Inspection on 31/08/05 for St Cecilia Care Home

This inspection was carried out on 31st August 2005.

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 15/02/06

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 Mallet Somerset BA4 5TZ Lead Inspector Justine Button Unannounced 31 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 Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Cecilia Care Home Address 1 Hitchen Lane Shepton Mallet Somerset BA4 5TZ 01749 342809 01749 342809 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) Mr David Edwin Wills White Mrs Lynn Denise Ashwell Personal Care Home Only. 16 Category(ies) of Dementia - over 65. registration, with number of places St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 10th March 2005 Brief Description of the Service: St Cecilia’s 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 2 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 D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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 the 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 with were satisfied with the service they receive at the home. The inspectors concluded that the home is providing a mostly 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. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. What the service does well: The home excels in the ethos and provision of recreational activities. There are good opportunities for activity and company. An activities programme is on going and service users spoken to enjoyed the activities provided. The staff team appear dedicated and committed to the service they provide and there was a relaxed and friendly atmosphere. People who access the service who were able to give an opinion all gave positive comments about the service they received. St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 6 Staff should be commended for their approach to death and dying. As the service supports people with dementia care needs, the subject of death and dying is not one that is always discussed effectively. One person at the service had recently passed away. A remembrance table had been formulated to assist people to deal with this and to remember the person who had died in a positive way. Staff were happy to discuss this with the people at the service in an open and honest way. 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 Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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 Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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) These standards were not assessed on this inspection. EVIDENCE: St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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, 8,10, 11. 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. It could not be confirmed if people had access to a dentist. A good range of assessment tools with regard to pressure risk, moving and handling, ‘slip, trip or fall’ and nutritional risk are used. A number of people at the service fall regularly. This needs to be kept under St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 10 review. The use of pressure pads may help to reduce the number of incidents particularly when staff supervision is reduced e.g. 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. The staff should be commended on their approach to death and dying. People living at the service are kept informed about the death of a fellow service user by the use of a remembrance table. This is an effective way of positively approaching this subject with a client group with some memory loss. St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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, 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. St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 12 EVIDENCE: St Cecilia’s places a strong emphasis on social stimulation. A wide range of activities is 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. One person who was seen to be “tidying” the lounge was offered a duster to help her in this task. This is line with current dementia care good practise. Staff should be complemented on the service they provide in this area. Links with the community are strong. Visitors are made very welcome and can visit at any time to suit the service user. They can share a meal with the service user. There are links with the local community via a Bridge Club, local schools and local churches. Holy Communion is celebrated monthly and other ministers and preachers visit regularly. People who live at the service have regular meetings to discuss any issues or improvements that they may like. The minutes of the meetings showed that people were involved in agreeing social activities and outings. Service users can bring personal possessions into the home under management agreement. Service users confirmed that they could spend their time as they wish and are consulted about this. Lunch was observed on the day of inspection. Lunch consisted of roast pork, roast potatoes, cabbage and swede. No person was served an alternative and the service should consider this. There was plenty of food available and second helpings were offered. The food served smelt and looked appetising. Rhubarb crumble and custard was then served. Several of the people at the service stated that the food was nice. St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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) These standards were not inspected on this visit. These were inspected and found to be satisfactory at the last visit. EVIDENCE: St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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, 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 D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 15 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. The décor, carpets and general maintenance continues to be improved in all areas making rooms pleasant and homely. The manager confirmed that redecoration, recarpeting and refurbishment is planned to continue in the areas where this is still needed. 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. One of the upper floor bathrooms was observed to have mildew staining around the bath seal and the flooring is in need of replacement. The other upper floor bathroom is small and is also in need of some remedial work. 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 D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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) 27, 28, 30. The service provides staff who are suitably trained and in adequate numbers. EVIDENCE: The staffing rotas were viewed on the day of inspection. The rotas demonstrated that there are adequate staff on duty. People spoken to during the inspection stated that there were enough staff on duty and that they did not have to wait if they required assistance. Staff training records were viewed. These showed that the majority of staff had received all mandatory training. The exceptions to this were two staff require moving and handling training. Additional training includes “minds and meals”, medication training, dementia care conference, continence study day and music and dance. The service also took part in the osteoporosis initiative. A number of staff had recently completed an NVQ qualification. These included seven staff with NVQ 2 and six staff with NVQ 3. Staff spoken to during the inspection stated that they felt adequately trained in order to fulfil their role. St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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, 32, 33, 38. This home generally has good occupancy rates. Service users speak well of the care and service they receive. Records are well managed and are stored securely. The home is well managed. EVIDENCE: 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. It is recommended that Mrs Ashwell undertake a management qualification to consolidate her experience. St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 18 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 approachability 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 D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION 3 3 1 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 3 x x x x 3 St Cecilia Care Home D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 20 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. The action plan should detail timescales for the refurbishment of the identified bathroom. Timescale for action Action plan to be submitted by 30th November 2005. 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 D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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 D53 - D02 S3288 St Cecilias V245226 310805 Stage 4.doc Version 1.40 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!