CARE HOMES FOR OLDER PEOPLE
St David`s 65 West Hill Road St Leonards On Sea East Sussex TN38 0NF Lead Inspector
Liz Daniels Unannounced Inspection 29th December 2005 10:15 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 St David`s DS0000014039.V269995.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St David`s Address 65 West Hill Road St Leonards On Sea East Sussex TN38 0NF 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) 01424-439266 melvenia@stdavids.wanadoo.co.uk Miss Melvenia Davidson Miss Melvenia Davidson Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That a maximum of two service users with physical disabilities requiring nursing care over 65 years of age may be accommodated in single rooms 7 or 22 when vacant. That one service user admitted in October 2003 under 65 years of age may continue to reside in the home. That only service users aged 65 years or over on admission are admitted into the home 13th July 2005 2. 3. Date of last inspection Brief Description of the Service: St. Davids Care Home is a large detached property located in a residential area of St. Leonards-On-Sea. It provides nursing and personal care for up to 23 residents of an older age or who have a physical disability. It is owned and managed by an experienced registered nurse. The Home is set out on three floors and a passenger lift provides access to all floors. A large lounge area with a sunroom attached provides sea views and some of the upper floor rooms also have spectacular views to the sea. At the front of the building there is a small area providing off road parking facilities. St David`s DS0000014039.V269995.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 a period of almost six hours, beginning at 10.15am. The Inspector met with the Registered Manager, two carers and the Registered Nurse on duty. There was the opportunity to meet several residents informally as they were relaxing in the lounge and to chat in more detail with two residents and a relative, before inspecting a range of key records and documentation. This report should be read in conjunction with the report from the first inspection this year, on 13th July 2005. What the service does well: What has improved since the last inspection?
Good pre-admission processes are in place to ensure the inclusion of Health and Social Services assessments prior to admission whenever possible. The Home now confirms in writing that it can meet the needs of residents. This meets the Requirement from the last inspection. A policy for ‘Reporting Abuse’, introduced in August, clearly identifies Social Services as the lead agency for investigation: it also has the necessary contact details for them and the Commission. This meets the Requirement of the last Inspection. The outside of St. David’s has been repainted since the last inspection.
St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 6 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 David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Comprehensive information and appropriate statements of the terms & conditions of occupancy are provided for residents, at the point of moving into the Home. Good pre-admission processes are in place to ensure the inclusion of Health and Social Services assessments prior to admission whenever possible. Following the pre-admission assessment, the Home now confirms in writing that it can meet the needs of residents. This meets the Requirement from the last inspection. EVIDENCE: A copy of the Home’s Service User guide and Statement of Purpose is given to each resident when they move into the Home. The Service User guide contains the Terms & Conditions of occupancy. This is completed for each individual: it covers the room to be occupied, the care & services provided and the fees. The notice period is also included. The resident is then also given a contract detailing any particular wishes they may have, the name & contact details of their next of kin and any dietary, social or cultural needs. The resident, the Manager and a third party then sign this. St. David’s has had one admission since the last inspection. The Manager received the Social Services assessment prior to undertaking a pre-admission
St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 9 assessment but the Health assessment was not available prior to admission (although it was undertaken very soon afterwards). Once the Manager had undertaken her pre-admission assessment she then confirmed to the resident, in writing, that the Home could meet their needs. The documentation for four of the residents was viewed, including the newest admission to the Home. On admission, a plan of care for daily living and longer-term outcomes are developed, based on the Care Management assessment and the Home’s own assessment. There is a policy in place for the “Assessment of Need of a Prospective Service User”, which outlines the assessment of residents required under Standard 3 of the National Minimum Standards. St. David’s does not offer intermediate care for residents. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 10 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 and 9 There is no clear evidence as to how much the care plans have been shared with the residents or their relatives, but they are individualised and by being reviewed and updated, they remain contemporary. The care plans are very good in encompassing the health, social and emotional needs of the residents. By accessing nurse specialists, health care prescribed is in line with clinical guidelines. Good processes are in place for the ordering, administration and disposal of medication, although two nurses should check and sign when medicines are ready for disposal. EVIDENCE: Four resident’s files were viewed and the Inspector met with one of those residents. Each resident has a Long Term Assessment, initially made on or soon after admission. These had been reviewed each month and new needs identified. Social and emotional needs, such as enabling the pursuit of hobbies or encouraging particular interests, are also included. A Risk Assessment for falls, a nutritional assessment, an assessment of mobility and an assessment of tissue viability were evident. All had been reviewed monthly. Needs identified during any of the assessments are then subsequently recorded on the Care Plan, with the nursing interventions needed. Specialist Health
