CARE HOMES FOR OLDER PEOPLE
St Christopher`s Home Abington Park Crescent Northampton Northants NN3 3AD Lead Inspector
Stephanie Vaughan Unannounced Inspection 19th June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000012922.V300231.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 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. DS0000012922.V300231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Christopher`s Home Address Abington Park Crescent Northampton Northants NN3 3AD 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) 01604 637125 01604 604114 manager@stchristopherscofehome.co.uk St Peter & St Paul, Abington Mrs Christine Anne Church Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54), Physical disability over 65 years of age of places (54) DS0000012922.V300231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. No person falling within the category Older Persons (OP) can be admitted where there are already 54 persons of category OP already in the Home. No person falling within the category PD (E) can be admitted where there are 54 persons in the category PD (E) already in the Home. The total number of service users in the Home must not exceed 54. Date of last inspection 9th December 2005 Brief Description of the Service: St Christophers is a large Home close to Abington Park in Northampton. The Home was originally an old vicarage, which has been extensively extended on the ground floor level and refurbished throughout. The Home now provides care and personal support for up to 54 older people with needs arising out of old age and physical disability. St Christophers is set in two acres of landscaped grounds, which are well maintained, and are accessible to the service users. All service users are accommodated in single rooms with ensuite facilities There are 9 bedrooms upstairs, which are accessed, by a stair lift or a passenger lift. The remaining bedrooms and a choice of communal rooms are on the ground floor. Other facilities offered within the Home include a hairdressing room; a small shop; a computer suite and two Chapels. St Christophers is registered as a Church of England War Memorial home. Currently the fees are £345 per week with additional charges for hairdressing, toiletries, newspapers, private chiropody and outings. DS0000012922.V300231.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Ninety Minutes was spent in preparation for this unannounced inspection, which included a review of the last inspection report, associated requirements and recommendations. In addition other documentation was reviewed such as the service history, risk assessments and notifications. The Commission have received no concerns of allegations about this service. No comment cards have been received from residents or their representatives. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Residents, and upon their views of the service provided. The Commission also has a national focus on Equality and Diversity for all within this current year and issues relating to this are included in the main body of the report. Five residents were ‘case tracked’ which involved following the care that residents receive through a review of their care plans, other associated documentation such as accident records, observations, and a limited tour of the premises was conducted, which involved a sample of the residents accommodation and communal areas. Residents case tracked were spoken to and discussions held with some of the care staff and a visiting General Practitioner. This unannounced inspection was conducted during the day and lasted for seven and a half hours, during which the Acting Manager was present and highly cooperative throughout. The Acting manager has been in post for five weeks and is currently seeking registration with the Commission. Seven requirements and six recommendations were made as a result of the last inspection and all of these have been met. What the service does well:
Residents are given good information and are able to visit the home before they decide whether they want to live there. A local doctor said that his patients are well looked after by the staff at the home. DS0000012922.V300231.R01.S.doc Version 5.2 Page 6 Residents said that the staff were nice to them and looked after them well. Residents are looked after and can see their visitors in private. Residents are able to choose how they spend their time and to make decisions about their day, like when to get up and go to bed. The home helps residents keep in touch with their family, friends and outside interests, residents are able to carry on going to church and to practice their faith. Residents are able to bring their own things to the home like pictures and small pieces of furniture. Most of the residents said that the food was very good, with a good level of choice provided which included the choice of a cooked breakfast. Residents know how to complain if they are unhappy about anything and staff have had training to make sure that residents are safe. The building is well looked after and residents have nice rooms There are enough staff working in the home to make sure that the residents are well looked after. Staff have the right training to make sure that they know how to look after the residents in the right way and are able to make sure that they are safe. The new manager knows how to run a home as she has done this before and she has applied to become the Registered Manger for St Christopher’s. What has improved since the last inspection?
All of the residents looked at had the right paperwork in place so that staff knew how they need to be looked after. Risk assessments are in place to make sure that residents are cared for safely in the home. Medicines are stored and given in the right way and the right records are kept. Arrangements have been made for a new kitchen to be fitted very soon, with a safe water heater and a food safety system to make sure that food is stored and prepared in a safe way. Radiator covers are going to be fitted on radiators that have hot surfaces and safety catches have been fitted on the up stairs windows. The carpets were safe and not likely to trip anyone up.
DS0000012922.V300231.R01.S.doc Version 5.2 Page 7 The staff that work in the home now have a better duty rota that shows what hours they are all expected to work. The new manager plans to make sure that the are good systems in place to make sure that the home is managed well and continues to be safe. 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. DS0000012922.V300231.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000012922.V300231.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 The quality in this outcome area is good; this judgement has been made using available evidence including a visit to the service Arrangements have been made to ensure that the admission of new residents is managed appropriately. EVIDENCE: There is a statement of purpose, which sets out all of the required information about the home. Following the retirement of the previous manager this is now out of date. This has already been identified by the new manager, who plans to up date it in the near future, clarify the admission criteria and include information as to how the organisation is to address equality and diversity issues. Residents have individual contacts, which set out the terms and conditions of residency and access to the service users guide.
