CARE HOMES FOR OLDER PEOPLE
St Edmund`s CCSC Victoria Park Road Torquay Devon TQ1 3QH Lead Inspector
Judy Cooper Key Unannounced Inspection 10:45 6th February 2008 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 Edmund`s CCSC DS0000037052.V356137.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. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Edmund`s 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 324595 01803 314839 sally.pritchard2@nhs.net Torbay Council Social Services Position Vacant Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24), Old age, of places not falling within any other category (24), Physical disability (24) St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registerd person may provide the following category of service only: Care Home providing personal care only - Code PC To service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Dementia (Code DE) 2. 3. Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 24. Service users may be accommodated from 40 years of age. Date of last inspection 8th May 2007 Brief Description of the Service: St Edmunds is currently classed as 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 home provides intensive rehabilitation for a period of up to six weeks. There is no charge to the service user as Social Services and the Health Authority fund places jointly. A multi-disciplinary assessment is carried out prior to admission, and service users benefit from the attention of physiotherapists, nurses and occupational therapists who are based in the home. Visits to clients’ homes are carried out before discharge for assessment of ongoing needs for adaptations or support. St.Edmunds is also in the process of preparing to provide an intermediate care service for people with mental health/dementia needs. The second floor of the home will eventually be dedicated to this service with the first floor providing an intermediate care service for people with physical care needs. All bedrooms are currently used for single occupancy, though two are large
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 5 enough to be used as double rooms for married couples. All have a spacious en suite toilet and shower. The home is well equipped for people with reduced mobility, having a shaft passenger lift, assisted baths and disabled toilets. There is also a well-equipped gymnasium for use by service users with the therapists. There is level access on each floor and out to the gardens. There is some car parking available on the site. Other services including a day centre are located on the ground floor of the building, but are not regulated by the Commission for Social Care Inspection. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This inspection took place on a Wednesday between 10.45 a.m. and 4.00 p.m. There were six people in the home, in receipt of intermediate care, at the time of the inspection. During the visit opportunity was taken to tour the home, examine appropriate records and policies and talk with the home’s newly appointed nurse manager and the home’s business manager as well as several staff members and four of the six people currently staying at the home. One questionnaire was received from a previous person who has had an intermediate stay at home. Additional information about the home, including the receipt of a very detailed Annual Quality Assurance Assessment, as well as a detailed in-house organizational evaluation and the organisations action plan in response to this evaluation has provided further feedback as to how the home performs. All of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well:
Since the last inspection carried out in May 2007, this service has undergone a huge amount of change. This has involved a complete change of management, a change of staff group with the redeployment of staff from two other Primary Care Trust establishments and a temporary stoppage on admitting more than eight people due to the findings of the organisations own evaluation which highlighted shortfalls in some areas, which are now being addressed. It is to the organisations credit that immediate action was taken to rectify the identified shortcomings and in doing so ensure that the service, that continues to be provided, is of a high standard and fully meets peoples’ needs. It also to the organisation’s credit that the newly proposed service to provide intermediate care for people with mental health care needs/dementia care
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 7 needs has been put on hold until the accommodation intended to be provided for this service is fully upgraded to the required standard and that staff feel confident to deliver this specialised care. The proactive approach of the Care Trust’s senior management and the home’s management has fully ensured, and will continue to ensure, that the care provided to those people in receipt of a service within St. Edmunds is of a high standard. What has improved since the last inspection?
