Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 07/03/07 for St Cecilia`s

Also see our care home review for St Cecilia`s for more information

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

St Cecelias provides excellent care to those that live in the home. One relative said that: "X is very fortunate to be treated at such a wonderful place" One resident wrote "My life has improved so much being here." The pre-admission procedures ensures service users have the information to enable them to make a decision on whether the home meets their needs with the home undertaking assessments in a "holistic manner" said one individual. The home values the residents, promotes and encourages residents to make decisions about their care and become involved in the running of the home to ensure it meets their needs. There is good information provided about the individuals` care needs with care plan and supporting in place for staff. Individuals are involved in providing this information. "St Cecelias goes out of their way to tailor care to the individual needs of the resident." One professional said whilst others said they go "the extra mile" Staff are well trained and competent and work as a team. There is effective communication between all individuals involved in the care of the resident, including the resident. One resident spoken to said "Staff are very good, I am very happy here." The health of individuals is also managed very well with residents with health professionals providing excellent feedback in this area. It "Provides an excellent nursing and day care facility for young people with advanced physical disability." There is excellent management, leadership and support with an open and inclusive approach enabling issues to be resolved. There are good systems in place for ensuring the health and safety of service users with many professionals telling the inspector of the good professional relationships between agencies. The standard of accommodation is good and a comfortable and wellmaintained environment for residents.

What has improved since the last inspection?

Since the last inspection last inspection the home has improved its recruitment procedures by verifying the reasons for leaving previous employment in care, whenever possible. Some medication practices that required improvement have also improved, although there is still a little more improvement required.

What the care home could do better:

Prospective residents would benefit from information on the terms and conditions of residency must be provided as part of the pre-admission information provided to prospective residents. Whilst there is good information provided about the care required by individuals gaps were noted in this information that would benefit the individual. Risk assessments should also contain more specific information on how risks are to be minimised. The manager should also consider how residents should be involved in the development of information about the home and how to present this information in different formats.Medication procedures must be improved to ensure the health and safety of residents. They could also consider the use of different transports methods that would give greater freedom to residents and discuss with residents the possibility of employment in the community. The manager must ensure that fire drills are carried out as required by the fire authority. The manager should also investigate different entry systems for residents who are unable to hold a key to their room to give them more privacy and independence.

CARE HOME ADULTS 18-65 St Cecilia`s Cheshire Home 32 Sundridge Avenue Bromley Kent BR1 2PZ Lead Inspector Wendy Owen Unannounced Inspection 7th March 2007 10:00 St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 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.V326389.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V326389.R01.S.doc Version 5.2 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 karen.harwood@lc-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) 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.V326389.R01.S.doc Version 5.2 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 27th October 2005 Brief Description of the Service: St Cecilias 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. The number of residents is 30; staff 76 and 107 volunteers. The home provides information to residents in the form of a Service Users Guide. There are terms and conditions of residency. These are produced after admission to the home. The current fees range between £752-£950 per week. There are charges for hairdressing, chiropody, toiletries, transport, magazines and papers, aromatherapy. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included a visit to the home over two days with information provided by the Manager and a survey undertaken by residents, relatives, health professionals and other agencies. Four survey forms were received from Care Managers: three from health professionals; one GP; relatives, nine and twenty from residents. The visit to the home included a group discussion with staff and residents, discussions with the Health and Safety representative, professional visitors and Manager and viewing of a number of records. What the service does well: St Cecelias provides excellent care to those that live in the home. One relative said that: “X is very fortunate to be treated at such a wonderful place” One resident wrote “My life has improved so much being here.” The pre-admission procedures ensures service users have the information to enable them to make a decision on whether the home meets their needs with the home undertaking assessments in a “holistic manner” said one individual. The home values the residents, promotes and encourages residents to make decisions about their care and become involved in the running of the home to ensure it meets their needs. There is good information provided about the individuals’ care needs with care plan and supporting in place for staff. Individuals are involved in providing this information. “St Cecelias goes out of their way to tailor care to the individual needs of the resident.” One professional said whilst others said they go “the extra mile” Staff are well trained and competent and work as a team. There is effective communication between all individuals involved in the care of the resident, including the resident. One resident spoken to said St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 6 “Staff are very good, I am very happy here.” The health of individuals is also managed very well with residents with health professionals providing excellent feedback in this area. It “Provides an excellent nursing and day care facility for young people with advanced physical disability.” There is excellent management, leadership