DS0000012922.V300231.R01.S.doc Version 5.2 Page 10 The new manager confirmed that residents are assessed prior to admission and that the pre admission format is currently being reviewed to ensure that residents are fully assessed for all of their needs including mental and emotional health as well as physical. It is important that this is done as one resident recently admitted to the home was noted to have been admitted without a specific diagnosis. However there was a strong indication that this resident may have dementia, a category of registration for which the home is not registered and not fully equipped to deal with. This admission occurred at approximately the same time as the new manager commenced employment and she has subsequently agreed to seek medical guidance to establish the full range of health needs and assess whether the home is able to meet these needs within the existing category of registration. Residents spoken to confirmed satisfaction with their own experiences of the admission processes, having had adequate information provided about the home and opportunities to visit prior to deciding whether they would like to live there. The home does not offer Intermediate Care DS0000012922.V300231.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to the service Residents’ physical health and personal care is managed appropriately, however further improvements are recommended to ensure that residents mental health care needs are addressed. EVIDENCE: All of the residents’ case tracked had appropriate plans of care developed and there was evidence that these are regularly reviewed and wherever possible involved the resident or their representative. Following a previous requirement the plans now contain detailed instruction to staff about how residents physical needs were to be addressed and there was evidence to demonstrate that that care was being delivered according to the individual plans of care. Key workers and other staff demonstrated a good understanding of the residents needs and residents spoken to confirmed this. Following a previous requirement all residents now have appropriate risk assessments for the management of pressure, falls and nutrition, which in general demonstrate that the appropriate interventions are in pace. However
DS0000012922.V300231.R01.S.doc Version 5.2 Page 12 some of the nutritional assessments indicated that guidance should be sought from a dietician and there was no evidence that this had been done. In addition there were some gaps in the information recorded, for example the residents’ diagnosis. One pre existing resident was noted to have some degree of dementia and although the outcome for that resident was generally satisfactory there was no specific care plan in place to manage this and the associated confusion and aggression. Nor was there any evidence that any referrals had been made to the relevant health professionals, such as the General Practitioner and the Community Psychiatric Nurse. A local General Practitioner spoke highly of the way that residents from his practice were cared for by the staff and general standards within the home. In general residents confirmed that staff were nice to them treated them well and that they were well cared for. Medication systems are managed well; a spot check was conducted, the monitored dose system was found to correspond with the medication administration records and generally found to be in good order. One signature had been omitted, however there was evidence that this had already been identified by senior staff and the required action undertaken. Following a requirement made at the last inspection the medication storeroom has been monitored and a portable air conditioning unit installed. The Acting Manager confirmed that residents who chose to self medicate have appropriate risk assessments conducted. There was evidence that the privacy and dignity of residents was respected at all times. Staff were seen to relate well to residents, to knock and await permission to enter prior to entering their private accommodation. Personal care and consultations with medical staff were conducted in private. DS0000012922.V300231.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15, The quality in this outcome area is excellent, this judgement has been made using available evidence including a visit to the service Daily life and social activities are managed well. EVIDENCE: Residents spoken to confirmed that routines were flexible and varied. One resident stated that she had lots of freedom to do what she wanted to do and when she wanted to do it. Records of activity evidenced that residents had access to a good and frequent range of personal and community activities. This was confirmed by the residents, however some commented that they regretted the fact that the computer club was no longer held. This was discussed with the Acting Manager who confirmed that she was aware of this and was currently seeking to address the situation. The home is a Church of England Home and residents are supported to maintain their faith through all aspects of their daily lives. One resident confirmed that he was able to maintain his participation in church activities outside of the home as both a chorister and organist. The home has its own chapel, which is supported by the resident clergy.
DS0000012922.V300231.R01.S.doc Version 5.2 Page 14 Residents confirmed that they are able to receive their chosen visitors in private should they wish. Relatives were seen coming and going throughout the day. Residents confirmed that they are supported to maintain choice and autonomy in their daily lives and that they are able to handle their own finances. Rooms evidenced a high level of personalisation and residents have access to their personal records. Lunchtime service was viewed and seen to comprise chicken chasseur, mashed potatoes, carrots and peas, with a soft alternative of beef mince. The choice of puddings comprised home made spotted dick with custard, pears and cream, yoghourt, and fresh fruit. A variety of fresh fruit juice was also available. Meals appeared well presented, of adequate proportion and to offer a balance diet. Residents were able to take their lunch in either of the two dining rooms or in their private accommodation. The dining rooms are very pleasantly located and furnished having linen tablecloths and table decorations. Residents confirmed satisfaction with the food provided by the home Staff serving lunch were appropriately attired for food hygiene purposes. Previous recommendations regarding food hygiene have been addressed in consultation with the Environmental Health Officer these include the installation of a Food Hygiene System and the imminent installation of a new kitchen. The Acting Manager was able to confirm satisfactory arrangements that would be made whist this work is undertaken to ensure residents safety and the continuity of service. DS0000012922.V300231.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome area is good, this judgement has been made using available evidence including a visit to the service Complaints and protection are managed well. EVIDENCE: The Commission have received no concerns of allegations about this service. There is an appropriate complaints policy, which is accessible to residents and their representatives. Residents confirmed that they knew how to complain and stated that they would feel confident in raising any concerns and had confidence that these would be appropriately addressed by the new manager. Staff have received training in the Protection Of Vulnerable Adults and were knowledgeable about the action that would need to be taken in the event of an abusive situation. Key workers were able to describe how they supported residents with their personal shopping and to provide evidence that appropriate systems are in place to ensure that financial transactions are managed and recorded appropriately. DS0000012922.V300231.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 The quality in this outcome area is good, this judgement has been made using available evidence including a visit to the service. The premises are suitable for the stated purpose, being well maintained and offering a good standard of accommodation. EVIDENCE: The acting manager confirmed that radiator covers are on order for all radiators with exposed high surface temperatures, in the interim a risk assessment has been conducted as required at the previous inspection. In response to a requirement made at the last inspection window restrictors have now been fitted to the first floor windows. No tripping hazards were identified indicating that the previous requirement regarding this had been met.