A new management structure has been introduced within the home. An experienced, qualified and competent nurse manager was appointed in December 2007. A new role of business manager was also created at the same time. An experienced assistant manager who has had extensive experience in a management role within a previous Local Authority residential care establishment now holds this post. The staff group consists of experienced, mostly qualified staff. Some current staff recently transferred into the establishment from two other establishments within the Care Trust. All staff were noted as working towards ensuring a good delivery of care to the people staying at St. Edmunds. The management team within the home are working hard to address the identified shortfalls, build on the identified strengths and involve staff as much as possible with planned changes for the home. The management team are in the process of upgrading the home’s environment to ensure that it meets the peoples’ health care needs but remains a pleasant, welcoming place to stay. All policies and procedures within the home have been, or are in the process of being reviewed, to ensure they are up-to-date and in line with current legislation. The management team have involved experts from within the Care Trust/Local Authority as well as seeking expertise from outside agencies such as the Alzheimers society to ensure that the plans for the future of the service are such that they will peoples’ meet needs fully and effectively. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 8 What they could do better:
As previously stated the service has/is undergoing significant change. However during this period some people continue to receive an intermediate care service. Therefore, although overall plans are for the future of the home, it must be remembered that the people who receive a service during this period of change, should also benefit from a service that ensures their needs are fully met. Shortfalls identified at this inspection in respect of this included the following: A temporary, up to date, Service User Guide/Statement of Purpose should be compiled and made available to the people who use the service during this period of change so that they and all their families/carers can be aware of what services/facilities they can expect to find during their stay. Risk assessments, regarding a persons ability to self medicate, should be fully completed with the person involved. This is to ensure that both the staff at the home and the person concerned are confident that self-medication is (and remains) a safe option. The homes menus should be displayed communally so that people know what meal they will be having and can then make an informed choice as to whether or not they want the main meal or would prefer a different choice. The home’s complaints policy should be displayed in an easily accessible place. This is to ensure that people know how to make a complaint, should they need to, and how they can expect it to be dealt with. The complaint’s policy should also contain contact details of the Commission. The ventilation of the staffs’ internal office area, sited on the first floor, should be reviewed as during this inspection it was noted to be hot and stuffy and staff using it stated that they often felt uncomfortable doing work in this environment. Weekly checks of the home’s hot water supply to peoples’ sinks, in their bedrooms, should be undertaken. This is to ensure that any risk, of unregulated hot water being delivered, is minimised and therefore lessens the risk of any person inadvertently scalding themselves. Additional, necessary measures, as has been identified as needed to be put in place, to ensure the peoples’ health and safety is maintained at all times, must be carried out in a timely manner. This refers to ensuring that work is undertaken to ensure that the fire compartmentation” of the building it up to the required standards of fire prevention legislation.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 9 Also the security of the building must be reviewed in light of a recent security infiltration, which the police were involved with. This is to ensure that the people remain protected at all times. During this period of change, the management should try to ensure that all staff receive regular supervision. This is to allow staff to talk through their obvious concerns and feelings surrounding the huge amount of change that has gone on, and continues to be ongoing, within the establishment. Staff stated that they felt, on occasions, less valued with some feeling that their new job roles, within the home, were not recognising their previously acquired skills. Therefore having regular, individual time with a manager to discuss such issues would allow staff the opportunity to explore their feelings and for the management to be aware of this and then be able to take action to help staff feel more valued/understood during this period of change. The newly appointed manager should apply to register with the Commission. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 10 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 Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 The quality in this outcome area is adequate. The home’s pre-admission assessment processes provide enough information to ensure that all staff would be aware of a person’s needs. There is not sufficient up-to-date information about the service to inform a person and/or their family/advocate about what services and facilities they can expect to receive whilst staying at St. Edmunds. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nature of the care provided is such that there is always a high turnover of people receiving intermediate care at the home. There was adequate pre assessment documentation to ensure that staff knew a persons needs prior to admission. A great deal of effort goes into the pre admission processes, involving the homes’ staff, as well as other professionals based at the home such as qualified nurses, occupational therapists, physiotherapists etc.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 12 This level of expertise ensures that the home takes people that they feel meets the home’s criteria, that is that a person has the ability, after a period of intensive intermediate care, to return to their home within the community. During their time at the home a person is continually assessed. If it is felt by all concerned, including the person themselves, that this will not be an option, other avenues for care are explored i.e. a residential care home setting. It was noted that the Service Users Guide/Statement of Purpose contained information about the service, which is no longer current. Although the services to be provided have yet to be finalised it is important that those people who do receive care during this period of change are aware of the facilities, staff group, management group etc they can expect to find on their admission. Therefore a temporary Service User Guide/Statement of Purpose should be compiled for this period. Two peoples’ admission was looked at in detail and one person was spoken to about their admission. They were pleased to be at St. Edmunds, as they had been there before on a previous occasion and the care provided had allowed them to return home. Another person also stated that the care made available had increased their confidence and was allowing them to think positively about returning home. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is good. People who are staying at the home have their health care needs met whilst their privacy and dignity is fully upheld. A small additional measure needs to be put in place to ensure that the administration of medication is as secure and safe as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care planning processes within the home are in depth and detailed. The management advised that the way that information is recorded is being looked at to ensure that it is presented in an easy to access manner for all staff. All care needs were noted as having been covered within the care plan and an ongoing, continuous review process takes place whilst a person is at the home. This involves all the different people involved in the care of the person such as nurses, physiotherapists, occupational therapists, intermediate care support workers as well as care staff involved in the day-to-day care of the person in the home.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 14 This means that all have an input into a persons care and into their future needs. The result of this is that peoples’ care needs are met appropriately within the home during their stay and appropriate provision is made for ongoing support once the person returns home. A comment received from a past resident stated that the care provided to them whilst at St. Edmunds had been: 5 star. As all the necessary professionals are based within the home including a daily (Monday to Friday)qualified general nurse, physiotherapist, daily occupational therapist etc, the people are seen regularly and as required. During this inspection it was noted that the qualified nurses were carrying out procedures, risk assessments and other clinical matters in respect of the people, whilst the occupational therapists and physiotherapists were also involved with the ongoing intermediate care of the people who were at the home. Medications are either given by the home’s senior staff (who have received training in this), or people can choose the option of self medicating if the person feels confident in doing this. Although a risk assessment was seen for those that self-medication, it was noted that it had not been completed fully with the person’s name and personal details missing. Also the person themselves had not signed to say they agreed with the contents of the risk assessment. This could cause wrong information being made available. All documentation should be fully completed and it should be easy to identify the name of the person to whom the documentation refers. Evidence that the new manager is reviewing procedures to ensure the peoples’ safety could be seen in the newly introduced policy of ensuring a GP visits when a person sustains a fall. In the event a GP chooses not to visit the staff have been instructed to call an ambulance and have the person checked over at the accident and emergency department. This is in response to when a person recently sustained a fall and although a GP was called the GP only gave verbal instructions over the telephone. A day later the person needed to be admitted to hospital with a serious fracture. There were excellent adaptations and aids made available for the people to help with their mobility, pressure area care and encourage their independence. This included such things as a fully adapted bath, specialised beds (one was provided on the day of inspection for a person who needed this, as was a stand aid), whilst there are adequate in-house aids such as hoists, grab rails, chair
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 15 raisers etc which all ensure that the care that is needed for intensive intermediate/rehabilitation of people to allow them to go back home can be provided. Staff were noted as treating people with the utmost respect and dignity and had a genuine positive attitude, which encouraged and supported the people in their quest for independence to allow them to return home. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 The quality in this outcome area is good. People benefit from a stimulating and busy environment, with visitors encouraged and welcomed, where they have the opportunity to participate in activities should they chose to, available in the day-care facility. Staff respect peoples’ personal choices and the home provides good nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff are skilled at recognising peoples’ individual lifestyles and try their best to ensure that they maintain these. For example one person, although physically quite dependent, wishes to maximise their independence as far as possible. Staff do this skilfully by allowing the person to undertake tasks, as they are able but being available as required. Activities are not normally provided within the residential parts of the establishment. This is due to the fact that the therapies and exercises etc form most of a person’ day.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 17 Therefore in house activities would not be appropriate. However activities are provided a daily basis within the day centre, situated on the ground floor. People receiving intermediate care are able to take advantage of these activities if they wish to and some people stated that they had (on the day of inspection there was a clothes party taking place in the day-care unit to which the people having intermediate care were invited). Meals provided are nutritionally balanced with choice available. On the day of inspection the meal was roast pork, roast potatoes, carrots and gravy followed by a choice of sweet. An alternative was available to the roast pork. However menu choices were not communally displayed and people would not always be aware, unless they asked, what was for lunch or tea. People who live at the home spoken to however stated that the food was always of a good standard. One person was noted as needing a diabetic based diet and their lunch provided was in line with this need. Meals are served communally in the home’s pleasant, light airy dining-room. This allows people the opportunity to get together socially. It was also noted that staff also ate their meals with the people at the home, which helps foster an atmosphere of mutual respect. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is adequate. Arrangements for protecting the people and responding to their concerns are such that they should be protected at all times. However not everyone was aware of how to make a complaint to the Commission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints received about the service since the last inspection. However there was a concern raised regarding some general care practice. This was investigated by the home and the Commission was satisfied with the outcome of the investigation. However since the conclusion of this investigation there have been significant management changes within the home. The homes complaints procedure was not easily available, especially for people staying on the second floor as it is displayed on the ground floor. Steps should be taken to ensure the complaints procedure is also made easily available to those people in receipt of a residential stay. Management stated, and staff confirmed, that they had received vulnerable adult training. The home does not deal with the peoples’ money on a regular basis other than to hold small amounts if requested/required. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 and 26. Quality in this outcome area is poor. Although people benefit from a clean and comfortable home setting, the recent assessment and identification of environmental risks within the home means that the people are not fully protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The part of the home’s environment, which is currently being utilised intermediate care, was noted as being clean, warm, comfortable and inviting. However during recent evaluations of the accommodation it has been noted that the second floor, which is due to provide care for people with mental illnesses/dementia has been found to be not fit for purpose. This is due to the fact that the fire precautions are not up to the required standard. Also the layout of this floor is not such that it would benefit a person with mental health/dementia needs in the best way.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 20 For example the corridors are long, dark and have the same colour doors leading into each bedroom. This could be confusing to clients suffering with mental health/dementia. The newly implemented home’s management team, along with experts from both within the Care Trust and external organisations have identified these shortfalls and this floor is now “closed off” until it is made safe from the risk of fire and made more user-friendly by changing the layout. It is to the Care Trusts credit that they have taken immediate action to rectify the shortfalls once they were identified. On the day of inspection it was noted that external contractors were on site making notes of the shortfalls in respect of fire prevention in respect of this floor. It was also noted that there was an infection control officer undertaking an infection control audit throughout the whole home, which had resulted in the recognition of the need to provide a different form of bed, other than the divan style bed that is currently being provided. It was noted that antibacterial hand gel and gloves were easily available in rooms and corridors to help minimise the spread of any infection. An external provider was also measuring up for new flame resistant curtains and bedcovers, which are to be provided within the residential areas of the home to help minimise the risk of any fire hazard. The home’s fire log book was seen and it was noted that general fire precautions are maintained appropriately within the home. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The quality in this outcome area is adequate. Trained, experienced staff at the home are employed in adequate numbers to meet the peoples’ personal care needs. However staff morale is lower than normal due to constant changes within the service. EVIDENCE: There were six people receiving intermediate care on the day of inspection. Four of these people were spoken with. All spoke highly of the care received and stated that the staff were excellent. People said call bells were answered quickly and that they could always get help when they needed it. They said the staff were kind and caring and had helped them gain their confidence and feel more able to think about going home. The staffing structure within the home is quite complex. It is headed up by the newly appointed nurse manager who has responsibility for overall care issues but is helped in this by the business manager, who has responsibility for the general day-to-day running of the home. They in turn are helped and supported by senior care staff who ensure the day-to-day maintenance of peoples’ care needs remains as required. Designated care staff deliver the care. Professional staff such as nurses, physiotherapists, occupational therapists support the care of the people by providing specialist input and devising exercise programmes etc which the care staff then follow.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 22 Care staff stated that, although, there were a lot of people involved in the delivery of care to the people, it did not feel that the current care staff numbers were enough, because although lots of other professionals had input it was for short periods only. Therefore the ongoing care fell to the carers only. There has not been any recruitment of new staff since the last inspection. However there has been redeployment of staff from two other establishments within the Care Trust. This redeployment has caused all staff to feel unsettled. The management are having a team building day within the next month to address these feelings and to allow staff to have the opportunity to work through them and to understand the direction the management wish to take with the home. It is hoped this event will help alleviate the staffs’ feelings of uncertainty and not feeling valued. The management are in the process of addressing any staff training needs and collating what training staff have undertaken. Several staff already have a recognised qualification in care and statutory training has continued to be provided. It is the management’s intention to provide staff with sufficient training to feel confident to be able to care for the people they intend to provide a service for i.e. people receiving intermediate care to enable them to go home. This will include people with mental health/dementia care needs as well as physical/health care needs/dependencies. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. The management of the service has recently changed significantly. The newly appointed manager has not yet had the time to fully complete the required management tasks identified as being necessary to ensure the home is run in the best interests of the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Senior management of the Care Trust identified some significant shortfalls in the day-to-day running of the home last year. These findings were the result of an in-depth organisational evaluation, which was undertaken at the end of last year. The evaluation makes it quite clear as to how the Care Trust are intending to deal with the shortcomings identified. A new management team has since been put in place within the home.