and support with an open and inclusive approach enabling issues to be resolved. There are good systems in place for ensuring the health and safety of service users with many professionals telling the inspector of the good professional relationships between agencies. The standard of accommodation is good and a comfortable and wellmaintained environment for residents. What has improved since the last inspection? What they could do better: Prospective residents would benefit from information on the terms and conditions of residency must be provided as part of the pre-admission information provided to prospective residents. Whilst there is good information provided about the care required by individuals gaps were noted in this information that would benefit the individual. Risk assessments should also contain more specific information on how risks are to be minimised. The manager should also consider how residents should be involved in the development of information about the home and how to present this information in different formats. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 7 Medication procedures must be improved to ensure the health and safety of residents. They could also consider the use of different transports methods that would give greater freedom to residents and discuss with residents the possibility of employment in the community. The manager must ensure that fire drills are carried out as required by the fire authority. The manager should also investigate different entry systems for residents who are unable to hold a key to their room to give them more privacy and independence. 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. The summary of this inspection report can be made available in other formats on request. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 8 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.V326389.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The information provided to prospective service users enables them to make an informed decision on whether the home is able to meet their needs. EVIDENCE: The home has procedures for the admission of service users including provision of information and assessment of prospective service users. Information is provided in the form of a brochure and leaflets. A Service Users Guide and Statement of Purpose has also been developed. This gives information about the home and what residents can expect. Currently this does not include information regarding terms and conditions of residency. It can be made available in other formats including Braille . The manager is also producing the information in signs and symbols as well as large print. Currently staff in the home read the details of the terms and conditions and other information, if required by residents, to ensure they are made fully aware of what is expected of them and of the home. The Service Users Guide is also available in widget. (See requirement) It is also positive to note that later on this month the content of the Guide is to be discussed at the Consultation meeting to enable them to have a say what is included and if it really describes the home and what it has to offer. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 10 Prospective residents are assessed prior to any decision being made and residents are encouraged to visit the home for a trial visit or stay. All service users are invited to stay for a trial period to ensure the home can meet their needs. When residents are referred by the local authority, the summary of needs is also obtained by the home as part of the information gathering process. The residents do not have sight of the contract prior to admission and signing often takes place sometime after admission. It is also the case that the Local Authority placement agreement is not provided until much later after admission. St Cecelia’s is able to meet a number of different needs with the support from health professionals and specialists. Staff are well trained and there is comprehensive information and reference guides available for staff in the training room. Bromley advocacy project have been involved in the supporting of residents’ living in the home. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home encourages and supports service users to make decisions on how they wish to lead their lives within the home. There is sufficient information for staff to provide the care and support required to meet the service users’ needs. EVIDENCE: St Cecelias strength lies in the way it values and actively promotes residents involvement in all aspects of the home and the way in which they live. Residents take part in all department meetings and residents committees and working groups have been formed to enable their views to be heard. They are able to influence the changes they require eg the staff roster was amended to meet needs of residents. They are also involved in recruitment of new staff. Residents spoken to and who provided feedback confirmed that they make decisions on all aspects of their lives. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 12 Information is kept confidential which is shared with residents and those they want to share it with. Bromley advocacy project is also involved with residents to ensure their voice is heard. All residents have care plans that have been developed with their involvement as much as possible. The care plan format is currently changing with support from Greenwich University Health and Social Care department. The manager has continued to “search” for a format that suits the residents and staff. Three care plans viewed were in varying stages of completion and of a mixed standard. One file that has almost adopted the new format was found to be of a good standard. There were some gaps but together with the summary of needs, assessment of living and risk assessment, it provides good information on how to meet the individuals’ needs. The manager is aware of the changes required and of the need to ensure all care plans are of a similar standard. Multidisciplinary Department meetings (MDMs) take place every six months with key-workers and other key staff involved in the individuals’ care eg physiotherapists, activity therapists. Where reviews take place the staff must ensure that they are signing and dating the records relating to the review and ensure there changes relating to the review are made clear. (See requirement) Residents spoken to stated that they are involved in the planning of their care and reviews. Reviews by the Local Authority are not as regular. However, the manager has identified the need to lead on this. This is good practice. Risk assessments have been develop din some core health area and where there may be a risk of aggression. There was limited information regarding the personal safety of residents, although staff were well aware of these risks and verbal information was good. However, this must be formalised. (See requirement) A health professional’s feedback included: “I have always observed staff being very respectful of clients privacy and dignity” St Cecelias follows the Leonard Cheshire policies ad procedures relating to confidentiality. The practice is good and records and information stored securely on computer and paper documents. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides activities and participation in the home to ensure service users are stimulated. Meals are nutritious and varied with choices to ensure their health and well-being . EVIDENCE: Within the home the residents have a choice of activities to choose from. There are dedicated activity therapists, over one hundred volunteers supporting the residents and staff. St Cecelias has a number of rooms available, including a dedicated therapy room and computer room. Many residents have their own computers and equipment such as TVs, DVDs etc. Some residents undertake activities outside of the home including attending adult education classes. Few have paid employment, although one resident does voluntary work at a local school. (See recommendation) The activity schedule for March showed the “normal” activities provided and the arranged activities for March. There was an array of different activities taking place to suit a number of needs. The St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 14 home also produces a regular newsletter notifying residents and relatives of changes including staff, improvement in the home systems, activities and entertainment. The feedback from residents showed that they were generally satisfied with the activities offered, although some stated that there were less activities provided at the weekend and this they found “boring” at times. The other area raised concerned the lack of transport to enable access to external activities. Currently the home has one minibus with two minibuses off the road. Two new buses have been ordered with the home now waiting to be adapted to meet the residents’ needs. The other issue is that, whilst the home has one full-time driver the other buses are driven by volunteers who need to have passed the Midas training and understandably not all are willing to do this. The manager should how this could be improved perhaps by considering use of other organisations such as dial-a-ride. (See recommendation) It is evident that there is a strong volunteer group supporting the home in its endeavours to provide support to residents in the way they wish to live. The home provides support to volunteers by involving and training them in this. The culture and ethos of the home is for everyone to work together to give the residents the home they wish. Residents are also provided with support to ensure their receive the benefits they are entitled to. Discussions with residents and written feedback showed that they are satisfied with the quality of food provided. The catering is supplied by an outside catering team. The inspector viewed the lunchtime routine where residents who required support were provided with this in a sensitive manner. Some staff do need to be monitored during this time to ensure there is appropriate interaction at these times. On the day of the inspection the lunchtime meal was not as detailed on the menu for week. Therefore there was chicken as one lunch choice and chicken for a tea choice. Residents had been given the changed menu the day previously and had made a choice from the menu offered. The explanation given by the catering team was due to the provisions for the correct menu not being ordered in time. The manager is looking into this issue. Discussions with a health professional also confirmed that the home is much more aware of the needs of diabetics and ensure that there are appropriate snacks available during the evening. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Staff have the knowledge and understanding of how to meet service users’ health needs and understand when to access advice and support from healthcare professionals. EVIDENCE: St Cecelias provides care and support to residents with physical disabilities and therefore the way in which they are moved and supported is integral to their care. The home has recently improved the documentation on relation to this area and comprehensive guidance is provided to staff that covers all areas where residents may require assistance and support, including the use of moving and handling equipment. The inspector received very good feedback from relatives and residents about the care they receive and the ability for many to choose their own GPs and attend appointments are the surgery. Gender choice is also detailed on the ISP and feedback confirmed residents are able to choose clothes, make up etc and the ISP details these areas. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 16 Staff are provided with training for staff in healthcare and the use of equipment and they work closely with external professionals to ensure the health and safety of residents. Feedback from a number of PCT staff and other professionals indicates that residents are provided with the support they require, that staff are aware of their healthcare needs and appropriate monitoring and referral is made. Risk assessments are completed in relation to nutrition, continence and pressure care as well as some individual risks such as behaviour. Information is also provided in the ISP on healthcare needs. Improvement could be made in the information provided in the written form in respect of the behaviour risk assessment specifically around the triggers and on the record relating to information on diabetes. (See recommendation) Whenever possible residents are responsible for managing their own health care with the support of the staff. All residents are registered with a GP and residents receive the specialist support and treatment they require to meet their healthcare needs as much as possible. The records supplied to by the home show a variety of support from the PCT and NHS including treatment to curb smoking, MS specialist support, nutrition and dietician and diabetes. On the day of the inspection the dental therapist was providing dental treatment and examination to thirteen residents. Discussions with the diabetic nurse also confirmed the home now providing appropriate support after providing training to staff. Physiotherapists are on site and support and treatment is provided where required. Access to outpatients is made available through the use of the home’s minibus with the use of the fulltime driver. The home has appropriate supporting documentation and records regarding the risks residents of nutritional and pressure care risks as