DS0000012922.V300231.R01.S.doc Version 5.2 Page 17 Also a previous requirement regarding the potential hazards associated with the location of the hot water heater is to be addressed by its relocation to a self contained environment, along with the imminent refitting of a new kitchen. Most residents spoken to commented on the high temperatures in their own rooms. The Acting Manager confirmed that she had made arrangements for appropriate window restrictors to be fitted to the ground floor accommodation to enable residents to have their windows open safely at night. In addition she is currently conducting a review of the heating system to ensure residents comfort. The premises are clean and hygienic. DS0000012922.V300231.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Inconsistencies in recruitment practices have the potential to place residents at risk EVIDENCE: Following a previous recommendation the Acting Manager has reviewed the Staff Duty Rota to ensure that all staff are listed and their duty hours recorded. There are adequate numbers of staff working in the home, with ten care staff throughout the day and five at night. This provides a ratio of 1:6 at the busiest times. Staff and residents confirmed that staffing levels were sufficient to meet the needs of residents. The acting manager confirmed that staffing levels are calculated according to the guidance issued by the Department of Health and that these levels are based on the assessed levels of residents dependency. Staff spoken to confirm that they have opportunities to gain appropriate qualifications, some had already achieved both National Vocational Level 2 and 3 in care. Newer staff confirmed that they had been involved in discussions about their wishes to undertake this training. The acting manager estimates that approximately 50 of current staff have NVQ level 2 qualifications in care.
DS0000012922.V300231.R01.S.doc Version 5.2 Page 19 Recruitment practices in general were seen to be satisfactory with appropriate references and Criminal Records Bureau Clearances having been obtained. However the most recently appointed staff member did not have either a Criminal Records Bureau Clearance or a povafirst check prior to commencing employment. Following further investigation it appears that this error has occurred during the hand over period between the previous and existing manager. The Acting manager has confirmed that the appropriate clearances have now been applied for and the staff member will work in a supervised capacity away from direct contact with the residents until they are obtained. All future staff must have appropriate Criminal Records Bureau and or povafirst Clearances prior to the commencement of employment. Staff files and staff spoken to confirmed access to appropriate training, including induction and mandatory training such as Fire Safety, Movement and Handling, First Aid, Food Hygiene, Health and Safety and Infection Control. Staff have also received training relating to the individual needs of residents such as dementia care. There is an Equal Opportunities Statement and Policy. DS0000012922.V300231.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The quality in this outcome area is adequate, this judgement has been made using available evidence including a visit to the service The service is well managed; however improvements to the management of risk would further ensure the health and safety of residents EVIDENCE: Following the retirement of the previous manager the trustees have appointed a new manager. The new Manager is known to the Commission having been the Registered Manager elsewhere and is currently seeking registration as the Manager for St Christopher’s. Quality Assurance systems are in place, which include internal audits of medication systems, falls and annual residents satisfaction surveys. The results of which are currently being collated. The acting manager confirmed that the Quality assurance Systems were to be reviewed and strengthened in the near future.
DS0000012922.V300231.R01.S.doc Version 5.2 Page 21 Staff spoken to confirmed the processes, which are used to monitor residents monies and these appeared adequate. The Acting Manager confirmed that the home only holds small amounts of money for residents. The Heath and Safety of residents is generally managed well with appropriate risk assessments being in place. However where residents choose to engage in individual activities, which may involve some risk and appropriate risk assessments should be developed. For example one resident was in receipt of an alternative therapy for the treatment of earwax, however there was no specific assessment for the associated risk of injury or fire. Accurate accident records are maintained and no hazards were identified. DS0000012922.V300231.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 DS0000012922.V300231.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 Requirement New staff must not commence employment within the home without either a povafirst or Criminal Records Bureau Clearance Timescale for action 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations Residents with a potential diagnosis of dementia should be referred to the appropriate health care specialists and have a specific plan of care developed to address their mental health needs Residents that are assessed as having a nutritional risk should be referred to a dietician Residents who chose to participate in individual activities, which involve some risk, should have appropriate risk assessments conducted. 2 3 OP8 OP38 DS0000012922.V300231.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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