St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 24 The newly appointed nurse manager (who is to apply for registration with the Commission), is qualified holding a Registered General Nurse qualification, a Registered Mental Nurse qualification and has also achieved 2 professional qualifications in management. Her previous role was as Community Mental Health Team Manager for older people and therefore she has the experience to ensure that the vision for St Edmunds to provide intermediate care for people with physical needs as well as mental health/dementia is correctly undertaken/provided. Although she had only been in post for a short time (since December 2007), staff spoken to stated that they found her approachable, knowledgeable, understanding of their situation and that they felt she would be a good manager/leader. She is, in turn, supported by an experienced assistant manager, who was redeployed from another Trust home, and is now known as the home’s business manager. The business manager has the registered manager’s award as well as a national qualification in care at level 4. Together they make an excellent management team as both have different but necessary skills to allow the service that had been planned for St. Edmunds to develop and grow. The nurse manager has recently undertaken an action plan to deal with the shortcomings identified by the senior management team during their evaluation process. A copy of the action plan was provided at the inspection and it was clear to see that there is every intention of meeting shortcomings with timescales given. It was pleasing to note that this self-evaluation had taken place and although shortfalls still remain, the way that the Care Trust firstly identified the shortfalls and then secondly appointed an experienced person who they felt could, with their support, address and meet them evidences that the Trust intend to ensure they are met. This evidences that the Care Trust are to ensure that the service will eventually be able to offer a needs led, professional service that will benefit the people that need to access it. Some health and safety issues have been identified including ensuring that the home meets the requirements of the Fire Department in respect of residential care homes, and evidence was seen at the inspection that the Care Trust are in the process of addressing these serious environmental shortfalls. The manager stated that the necessary policies and procedures are in place. During the inspection it was noted that some personal notes were left unattended in the communal dining room. This should not happen as it compromises peoples’ rights to confidentiality. However all other documentation inspected was being maintained in a professional and correct manner. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 25 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 1 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 n/a DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 23 (4) (a) and (b Requirement The registered provider must ensure that the requirements of the fire authority are followed in relation to maintaining the fire precautions to a satisfactory standard. This refers specifically to ensuring that the fire compartmentation” of the building it up to the required standard. This will ensure that the people who live at the home will be protected in the event of a fire. 2. OP19 13 (4) (c) The registered provider shall ensure that unnecessary risks to the health or safety service users are identified and so far as possible eliminated. This refers specifically to reviewing the security of the building to ensure that the people at the home using the service remain safe. 06/03/08 Timescale for action 06/03/08 St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 27 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. 2. 3. 4. 5. 6. 7. Refer to Standard OP1 OP10 OP15 OP16 OP19 OP19 OP36 Good Practice Recommendations A temporary, up to date, Service User Guide/Statement of Purpose should be compiled and made available to the people who use the service during this period of change. Risk assessments, regarding a persons ability to self medicate, should be fully completed with the person involved. The homes menus should be displayed communally. The home’s complaints policy should be displayed in an easily accessible place. The ventilation of the staffs’ internal office area, sited on the first floor, should be reviewed Weekly checks of the homes’ hot water supply to peoples’ sinks, in their bedrooms, should be undertaken. All care staff should receive formal supervision at least six times a year, to ensure they are up to date in knowledge of the home’s policies and procedures, to consider their training needs, and to give them an opportunity to discuss any issues or anxieties. St Edmund`s CCSC DS0000037052.V356137.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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