CARE HOME ADULTS 18-65
St Cecilia`s Cheshire Home 32 Sundridge Avenue Bromley Kent BR1 2PZ Lead Inspector
Wendy Owen Unannounced Inspection 24th November 2005 10:00 St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 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`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 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 Adults 18-65. 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`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Cecilia`s Cheshire Home Address 32 Sundridge Avenue Bromley Kent BR1 2PZ 020 8460 8377 020 8466 8292 cecilias@ikleonard-cheshire.org.uk 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) Leonard Cheshire Ms Karen Harwood Care Home 30 Category(ies) of Physical disability (30), Physical disability over registration, with number 65 years of age (30) of places St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Staffing Notice issued 27 November 1992 The home can be used for up to two (2) day care clients per day Date of last inspection 15th June 2005 Brief Description of the Service: St Cecilia’s is a two-storey care home, which provides nursing care for 30 physically disabled people. The registered provider is Leonard Cheshire. The home is in a quiet residential area, on a bus route and convenient to Bromley Town centre. The home was extensively renovated in 2002 to provide large single en-suite rooms, for all the service users plus a wide variety of communal areas. There are mature gardens at the rear and parking at the front of the house. The home is staffed to provide 24 hour care through a staff team consisting of nurses, care staff, ancillary and administrative staff. The home is managed by a qualified nurse with a number of years management experience. She has recently been successful in achieving the required management qualification. St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one and a half days. It included a brief tour of the home; viewing records and discussions with service users; management and staff and written feedback provided by 3 relatives, 9 residents, 3 health professionals and 4 Care Managers. The inspection also inspected the progress the home is making in meeting the requirements and recommendations raised at the last inspection. What the service does well: What has improved since the last inspection?
The home has progressed with obtaining professional assessments prior to admitting service users and using this information to ensure care plans reflect
St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 6 individual’s needs. Service users are also benefiting from terms and conditions of residency which are provided in the shorter timescale required previously. The last few months have also seen some improvement in the medication practices within the home and in recruitment procedures, providing a safer environment for residents. 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`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 & 5 Progress has been made in the admissions procedure, which now ensures assessments are obtained prior to a resident’s admission. This provides staff with the information and guidance on how best to meet the individual’s needs. Residents are given the opportunity to visit the home prior to admission to ensure the home best suits their needs. EVIDENCE: The home is currently updating the Statement of Purpose to reflect the shortterm care aspect of the care provided and its recent success as preferred provider with the Multiple Sclerosis Society. The last inspection required improvements in the assessment procedures. The files of the last two service users admitted were viewed. Whilst some of this information, specifically the home assessments, were easy to hand, it was not always possible to identify the record keeping in relation to the initial assessment. Some of this information was also quite sparse. However, the home had also obtained the Care Manager’s assessment. This was kept separately and in one instance was very difficult to locate. The Manager should review the record-keeping to ensure a more user-friendly system. The Manager also stated that they were currently reviewing the assessment process and records to improve upon the current system. (See recommendation) The home had also produced contracts in respect of these two service users. Service users spoken to told the inspector that they had visited the home prior to admission so that they could view the home the individual accommodation and meet with the staff.
St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 9 St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 8 Care plans reflect individual needs and gives assurance to residents that, staff have current information, on how to meet these needs. The home actively promotes residents’ involvement in how the home should be run to ensure the service meets their needs and is developed in their interests. EVIDENCE: Of the two files viewed on the first day of the inspection, one contained good information relating the service users’ needs. The second file however, did not contain much information (and the assessment was quite sparse). However, some work had been completed on this by the second day. The home must however, ensure that this information is provided at the earliest opportunity, to ensure staff are aware of residents’ needs and not reliant on word of mouth guidance. Residents spoken to said that staff were aware of their particular routines and provided the care which reflected their preferences. It is also evident that the home continues to ensure service users are given every opportunity to make decisions and be consulted on they way the home should be run to ensure the home is being managed in their interests. There are a number of committees and groups which service users are encouraged to participate in.