St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 11 Professionals are accessed as needed and their advice sought for the care prescribed. Evaluations of care are recorded in the Daily Progress Sheet. Although the administration of medicines was assessed, none of the current residents are able to take responsibility for their own medication. However a policy is in place for the “self administration of medicines” and each room has a lockable facility where the medicine can be stored. The clinical room was seen and was clean and well stocked. The medicine charts were seen and were correctly maintained. Policies and procedures are in place for the correct receipt, storage, administration and disposal of medicines. Photographs of the residents are included with the medicine charts. The disposal of the medicines has recently transferred to a Waste Management Company. A policy for “The disposal of unwanted medicines” has recently been developed. All medicines ready for disposal are recorded with the date, name of the resident, drug name and dose. This was discussed during the inspection and it was agreed that in future two nurses would check and sign when medicines are ready for disposal. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 12 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): None of these standards were assessed at this inspection. Please refer to the report from the inspection on 13th July, when the core standards (12, 13, 14 and 15) were assessed. EVIDENCE: St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The Home has very good contemporaneous policies to ensure correct processes are in place for the protection of vulnerable adults. The policy for ‘Reporting Abuse’, introduced in August, clearly identifies Social Services as the lead agency: it also has the necessary contact details for them and the Commission. This meets the Requirement of the last Inspection. EVIDENCE: St. David’s has a policy for the ‘Protection of Vulnerable Adults’ that outlines the different types of abuse, signs & symptoms to be aware of and a flowchart for potential alerters. This guides the reader to contacting both Social Services and the Inspection Authority. A recent policy ‘Reporting Abuse’ was introduced in August 2005. This identifies that Social Services is responsible for investigating Adult Abuse in a Home setting, giving the contact number for the Assessment Team at Social Services. It also includes the emergency duty number and the contact details for the Commission. The Home also has a ‘Whistle Blowing’ policy. The staff that met with the Inspector were able to identify when to raise any concerns and what action to take. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. Please refer to the report from the inspection on 13th July, when the core standards (19 and 26) and several of the other standards, were assessed. EVIDENCE: St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 15 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): 28 St. David’s demonstrates a commitment to training care staff. Currently 75 of care staff are trained to NVQ level 2 or above. EVIDENCE: The Manager reported that she promotes the importance of care staff training to NVQ level 2. The Home offers adaptation training for nurses from overseas, to enable them to register with the Nursing & Midwifery Council. Currently five carers are undertaking their adaptation training. Once trained, they will be assessed as being equivalent to NVQ level 3. One carer has completed NVQ level 2, one is undertaking NVQ level 3 and one has completed NVQ level 3. Currently there are 12 carers at St. David’s and 3 of those are not undertaking their adaptation or have not trained to NVQ level 2. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 16 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 and 35 The Inspector found that staff and residents demonstrate that the Home is managed in a positive and motivated way. Effective quality assurance and quality monitoring systems, based on seeking the views of residents, are in place. There are good financial arrangements for residents’ monies. EVIDENCE: The Registered Manager is a Registered General Nurse who has owned the property for some years now. She has many years experience with caring for older people in the care home setting and has completed her Registered Managers Award (RMA). She also works in conjunction with Manchester University to provide training for trained nurses from overseas, thereby enabling their adaptation for registration in this country. Staff, residents and relatives who met with the Inspector demonstrated that they have confidence in the management of the Home and said they feel the Manager is helpful and supportive. However the current Registered Manager is in the process of appointing a new Manager who will take day-to-day responsibility for the
St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 17 management of the Home, although she will continue as owner and remain in regular contact. An internal audit, covering all areas of the Home, has been undertaken recently and has been sent to the printers. A copy will then be forwarded to the Commission. The views of the residents are actively sought both formally and informally. Questionnaires are circulated once to twice per year. The last survey was conducted in the Spring. The Manager explained that in future the plan is to give the questionnaire to two or three residents each month. The ‘Quality Assurance’ policy reflects that the Home will seek the views of the relatives if a resident is unable to express their thoughts. Feedback is also sought from the staff: an anonymous questionnaire is circulated twice a year. The management team then reviews the results. The process for staff feedback is underpinned by a policy entitled ‘Staff feedback regarding the Care Service’. There are also monthly staff meetings providing an opportunity for staff to be given information, but also for them to express any concerns they may have. Any ongoing issues are then taken to the twice-yearly management meeting attended by the Registered Manager, the co-owner, a trained nurse, a senior carer and the head of maintenance. From this meeting, decisions are made regarding the development of the Home. Some of the residents handle their own financial affairs, but in general Social Services or solicitors are appointed to act on their behalf. The Home’s management team do not act as appointees for the financial affairs of any of the residents. The owner for the Home invoices residents or their appointee monthly. The fees and any sundry items or services are separated out on the invoice. The Home also holds personal monies for sundries and services not included in the fees, for those residents (or appointees) who prefer. The personal money for one resident is paid directly to the Home and held for that resident. Any money brought in is held in a safe place within the Home and separate records of balances for each resident are maintained. A locked cupboard is provided in each room although residents are encouraged not to hold valuables in their room. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 18 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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X x St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 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 9 Good Practice Recommendations Two nurses should check and sign when medicines are ready for disposal. St David`s DS0000014039.V269995.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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