CARE HOMES FOR OLDER PEOPLE
St Edmunds CCSC Victoria Park Road Torquay Devon TQ1 3QH Lead Inspector
Mark Sharman Announced 14 June 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service St Edmunds CCSC Address Victoria Park Road, Torquay, Devon, TQ1 3QH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 314839 Torbay Council Linda Bryant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 60 years of age. of places St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 8/12/04 Brief Description of the Service: St Edmunds is an intermediate care facility for up to twenty five service users who have been identified as having the capacity to return home following rehabilitation input. The service is a joint venture between Social Services and the Health Authority, and there is no charge to the service user. The home provides intensive rehabilitation for a period of up to six weeks, and service users can be referred from a variety of sources. During their time at the home service users will be screened and assessed by the home’s intermediate care nurse, who is based there and who has access to the GPs at a local health centre. Service users also benefit from the attention of physiotherapists and occupational therapists who are based in the home. Nearly all bedrooms are single rooms, and all have an en suite toilet and shower. Two bedrooms can be used as double rooms for married couples. The home is well equipped for people with reduced mobility, having a shaft passenger lift, assisted baths and disabled toilets. There is a well equipped gymnasium for use with service users by the therapists. There is level access on each floor and out to the gardens. There is some car parking available on the site. There is also a day centre within the building, but this is not regulated by the Commission for Social Care Inspection. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection lasting about eight hours, and eight of the service users were interviewed. Several of the staff were spoken to in addition to the manager, including senior care staff, care workers and a nurse based in the home. All communal parts of the building were inspected and several of the bedrooms. Before the inspection a completed pre-inspection questionnaire was received from the manager. Also four comment cards were received from service users and four cards were received from relatives. What the service does well: What has improved since the last inspection?
No requirements were made at the last inspection. A recommendation was made at that time that monthly checks of the home’s fire extinguishers should be carried out, and these checks are now being recorded in the fire log. Regular checks of the extinguishers will contribute to the home’s fire safety regime.
St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 6 Maintenance of the building is ongoing. New carpets have recently been laid in five of the bedrooms, thus improving the environment for service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6. The assessment of service users’ needs is very thorough, and the efforts of all the staff are focussed on helping service users to regain their independence so that they can return to their own homes. EVIDENCE: Three service users’ individual files were inspected. A full needs assessment by the professional making the referral of a potential service user is required by the home, without which no service user is admitted. On admission each service user has a health screening carried out by a nurse, which was described by the nurse who was spoken to during this inspection. In addition in the few days following an admission further assessments of need are carried out by the home’s staff, including an occupational therapist and a physiotherapist. Service users spoken to confirmed that they had received such assessments. The main function of the home is to provide intermediate care to enable service users to return home. The success of the staff in achieving this aim is reflected in the fact that in the last year 73 of those admitted returned to their own homes after an average stay of 28 days. The home is well equipped for this purpose, and specialist staff employed include occupational therapists
St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 9 and physiotherapists. These specialists also provide rehabilitation training to the care officers. The gymnasium includes specialist rehabilitation equipment. During the afternoon of the inspection one of the occupational therapists and a care officer accompanied a service user to her own home to assess what help she might need when she returned home. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 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 standard(s) 7 and 8. Service users’ care needs are set out in an individual care plan, and their health care needs are assessed and well met with evidence of good multidisciplinary working. EVIDENCE: Three of the service users’ files were inspected. The plans of care were generated from the needs assessments carried out, and included goals to be achieved during the service user’s stay. There was evidence that they were involved in the setting of these goals and in the review of their care plans. In fact on the morning of the inspection a review was taking place, at which the service user (and relative) was present. A commendable standard is achieved with regard to health care needs. All new service users are screened by the nurse on admission, who calls in a general practitioner if she feels this is necessary. One of the service users said that the nurse had identified a skin condition which required treatment at the time of her admission to the home. The home’s rehabilitation co-ordinators arrange for attention by a dentist, optician or chiropodist after admission if this is necessary. A service user said that he had been treated by a chiropodist that morning. All of the service users benefit from attention by the home’s occupational therapists and physiotherapists throughout their stay.