St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 11 St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14,16 & 17 Meals are nutritious and balanced and offer a healthy diet to residents. Activities are well organised and offer a stimulating and interesting environment for residents. EVIDENCE: Service users stated that they are able to vote mainly via postal voting system. Service users are also supported with financial issues especially obtaining benefits, through the financial administrator. One resident told the Inspector of an outing at the weekend. The local MP took two resident, who are wheelchair bound, into the local shopping centre to assess the access for those who are disabled. This proved to a very eventful day and highlighted issues which will now be taken up by the MP. Two other residents spoken to were about to attend their local WEA group, which discusses politics and topical events. Of the twelve service users feedback received only two stated when asked “if you like the food” only two said sometimes. St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Medication practices have improved since the last inspection although further improvement is still required to ensure residents are fully protected. EVIDENCE: The last inspection identified shortfalls in the medication practices. This inspection included monitoring of the progress in their implementation. There has been progress with all medications now being counted, signed and dated as being received. Where medication is hand-transcribed two signatures are obtained to verify the transcription. The Medication records were in the main complete. However where residents had allergies these had not been recorded and where medication was hand transcribed the records did not identify all the information. For example; the start date and dates recorded in full on the medication records. (See requirement 1) The last inspection also required the home to improve the practice in relation to “on leave” medication. This practice has also improved and the home is now aware of the need to record all medication leaving the home or where there medication has been omitted. Three service users retain their medication for self-administration. The medication records record this and risk assessments are also in place. Two of these were viewed. There is a need to ensure that they reflect the individual risks and that monitoring takes place with a record of this. The medication is
St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 14 kept in residents’ rooms. However, the two rooms viewed did not ensure the safety of this medication. In one room the key was in the drawer, which stored the medication and the bedroom door left wide open and in the second there was no locked facility. (See requirement 1) St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home has good systems in place to protect service users from abuse. Residents are able to voice concerns or issues through a number of ways. They feel they are listened to and concerns taken seriously and acted upon. EVIDENCE: The home has procedures in place for the protection of vulnerable people, which includes a whistle-blowing policy located in the entrance hall of the home. The home also provides training for staff, volunteers and residents in relation to adult abuse and what one should do if they have concerns. Staff spoken to, with the exception of the latest member of staff currently being inducted, all had a good understanding of what abuse is and what they would do if they had concerns. Many residents require some form of protection from risks identified with falls. In the main risk assessments identify the use of lap belts and bed -rails which are also forms of restraint. The risk assessments must be elaborated on to ensure they give full details of the risks associated with the use of the equipment used as well as the reasons for its use. The decision-making process should detail that the use of the equipment is in the best interests of the residents. (See recommendation 1) Of the 12 service users feeding back there were two that stated that they did not know who to go to if they were unhappy with the care. However, the inspector felt the home very proactive in this area. Therefore the inspector suggests that discussions with individual residents are held to assure them of the procedures within the home. St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 26 & 29 The home offers, in the main, a well-decorated, well -maintained and comfortable environment for residents and progress is being made to ensure all areas are refurbished to an acceptable standard. EVIDENCE: The Environmental Health Officer visited during the September 2005 and required food hygiene training for kitchen staff and refurbishment of the kitchen area. Subsequent to this visit the home has plans in place for the refurbishment of the kitchen area as a priority and staff training has already commenced. The progress in this will be monitored at the next inspection. The home also has plans for the redecoration of the lounge and dining room and replacement of the flooring also in the plans. Discussions with residents and written feedback confirmed that residents are supported in their independence through the use of appropriate specialist equipment in their private areas and to maintain independence throughout the home. Service users all provided positive comments on their rooms; the furniture provided, decoration and the layout. St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 There is a good mix of staff to ensure the whole needs of the residents are met. Staff are well trained, enabling them to understand residents’ needs and provide good care. Whilst recruitment procedures are good there are areas to be addressed to ensure residents are fully protected from unsuitable staff working in the home. EVIDENCE: Staff records viewed and discussions with staff members showed that home to have a positive approach to the training and development of staff. Staff showed a good knowledge and understanding of the needs of the clients. Discussions with staff also highlighted possible gaps in their knowledge including epilepsy and multiple sclerosis training. This was discussed with the training officer who immediately set about arranging training. It was apparent from discussions that the home provides induction for new staff and it is not until they are assessed as competent do they become part of the team. The records provided by the home in relation to the progress of care staff to achieving the NVQ qualification, show sixteen members of care staff with NVQ 2 or 3 and five currently registered and undertaking the qualification. The records show in total of 36 care staff, including bank staff. Once the current staff have obtained the qualification, the home will have met the standard. The staff team consists of Registered Nurses, care staff; occupational therapists; physiotherapists; activity co-ordinators; administrators; laundry
St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 18 and domestic staff; maintenance staff and a management team. This provides residents with all round support and enables the home to provide a good quality of care. Recruitment procedures have also improved with the required checks made to ensure the suitability of the prospective employee. The records showed some good work in relation to those employed from overseas, to ensure the required documentation is in place. The home should, however, consider the good practice of ensuring the references provided by the employee are appropriate. The home also needs to obtain, in writing, written validation as to the reason the individual left their previous employment in care. (See requirement 2) St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Good management systems are in place which promotes the health, safety and well-being of residents. EVIDENCE: The home actively promotes the health, safety and welfare of residents and staff. Staff have received training in core areas such as moving and handling;’ infection control and First Aid. Food hygiene has been arranged for all kitchen staff with training for care staff to follow. This is good practice. The requirements from the last inspection have now been implemented including the remedial action required on the fixed wiring within the home. St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 x 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 4 x x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 3 2 4 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Cecilia`s Cheshire Home Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 x DS0000010142.V259429.R01.S.doc Version 5.0 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement The Registered Person must ensure that medication practices are safe. Specifically, • Service users who selfmedication must be provided with appropriate lockable storage. • Monitoring of those who self-medicate must be carried out and compliance checked. The monitoring must include the appropriate use of secure storage. • Where medication records are hand transcribed the information records must be complete and accurate. • Allergies must be recorded on the medication record. The Registered Person must ensure they obtain written verification of the reasons why the applicant left their previous employment in the care sector. Please see Regulation 17 Schedule 2 for further guidance. Timescale for action 01/12/05 2 YA34 17 & 19 01/12/05 St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 22 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 Refer to Standard YA42YA9 Good Practice Recommendations The Registered Person should ensure the home records fully the decision-making process in the use of restraint equipment including bed-rails and lap belts. St Cecilia`s Cheshire Home DS0000010142.V259429.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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