CARE HOMES FOR OLDER PEOPLE
St Edmunds CCSC Victoria Park Road Torquay Devon TQ1 3QH Lead Inspector
Mark Sharman Unannounced Inspection 2nd December 2005 11:20 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 Edmunds CCSC DS0000037052.V271074.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 Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Edmunds CCSC Address Victoria Park Road Torquay Devon TQ1 3QH 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) 01803 314839 01803 314839 Torbay Council Social Services Linda Jayne Bryant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (25) of places St Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users in both categories may be accommodated from age 60. Date of last inspection 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. 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 they will be screened and assessed by the home’s intermediate care nurse, 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 a spacious 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 DS0000037052.V271074.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and about four hours were spent at the home. Eight of the service users were consulted, and the communal areas and several of the bedrooms were seen. Some time was spent with the manager and five of the staff were also spoken with. What the service does well: What has improved since the last inspection?
There has been an agreement that there will now be a third carer awake at night (rather than two) plus a senior care officer sleeping-in. This will of course increase the level of care available at night. St Edmunds CCSC DS0000037052.V271074.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 Edmunds CCSC DS0000037052.V271074.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 Edmunds CCSC DS0000037052.V271074.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): 3. Assessment of service users’ needs is carried out prior to their admission and continues after admission. EVIDENCE: Two service users’ files were inspected. Both of these people were admitted from hospital and in both cases the home received a written assessment from the hospital staff, which had been contributed to by an occupational therapist and a physiotherapist. Assessment forms had also been completed by the home’s staff after the service users were admitted. St Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 9 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): 9 and 10. There is a satisfactory medication system. The service users are treated in a respectful and caring manner by the staff. EVIDENCE: The home has a medication policy (examined previously). Service users may look after and take their own medication if they can do this reliably, and several were doing so at the time of this inspection. All bedrooms are equipped with a lockable drawer. The medication storage and a sample of medication administration recording sheets were inspected, and a controlled drugs book is maintained. Only senior care officers administer medication to service users, and the senior on duty said that they have all had medication training (with Boots in her case). The service users were very complimentary about the attitude of the staff and said that their privacy and dignity are respected. The staff on duty were seen to be assisting service users in a kind and caring way. All service users have a single bedroom, although there are two double rooms for use be couples. There is a designated telephone room on both floors, enabling service users to make calls in private.
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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): 14 and 15. Service users stay for only a few weeks and they are encouraged to remain as independent as possible. The catering arrangements are commendable. EVIDENCE: The service users retain control of their personal finances, and look after their own medication (at least before they return to their own homes). Some of those consulted said that they are encouraged to do as much as they can for themselves so that they are better prepared for their return home. They were very complimentary about the standard of the meals provided. A five weeks menu is used, which showed a good variety on offer. The cook said that there is always a choice for lunch and for tea, which was confirmed by service users. One of them said “you’re always offered seconds”. The lunch on the day of the inspection was beef casserole or pasties or salad, followed by a choice of three desserts. Fresh fruit is always offered at tea time, when there is also a choice of main course. The manager said that it is standard practice to provide a hot drink to service users during the night if requested. St Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 12 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. There is a satisfactory complaints system. EVIDENCE: The home’s complaint policy was displayed in the foyer and is also included in the service users guide, a copy of which was seen in the bedrooms. The reference to the National Care Standards Commission should be replaced with the Commission for Social Care Inspection. A service user said she was sure that if she had a complaint it would be listened to and dealt with if possible. Complaints are recorded – the one recent complaint made related to the attitude of an agency worker. St Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 13 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, 22 and 26. The home was designed for its stated purpose and provides a high standard of accommodation, and it was very clean and hygienic. EVIDENCE: The building is suitable for the purpose of intermediate care and is very well equipped to enable service users to maximise their independence. Specialist equipment includes a shaft lift to all floors, assisted baths and disabled toilets on both floors, a specialist gymnasium. It is light and spacious with wide doorways to all rooms, and the long wide corridors enable service users to exercise indoors in poor weather. All of the bedrooms have a spacious en suite toilet and shower. There is level access outside to a level garden. All parts of the home seen were very clean and hygienic, including bathrooms and toilets, and the service users said this is usual. There was no unpleasant odour. The laundry room is large and particularly well equipped.
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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 and 28. The staffing arrangements are commendable, and the staff group is trained and appropriately experienced. EVIDENCE: This was an unannounced inspection and there were certainly enough care staff on duty to meet the service users’ needs. This had enabled one of the carers to go out with a service user on a home visit. The service users consulted also said they felt that enough staff are deployed. They benefit greatly from the fact that on weekdays the occupational therapists and physiotherapists work with them in addition to the care staff, and on the afternoon of this inspection some service users were receiving this help in the gymnasium (these therapists do not work at the weekends). It has just been agreed to have three carers awake at night (rather than two), plus a senior carer sleeping-in. The manager said that about 80 of the care staff have achieved NVQ level 2 or above. St Edmunds CCSC DS0000037052.V271074.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 and 35. The home is managed in a competent and professional way, with some supervision from the organisation’s management structure. EVIDENCE: The manager is qualified and appropriately experienced. Prior to managing this home she had several years experience of managing a residential care home/rehabilitation centre. She has achieved the registered managers award and NVQ level 4 in care. Full staff meetings are held as the need arises, and the senior care officer said there had been one a few days previously. There is also a monthly management team meeting. The Trust has not sent a monthly report on the conduct of the home to the Commission for Social Care Inspection as required. All service users manage their own money, although a safe-keeping facility is available (for which receipts are issued to service users).
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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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 x x 4 x x x 4 STAFFING Standard No Score 27 4 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x x St Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? Yes. 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 OP33 Regulation 26 Requirement A report on the conduct of the home following a monthly inspection must be sent to the Commission for Social Care Inspection and to the home’s manager. (Previous timescale of 31/7/05 not met). Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Edmunds CCSC DS0000037052.V271074.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Ashburton Office 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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