St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 11 St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 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 standard(s) 12 and 13. The lifestyle in the home matches the service users’ expectations, and they are able to maintain contact with their relatives and friends. EVIDENCE: Saint Edmund’s is exclusively an intermediate care facility at which service users normally stay for no more than six weeks. Those spoken to were well aware of the purpose of their stay, and their primary objective was to take part in their therapy in order to regain their independence. Accordingly they said that they were not looking to the home to provide recreational activities, although they were aware of activities available in the day centre. They said that they enjoyed the daily exercise class, which is sometimes followed by a quiz or similar activity. Visitors are welcome at any reasonable time, and the visitors book showed that many relatives and friends do visit service users. One visitor was spoken to and said that she is made to feel welcome. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. There is a satisfactory complaints system, and arrangements for protecting residents from abuse are also satisfactory. EVIDENCE: The home’s complaint policy was displayed in the foyer and is also included in the service users guide, a copy of which is kept in every bedroom. A new service user admitted on the day of the inspection was reading this at the time she was spoken to. Other service users spoken to said they were confident any complaint would be taken seriously, although they emphasised that they had no complaint to make. A record of complaints is kept by the manager and was inspected, although there were no recent entries. There are appropriate policies in relation to abuse and adult protection, and the staff spoken to were aware of what these policies are. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. The home’s layout is suitable for its stated purpose, it is safe and well maintained, and it was very clean and hygienic. EVIDENCE: The building is suitable for the purpose of intermediate care, having a shaft lift to all floors, level access throughout, and wide doorways. It is light and spacious, and the long wide corridors enable service users to exercise indoors in poor weather. There is level access outside to a pleasant, level garden. There is ongoing maintenance, and for example new carpets were recently laid in five of the bedrooms. There is good domestic assistant cover, and the service users commented on how very clean the home is kept. This was certainly so on the day of the inspection, and there was no offensive odour. The laundry room is large and particularly well equipped. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. The staffing cover on weekdays is very suitable for the home’s purpose, although more limited at weekends. The staff receive training which is appropriate to working with this client group. EVIDENCE: Staff rotas were inspected and were considered to be generally very satisfactory. On weekdays the occupational therapists and physiotherapists work with service users in addition to the care staff, which enables the service users to receive the individual therapy which they need. These therapists do not work at the weekends. One service user spoken to said that staff respond promptly if she uses her call bell. The domestic staff cover is satisfactory, which was evident from the cleanliness of the home and the fact that service users were very complimentary about the meals provided. Staff cover at night (two awake and one sleeping-in) may limit the number of highly dependent service users who can be accommodated at one time. The home’s recruitment practice is satisfactory, and a sample of Criminal Records Bureau disclosures and references was seen in staff files. Staff training records were also seen, and the staff said that they are offered regular training opportunities. Over 75 of care staff have achieved NVQ level 2 or above. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38. There are appropriate quality monitoring systems in place, and there are satisfactory arrangements to ensure the health and safety of service users and staff. EVIDENCE: Quality monitoring is based on the service users’ views. They are always involved in reviews of their progress, which take place soon after their admission and again just before their discharge from the home. One such review took place on the day of the inspection. All service users also complete a satisfaction questionnaire a week or so after their admission, allowing staff to consider any suggestions or criticism well before the person’s discharge from the home. All service users manage their own money, although a safe-keeping facility is available. With regard to health and safety issues, various steps have been taken to make the environment safe. All hot water outlets accessible to service users
St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 17 are temperature regulated, radiators have low temperature surfaces, and all windows are restricted (to prevent falls from them). There is always a qualified first aider on duty, and a list of such staff was seen. Core training for all care staff includes health and safety, manual handling, first aid and food hygiene. St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 19 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 33 Regulation 26 Requirement A copy of the report on the conduct of the home following the monthly inspection must be sent to the Commission for Social Care Inspection and to the homes manager. The Commission for Social Care Inspection must be notified of any event notifiable under this Regulation, including the death of a service user or serious injury sustained by a service user. Timescale for action 31/7/05 2. 37 37 30/6/05 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 Good Practice Recommendations St Edmunds CCSC D54-D07 S37052 St Edmunds V221341 140605 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Unit D1 linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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