Inspection on 15/02/06 for St Cecilia Care Home

This inspection was carried out on 15th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Cecilia Care Home 20/02/09

St Cecilia Care Home 10/08/06

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 Justine Button Unannounced Inspection 15th February 2006 12.45 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.V283604.R01.S.doc Version 5.1 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.V283604.R01.S.doc Version 5.1 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.V283604.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2005 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.V283604.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over one day by one inspector. The inspection was unannounced and carried out as part of the annual inspection programme for the home. The Registered Manager, Mrs Ashwell, was available for part of the inspection and inspector appreciated the help provided by Mrs Ashwell and her staff throughout the inspection. Feedback was given to Mrs Ashwell at the end of the inspection. All of the people living at the service and relatives spoken to were satisfied with the service they receive at the home. The inspectors concluded that the home is providing a good service. There is however evidence of lack of investment in the provision of bathrooms People spoken to confirmed that staff are kind and respectful and inspectors observed staff interacting in a kindly manner with all service users. Lunch was observed and looked plentiful and appetising having been freshly prepared by the cook. What the service does well: What has improved since the last inspection? Only one requirement was made at the last inspection. This inspection related to the provision and refurbishment of the bathrooms. There are plans to St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 6 refurbish the lounge area and to add a conservatory. The inspector was informed that the bathrooms would be refurbished at this time. 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 Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3, 4 & 5. Standard 6 is not relevant There is adequate information available for people who may want to move into the home. All people are issued with a statement of their stay. People are able to visit the home prior to moving in. EVIDENCE: St Cecilia’s has a statement of purpose and service user guide. This contains all the necessary information that would be required for prospective service users. A copy is given to all prospective and current service users. All service users have a copy of the statement of terms and conditions. The terms state the criteria for continued occupancy and notice periods. The proprietor has a block contract with Somerset Partnership. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 9 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 service user. Admission is then subject to the agreement of all parties involved, including the service user and/or representative. The home provides an environment appropriate to the specialist care offered. The home is secure and areas are risk assessed with the needs of dementia care and the older person in mind. Relatively safe and secure indoor and outdoor routes have been created for those who wander and the manager has demonstrated the home’s ability to react appropriately if additional risks to safety are identified. New staff are given information about dementia and the SCDN visits twice a week to advise and support staff. A variety of orientation cues were in evidence at the inspection. Trial visits are available if wanted. For Social Services funded people the first four weeks is considered to be a trial period and then a review is held. The home rarely takes ‘emergency’ admissions St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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. All people who live at the service have a care plan. Health care needs are met. Privacy and dignity is respected. EVIDENCE: A sample of four care plans was viewed on the day of inspection. The plans 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 service users and/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 service users. As the home provides personal care only the community nurses visit the service regularly to complete any nursing tasks. The service user plans confirmed that health professionals visited the home on a regular basis including GP, podiatry and optical care. A good range of assessment tools with regard to pressure risk, moving and handling and ‘slip, trip or fall’ and St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 11 nutritional risk are used. A number of people at the service fall regularly. This needs to be kept under review. Pressure pads have now been purchased and are used for some people who are at risk of falling at night. People spoken to stated that staff were very kind. During the inspection, the inspector observed staff interacting with service users in a professional, kindly and respectful manner. Staff are friendly, but professional in their approach. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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. There are a wide range of social and leisure activities available. Family and friends are able to visit at any time. People who live at the service are able to maintain control of their lives and choices are offered. The food provided is of a good quality. EVIDENCE: St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 13 St Cecilia’s places a strong emphasis on social stimulation. A wide range of activities are available. This was evidenced from the entries made in the service user plans. On the day of inspection staff were observed engaging service users in reading the newspaper and discussing world events. The articles were then used to reminisce about previous events. Service users were involved in chair exercises and games. Staff were also involved in one to one time with service users. Staff were mindful that several of the service users had short attention spans and therefore changed the emphasis of the activities as required. Activities were conducted in a non demeaning manner and respected service users dignity. Staff should be complemented on the service they provide in this area. There is open visiting; in either communal areas or service users may use their own rooms. Service users would benefit from a separate quiet sitting room/area to receive visitors. Staff