home DS0000003288.V303213.R01.S.doc Version 5.2 Page 24 - 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. 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