Inspection on 20/02/09 for St Cecilia Care Home

This inspection was carried out on 20th February 2009.

CSCI found this care home to be providing an Good service.

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 10/08/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Cecilia Care Home 1 Hitchen Lane Shepton Mallett Somerset BA4 5TZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Justine Button     Date: 2 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Cecilia Care Home 1 Hitchen Lane Shepton Mallett Somerset BA4 5TZ 01749342809 01749342809 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr David Edwin Wills White care home 17 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 17 The maximum number of service users who can be accommodated is 17. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of iether gender whose primary care needs on admission to the home are within the following category: DementiaCode DE Date of last inspection Brief description of the care home 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 4 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. 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. Care Homes for Older People Page 4 of 27 Brief description of the care home We were informed in Febuary 2009 that the current fee levels are 479 pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The inspection was carried out over a one day period. During this time the inspector was able to talk with people living, working and visiting the home, observe care practices, tour the building and view records. The inspector was made welcome and given unrestricted access to all areas of the home. All records requested were made available. Care Homes for Older People Page 6 of 27 Prior to the inspection the registered manager completed an Annual Quality Assurance Assessment (AQAA) This was completed to a high standard and gave a clear picture of the home and plans for the future. In addition surveys from five people living at the home were received. These had been completed on the whole with the help of relatives or friends. Feedback was also gained from a visiting healthcare professional. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 27 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anyone wishing to move into St Cecilias has their needs assessed and has an opportunity to visit the home to ensure that it meets their needs and expectations. Intermediate care is not provided. Evidence: Before moving into the home people are given a copy of the statement of purpose, service user guide in the form of a brochure. Everyone wishing to move into St Cecilias has their needs assessed by the home and is able to visit before deciding to move in. People spoken to during the inspection stated that they had been able to spend time at the home to help them to decide whether or not they wished to move in. In addition to full residential care the home also offers respite. Two people spoken to stated that they had originally had a respite stay which gave them an opportunity to make sure that it was the right place for them. Care Homes for Older People Page 11 of 27 Evidence: The terms and conditions of residency state that there is a trial period at the beginning of any stay. This gives people an opportunity to ensure that the home meets their expectations and the home a chance to ensure that they are able to meet the individuals needs. The inspector saw copies of pre admission assessments completed by the home and full assessments completed by professionals outside the home. The manager gave evidence that as well as physical needs the assessment looks at social and emotional needs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place for each individual living at the home. The plans are detailed and reflect the person centred care that is provided at the home. People living at the home have access to healthcare professionals in line with their individual needs. Evidence: The inspector viewed a sample of 4 care plans. These gave good information to enable staff to meet the needs of the people living at th home. The plans gave a detailed picture of the individual including their preferences and lifestyle choices. People living and working at the home gave evidence that the care delivered is very person centred and all staff appeared to have a good knowledge of peoples personalities and preferences. Staff stated that they involve people living at the home, and their representatives if appropriate, in the creation and review of care plans. Records of care reviews show that people are present at their reviews and are able to contribute to the process. Care Homes for Older People Page 13 of 27 Evidence: Everyone living at the home is registered with a local GP and other healthcare professionals according to their individual needs. The inspector discussed the home with a healthcare professional who stated that the home is pro active in seeking advice and services for the people living at the home. It was stated that staff were very open to training to enable them to provide a good service to people living at the home and to monitor healthcare needs. Records of all appointments with professionals are recorded. The home uses a monitored dosage system for medication and all staff who administer medicines have received specific training in this area. Medication Administration Records (MARs) were well maintained. All medication is checked and signed for when it enters the home and when administered. This gives a clear audit trail. There are protocols in place for medication that is administered on an as required basis but these would benefit from more detail, especially for people who are unable to express themselves verbally or request medication when in discomfort. The home has a storage room for medication and temperatures of this room is recorded. This was within acceptable limits. The drug fridge temperature could not be recorded as the thermometer was broken. Staff stated that a new one had been ordered. Throughout the inspection it was noted that people were treated with warmth and respect. People were assisted by staff in a sensitive manner and people spoken to stated that their privacy was respected. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an extensive activities programme in the home to provide social stimulation and enjoyment. People are able to continue their chosen lifestyle within the home. Good quality food is provided and the assistance offered to people with meals is excellent. Evidence: Routines in the home are flexible and people spoken to said that they could choose what time they got up, when they went to bed and how they spent their day. One person spoken to said that the best thing about living at the home was that it gave them the freedom to live their own life in a safe environment. Another person said that they could do what they liked and remained in control. There are a variety of communal areas and we observed that people were able to choose where they spent their time. Some people said that they preferred the privacy of their rooms whilst others said that they enjoyed the company of other people. It Care Homes for Older People Page 15 of 27 Evidence: was observed that people had unrestricted movement around the home and are able to independently access a pleasant secure garden. There is an extensive activity programme. People said that they are able to choose whether or not to join in with organised activities or occupy themselves. Records of activities show that the staff spend time with people on a one to one basis as well as facilitating group sessions. Staff and relatives have developed a life history photograph album for some people living at the home. This is used to stimulate memories and discussions between staff and individuals. People living at the home said that there was always something going on. This was confirmed in the surveys received. There are numerous photographs around the home of activities and events that have taken place. Everyone asked said that they were able to have visitors at any time and many enjoyed trips out with family and friends. We spoke to relatives visiting the home. All stated that they could visit at any time and were always made welcome. Everyone spoken to was complimentary about the food in the home. All said that they received ample portions of good quality meals. There is a choice at each meal. We observed lunch being served. Food was well presented and the we were impressed by the assistance offered to people who required help. People living at the home were shown two different meals to enable them to choose from the choices available. Staff were discreet and respectful when encouraging people with eating and drinking. It was observed that people were able to choose where they ate their lunch and trays were taken to people who did not want to eat in the dining rooms. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were confident that any complaint would be taken seriously and appropriately addressed. Evidence: The home has policies and procedures on recognising and reporting abuse, making a complaint and whistle blowing. All staff receive training on the protection of vulnerable adults and staff spoken to were aware of how to recognise abuse and what to do in the event of an allegation being made. New staff were aware of the procedure to follow and of the whistle blowing policy. There is information around the home about abuse and it was noted that it is an issue discussed at staff meetings. People living at the home, and visitors, said that they would be comfortable to approach the manager or a member of staff if they were unhappy about any aspect of their care. People said that they would be listened to and action would be taken to address any worries. No complaints have been received by the home or the Commission for Social Care Care Homes for Older People Page 17 of 27 Evidence: Inspection since the last inspection. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Cecilias provides a comfortable homely environment for the people who live there. Standards of cleanliness are excellent. Evidence: All areas of the home are fitted with a fire detection and emergency lighting system. There are a variety of communal areas to ensure people have choices about where they spend time. Communal areas are comfortably furnished and have been made to feel homely and welcoming. The main lounge has recently undergone an extension. All areas of the home have access to well maintained and pleasant gardens with seating. Given the time of year the gardens were well maintained and pleasant. Since the last inspection some updating has been completed. This has included some of the bedrooms. There are plans to update the remaining bedrooms. Personal rooms are small but have been personalised to reflect the personalities and needs of their occupants. People are able to bring personal possessions and small items of furniture with them when they move in. Everyone asked was happy with their room. There are adequate assisted bathroom and toilet facilities throughout the home. Care Homes for Older People Page 19 of 27 Evidence: There is a laundry facility, which is adequate to meet the needs of the people who live at the home. Appropriate hand-washing facilities are available throughout the building. Given that the home provides care and support for people with dementia consideration should be given to increasing the signage in some areas to enable people to understand more readily which is their bedroom toilets and bathrooms. Consideration should also be given to the replacement of some of the patterned carpets which are located throughout the home. There is evidence that carpet patterns have an impact on walking and stability of people with dementia, with large patterns and bold value contrasts causing difficulties for people with perception problems. Therefore low pattern carpets may also help to reduce the risk of falls. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for staff training, which leads to a competent and well motivated staff team. Recruitment processes are robust to minimise the risk of abuse to people who live at the home. Evidence: The home employs 25 staff 16 of which are care staff, 13 (81 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. Staff observed during the inspection were well motivated and competent in their roles. All spoken to said that there were excellent training opportunities for all levels of staff, including a comprehensive induction for new staff. The majority of staff have received in-depth training in the care of people who have a dementia. Training records show that all staff have completed up to date statutory training which includes health and safety issues, the protection of vulnerable adults and end of life care. Other training has been completed appropriate to role and responsibility. Care Homes for Older People Page 21 of 27 Evidence: The manager in the home shows a clear commitment to training and there are opportunities for people to develop themselves and further their career within the company. The home regularly reviews staffing levels. Rotas given to us showed that the staffing is adequate to meet the needs of the people living at the home. People felt that generally there were enough staff to meet their needs. Staff spoken to said that there were always adequate numbers of staff on duty. People living at the home and visitors praised the staff who worked at the home. Comments included very good and kind staff are excellent staff are nice and you get the help you need and staff are always polite and nothing is too much trouble. We viewed a sample of 2 recruitment files which gave evidence of a robust recruitment procedure which included obtaining written references, checking people against the Protection Of Vulnerable Adults (POVA) register and carrying out Criminal Records Bureau checks before people began work. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed taking account of peoples views and ensuring a high standard of care. There are formal quality assurance systems in place and a commitment to ongoing improvement. Evidence: St Cecelias 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. People living at the home 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 Care Homes for Older People Page 23 of 27 Evidence: 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. 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. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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