well as more individual risks such as aggression. An audit of the medication showed there to be good practices in place with records completed accurately and no gaps. Risk assessments are completed. The assessment should be further developed to show how the home is monitoring the resident’s compliance with this although discussions with staff demonstrated that this is actually occurring but not recorded in detail. The inspector visited one such resident who confirmed that medication was kept safe in their room. Medication is administered by the RGNs who receive training from the prescribing pharmacist. The pharmacist also regular audits the home’s procedures and systems. Controlled drugs were found to be accurate with complete records. The only concern related to medication given to residents whilst they are away from the home. In one case there is an issue about secondary dispensing. Whilst this may be possible where the resident is self medicating for those that are not the home must ensure that this does not occur either by obtaining a second prescription for the period of sending all the medication with the St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 17 resident. Staff had recorded the medication taken by the resident. (See requirement) St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home has excellent systems in place to ensure service users’ concerns are listened to and acted upon to enable improvements in care to be made. Vulnerable individuals are safeguarded through staff having a good understanding of abuse and how they should manage any incidents or concerns. EVIDENCE: St Ceceilas has a complaints policy and procedure that is made available as part of the pre-admission information provided to prospective residents. The pre-inspection material stated that the home has had five complaints in the last twelve months. Two are still pending an outcome. The manager and staff are open to complaints and staff are aware of the need to refer any issues or concerns to the management team. Feedback from residents and other interested parties including agencies, show how the manager listens to, investigates and responds to the concerns to ensure the service is improved. In general there is good information provided. The inspector also discussed the need to record fully the outcome of any complaint and how the home is taking action to address the issues. This is also true where complaints have been referred to another level. A resident wrote “ I have found all complaints are taken seriously and the Head of Home deals with them promptly and keeps me informed of the progress.” St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 19 There are regular meetings with residents where the complaints process is openly discussed to remind service users of how they may wish to raise concerns. Information in other formats St Cecelias also has a policy and procedures in place for safeguarding adults. The staff, residents and volunteers are provided with training that gives information on how staff are to recognise and respond to any allegations or suspicions of abuse. The home also Whistle-blowing procedures. The home responds appropriately to any concerns in this area, ensuring the lead agency is involved in the decisions making on how the allegations is to be investigated. Appropriate records are also maintained. One member of staff is currently undertaking a course that will enable them to provide approved training in this area. Whilst many residents or their relatives manage the residents’ personal finances, the home also operates a safe system to ensure where they are involved in looking after personal monies, appropriate records are in place for auditing purposes. Robust recruitment procedures are in place for the protection of vulnerable people in their care. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. St Cecelias provides a warm, clean, comfortable and wellmaintained environment that enables service users to access all areas of the home, whenever possible. EVIDENCE: The home has over the last few years been refurbished to a good standard to ensure it meets the needs of individuals with disabilities. All residents benefit from private rooms with en-suite facilities. All are able to have keys to have keys to their rooms, although where this is not possible (may be due to inability to manage a key) this should be recorded in their ISPs. The home should investigate the use of other entry systems. (See recommendation) Residents are satisfied with their rooms with a number being equipped with the equipment needed to encourage an independent lifestyle. Rooms viewed were personalised with possessions and mementoes to give Residents are also provided with the specialist mobility equipment through the relevant agencies. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 21 Staff and volunteers are provided with wheelchair training-how to use and how to inspect a wheelchair before its use. The home also operates a wheelchair clinic with the mobility service servicing the wheelchairs annually. This is good practice. Beds and other equipment used by residents are serviced regularly. There are sufficient communal areas including a visitors or quiet room where residents are able to spend time on their own or with families. There are some areas which need redecoration particularly the dining room. These are planned by the home to be redecorated in the next few months. The kitchen has recently undergone some refurbishment and has been awarded the Clean Food Award. The grounds are of a good standard with a number of areas having been developed including a pond now finished and a Japanese garden still in development. Residents are able to enjoy this outdoor area with raised beds and surfaces suitable for those using wheelchairs. The home is well maintained and of a good standard of cleanliness with no offensive odours and good infection control procedures in place. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Staff have the skills, knowledge and understanding to provide good care to individuals within the home. They work as part of a team to ensure they work effectively with senior staff monitoring and supervising to ensure they provide consistent care. The recruitment procedures ensure that vulnerable individuals are protected. EVIDENCE: St Cecelia’s has a staff complement consisting of management, RGNS, team leaders and support staff, ancillary staff, administrative, physiotherapists and activity therapists supporting and providing care to residents living there. The home has an outside caterer providing the main meals or residents. RGNs are responsible for each shift with two RGNs on duty in the morning and one in the evening. Currently the home has 44 of care staff qualified to NVQ 2 or above with a number of staff registered and in the process of completing the award. Previous inspections have highlighted the high turnover of staff and this has also been mentioned during the feedback. It is evident from the pre-inspection information with 102 shifts being completed by agency staff in the last eight St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 23 weeks. The manager has provided information on the reasons for staff leaving that showed few leaving due to their dissatisfaction with the employer. It is positive to note that the manager has, due to residents request, changed the shift pattern to ensure there are enough staff on duty at times most needed by residents. This demonstrates the manager’s commitment to listening and improving the service to meets residents’ needs. It is clear from the feedback that the residents, relatives and others involved in the provision of care believe that the staff provide a good standard of care and support and are effective in the way the meet the aims of the provision. Discussions with staff provided evidence that they are provided with job descriptions, contracts and issued with codes of conduct. There is also evidence of induction to skills sector standards with appropriate records in place, including monitoring of competency. Staff also have their own training and development plans to detail training provided and what is needed for their own development as well as to meet needs of the residents. The home is very proactive in providing a wide range of training to staff and volunteers through the internal training of LC and external training providers. RGNS are able to keep up with their practice through training provided by the PCT and other providers. Staff are also trained to provide training to others, including moving and handling and fire instruction. “The staff have always attended meetings and conferences to develop their skills and expand their experiences” said one professional. The manager has also delegated the responsibility of the health and safety of the home to a member of staff and provided the resources to ensure they are trained to undertake this responsibility; for example fire warden training and NEBOSH health and safety certificate. The home also operates a robust recruitment procedures with the relevant checks completed on all new staff prior to the new members of staff commencing employment. Volunteers are also subject to Criminal Records Bureau checks. Records were well maintained and organised. Discussions with a group of staff (from a number of departments) also provided evidence of a good system of supervision and appraisal in place. The frequency of supervision is higher for those involved in the care side to those in other departments as recommended by the standards. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The manager provides leadership, guidance and knowledge to ensure the health, safety and well-being of service users. The service is monitored to ensure the quality of service is continually reviewed and consistent care provided. EVIDENCE: The Manager is experienced and qualified to manage the home. There is an open and inclusive approach to managing the service with the Manager welcoming individuals views on improving the quality of care. The Manager and staff ensures, that they implement the requirements made by the Commission within the required timeframe. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 25 The home has delegated responsibility for monitoring the health and safety of the home to a member of staff. They have undertaken training relevant to this role and there is evidence of regular servicing of the equipment used. Records are also maintained in respect of fire training and fire drills. There is some improvement in the number of drills to be undertaken each year (See requirement) Leonard Cheshire has systems in place for reviewing and monitoring the quality of care. The Manager undertakes an annual self-assessment and audit of the service and an annual survey. The tool has been developed with the impending move by the regulator to self-assessment. The last assessment was completed in March 2007 and covers four key areas: service provision, finance, health and safety and personnel. The assessment is objective and generally in line with the Commissions findings. The survey was completed by February 2007. A report has been completed with analysis, evaluation and outcome together with the action plan for improvements. This is in the process of being fed back to residents. The inspector has received very good feedback about how the home relates and communicates, not only to residents and relatives, but also professionals visiting the home to support them. St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 4 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 x 4 4 3 3 X 3 x St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 5 Requirement The Registered Person must ensure that prospective residents are provided with information about the terms and conditions of residency prior to admission to enable them to make a decision on whether the home is suitable for them. The Registered Person must ensure that care plans contain full information on all health, emotional, personal and social aspects of the care the resident requires. The Registered Person must ensure that medication is not secondary dispensed to ensure the health and safety of the resident. The Registered Person must ensure that risk assessments are developed in relation to personal safety. The Registered Person must ensure that, the number of fire drills are increased, in line with fire regulations to ensure the safety of residents. Timescale for action 01/07/07 2 YA6 15 01/07/07 3 YA20 13 01/04/07 4 YA9 13 01/06/07 5 YA42 23 01/07/07 St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 28 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 YA1 Good Practice Recommendations Residents should be involved in the developing of information provided by the home in particular the Service Users Guide and complaints procedures. Information provided in the home should be available in other formats. The manager should investigate the opportunity for employment of residents in the community if this is an aspiration of the resident. The manager should Investigate how residents could benefit from using transport that may be available. Risk assessments should contain more detailed on the how the risk may occur and how the risk may be minimised. The manager should investigate the use of alternative door entry systems 2 3 4 5 YA12 YA13 YA19 YA29 St Cecilia`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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`s Cheshire Home DS0000010142.V326389.R01.S.doc Version 5.2 Page 30 - 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!