support service users to use the local community and stay in contact with any clubs identified in the activities assessment. The town is close enough for people to walk into. A monthly church service is held at the home. Service users are able to handle their own financial affairs for as long as they wish to so and as long as they are able to do so. Service users and their relatives are informed via the service users guide on how to contact the external advocate service provided by Age Concern. Service users are able if they wish to furnish their own rooms. Staff were observed supporting service users to make choices about how they spent their time and service users were free to access all areas of the building according to their wishes. St Cecilia’s provides a four-week menu cycle, which showed a varied and well balanced diet. On the day of inspection the service users 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 service users room if they wished. The management stated that they were able to cater for specialist dietary needs. Lunch on the day of the inspection consisted of roast Pork roast potatoes and two vegetables. A hot pudding with custard was then served. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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, 17 & 18. There is a complaints procedure. Service users are protected from abuse. 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. Service users interviewed 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. All employees have under gone CRB and POVA checks St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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, 20, 21, 22, 23, 24, 25 & 26. The building is safe and homely. On the whole it was clean and tidy although some work is required in the bathrooms. EVIDENCE: St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 16 The surroundings have been assessed against the specification for SRC accreditation. The home is secure and provides space for those individuals who need to wander. All service users are risk assessed for their safety on the stairs. All areas are rooms pleasant and homely. The manager confirmed that redecoration, recarpeting and refurbishment are planned. This will include increasing the homes occupancy by two. In addition the lounge will be extended by the addition of a conservatory. The garden is accessible with planting, a raised bed and garden furniture making this a pleasant area for people to enjoy. Orientation cues are around the home to help service users identify different rooms. The environment is monitored through an Environment Audit. The bathrooms were viewed during the inspection. These are in need of some refurbishment. The manager stated that these will be refurbished later this year while the extension is taking place. Infection control measures are in place including hand washing facilities for staff. All the bedrooms are for single occupancy. All can be furnished with personal possessions if people wish. All were relatively clean and tidy. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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 service provides staff who are suitably trained and in adequate numbers. EVIDENCE: St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 18 Two weeks duty rotas were viewed as part of the inspection process. These showed that the service is adequately staffed. There are two night staff at all times. Daytime hours are covered by two or three staff dependant on the needs and requirements of the service on a given day. In addition ancillary staff including a cook, cleaner and laundry person are on duty on a daily basis. Agency staff are used on a very occasional basis to cover any staffing shortfalls. There is an on going training programme to provide NVQ qualifications. Staff spoken to during the inspection should 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. All contained 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. All new employees complete an induction programme that meets TOPPS guidelines. The Foundation programme is then made available. The service provides staff who are suitably trained and in adequate numbers. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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, 32, 33 & 38. care and service they receive. Records are well managed and are stored securely. The home is well managed. EVIDENCE: St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 20 Mrs Ashwell has many years of experience in caring for older people, including about 2 years at St Cecilia’s, as deputy manager, following the change to provide dementia care. Mrs Ashwell stated that she felt confident in being able meet the aims and objectives of the home. Service users stated that they would be able to discuss any concerns with the manager 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. 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. Service users spoken to, who were able, knew the staff and felt included in the home. The manager meets formally with relatives and the service user annually. The management team conduct a number of audits and quality assurance systems are in place. This with the open door policy and the approach ability of the management ensure the continued excellent standard of care and support which is offered to service users. Some maintenance records were viewed these included the accident records, hoist records and fire safety. All were well maintained and equipment was serviced in line with good practise. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 2 3 3 3 3 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 3 3 X X X X 3 St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 (2) (b) Requirement It is a requirement of this inspection that the provider (Mr White) submits an action plan to the CSCI that details the refurbishment of the bathing facilities. Timescale for action 30/04/06 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 OP31 OP8 Good Practice Recommendations It is recommended that Mrs Ashwell undertake a management qualification to consolidate her experience. It is recommended that the use of pressure pads be considered for those people who fall frequently. St Cecilia Care Home DS0000003288.V283604.R01.S.doc Version 5.1 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.V283604.R01.S.doc Version 5.1 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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