Inspection on 26/04/06 for St Edmunds

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Edmunds 24/04/07

St Edmunds 21/02/06

St Edmunds 16/08/05

St Edmunds 20/01/05

St Edmunds 20/07/04

St Edmunds 26/03/04

St Edmunds 03/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Edmunds Surrogate Street Attleborough Norfolk NR17 2AW Lead Inspector Mr Pearson Clarke Random Unannounced 26th April 2006 10:30 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 DS0000035075.V292637.R01.S.doc Version 5.1 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 DS0000035075.V292637.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Edmunds Address Surrogate Street Attleborough Norfolk NR17 2AW 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) 01953 452011 01953 457463 terri.mcwilliams@norfolk.gov.uk Norfolk County Council-Community Care Ms Theresa McWilliams Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate up to 35 Service Users who are Older People, not falling into any other category. That Service Users who need a wheelchair to assist with independent mobility at point of admission can only be accommodated in rooms 30, 35, 36, 40, 41, 44, 72, 74 and 75. The Home may accommodate one (1) named Service User who is mentally disordered. Maximum not to exceed 35. 21st February 2006 3. Date of last inspection Brief Description of the Service: St Edmunds Home is situated close to the market town of Attleborough. It is a purpose built home, providing residential care to up to thirty-five elderly people, operated by Norfolk County Council. Accommodation is on two floors and there are bedrooms, sitting and dining rooms on both floors. Access between the floors is by a shaft lift or one of three staircases. The premises were not built to comply with space standards now applicable under the Care Standards Act 2000. This has been partially resolved by a reduction of numbers of service users and the attachment of conditions in relation to rooms occupied by those needing wheelchairs to move independently around their rooms. The home itself is situated by the side of part of the one-way, traffic system around the town centre and there is limited parking on the site. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of St Edmunds was unannounced and took place over two days. The inspector met with a number of service users, one set of visitors to the home and interviewed staff and management. Records were inspected, a tour of the building undertaken and time was taken in direct observation. All of the above helped inform the judgements made. What the service does well: What has improved since the last inspection? Since the last inspection the management have worked hard to address issues raised. Care planning has improved, recruitment of staff has produced more stability and new staff rotas offering extra staffing are shortly to be introduced. The service management are now able to demonstrate that safe recruitment is taking place. Water temperatures are now fully regulated, some work to improve lighting in service users rooms has commenced and at the time of inspection the fitting of window restrictors to ground floor windows was almost complete. The inspector was assured that the fitting of locks to bedroom doors would soon commence. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 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 DS0000035075.V292637.R01.S.doc Version 5.1 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 DS0000035075.V292637.R01.S.doc Version 5.1 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): 1,2,3 The service provides information to service users to allow them to make an informed choice when entering the home, however they should review their systems to ensure that it is provided on every occasion. The management must continue its review of service user need, so that they can ensure that the needs of all people accommodated can be met. EVIDENCE: During the inspection the inspector spoke to a selection of service users and it was clear that those spoken to were unsure as to whether they had received written information about the service at the time of admission. The homes management confirmed that all service users and their representatives are given the homes terms and conditions and a copy of the service user guide which is also displayed in the entrance area. It maybe that those spoken have forgotten what was made available at the time, however the inspector recommends that a dated and signed check list is produced for all admissions which will allow the service to evidence that all necessary steps including the provision of information are followed on all occasions. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 9 Previous inspection has indicated concerns about the service accommodating people whose needs they could not meet. It was encouraging to the inspector to see that this issue is being addressed by the homes management. As such one named service user has been reassessed and has moved to a more suitable placement and the cases of three other service users are currently being evaluated to decide if the home is still an appropriate setting. In one of these cases a referral has been made to a social worker to seek a new placement and whilst the inspector understands that this process will be managed by people outside of the home it is important for the homes management not to allow the situation to drift as it is the responsibility of the registered manager to ensure the safety and welfare of those looked after. The service has recently been operating at a much reduced capacity as a result of work at the home and staffing difficulties. As such there have been no recent admission’s which the inspector could track to ensure a robust assessment process. However discussion with the registered manager indicated that there was an understanding of the need to assess thoroughly and to ensure that people accommodated in future have needs which can be met. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 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): 7,8,9,10 The needs of service users are set out in care plans which are better structured than at the time of the last inspection. Health care needs are met and medication appropriately managed. Residents feel that staff are mindful of their privacy and treat them with respect. EVIDENCE: The Inspector looked at four care plans in detail during the inspection process. Since the last inspection of the service much work has been undertaken to ensure that the plans are consistent with review notes and day to day recording. This represents a much improved position from that found at the last inspection and assuming that the service management complete the task and maintain this level of recording then service users should benefit from a more consistent approach to their care. The inspector saw evidence that the risk assessments for individuals who may develop pressure sores have been revised to ensure that each assessment is geared to the needs of that specific individual and are not a generic document. Service users spoken to by the inspector felt that their care and health needs were being met in a satisfactory manner and the manager indicated appropriate levels of support from external health professionals. The inspector St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 11 looked at the services approach to the storage and administration of medicines, including sampling medication administration records. The service has secure storage and the inspector was told that all staff who administer medicines receive training before being approved to do so. Service users interviewed by the inspector stressed that they felt that staff respected their dignity and privacy and this picture was confirmed by the inspectors observation of the approach undertaken. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 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): 12,13,14,15 Service users indicated that they were happy with their lifestyle and leisure opportunities and felt supported to exercise choice and control over their lives. The quality of food has been reported to have deteriorated recently and the management should monitor provision to ensure service user satisfaction. EVIDENCE: The inspector interviewed a selection of six service users and also talked to one set of visitors to the home. It was noted that all of those spoken to appeared relaxed, confident and at home in their surroundings. Residents told the inspector that they were able to exercise choice and control over their lives and generally felt well cared for. The last inspection identified concerns that poor staffing levels were compromising the level of choice and control individuals could exercise. As indicated elsewhere in the report staffing has improved and as such the inspector found no indications of a similar picture on this occasion although firmer judgements will be enabled as occupancy increases. The inspector noted the minutes of a recent residents meeting which indicated that there is a forum for service users to influence daily life. A programme of monthly activity is displayed and although this did not appear unduly extensive, all of the service users spoken to were happy with the provision. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 13 The inspector observed lunch being served in the main dining room and saw a relaxed and appropriate approach adopted by staff. The menu is displayed on a daily basis and offers choice and variety. Some of the service users spoken to suggested that on occasions the quality of food had been variable lately. This was explored with the service management who confirmed that there had been recent personnel changes in the kitchen, however this was now resolved and improvement was now expected. Given the importance of food in the lives of service users then this area needs to be monitored by the service management. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The service needs to ensure that they can evidence that all complaints are fully investigated. Policies, procedures and training help protect service users from abuse. EVIDENCE: The services record of complaints was inspected and showed one complaint since the last inspection. The inspector discussed this complaint and its recording with the service manager and would want to stress the importance that all investigations can be evidenced to have been thorough. As such the investigation should demonstrate that all possible sources of information are sought and any action to flow from the investigation is clearly recorded. The provider has whistle blowing and adult protection policies and these are supported by a staff training programme. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 15 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): 19,20,23,24,26 The provider has acted to address some of the shortcomings in the environment, however some of the solutions adopted are not ideal. Residents bedrooms are not always suitable for their needs, particularly in relation to adequacy of lighting and control of heating. EVIDENCE: The Inspector toured the building and sought the views of service users, staff and management about the environment. The home is a 1960’s built local authority home with a later extension and as such it shares many of the disadvantages of other similar homes when measured against modern provision. Previous inspection has resulted in a number of requirements in this area particularly relating to security. As such it was encouraging to see that some of these requirements had been or were being addressed, although others are still outstanding. At the time of inspection window restrictors were being fitted to all ground floor rooms in line with the requirement made. Although this is to be welcomed it was disappointing to see the solution (window chains with St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 16 highly visible padlocks) was aesthetically unpleasing and reinforced a feeling of institutionalisation. Whilst the inspector is aware of the pressure on budgets this solution is far from ideal and in reality a better solution for the building as a whole would be the replacement of the existing outdated and inefficient metal windows with modern double glazed units which would have restrictors designed in. An outstanding requirement has been the fitting of locks to service users bedroom doors to allow them the option of holding a door key. Whilst this requirement had once again not been met the inspector was assured by the homes manager that the work had been approved and would commence soon. On this basis the inspector has not repeated the requirement although the issue will be revisited if for any reason the work is not carried out. Another issue related to the quality of lighting in service users rooms which is generally poor. It was noted that some work has commenced in respect of this, with new fittings in some bedrooms. Whilst again this is welcomed, in the inspectors opinion the solution may not be fully what is needed. Although the replacement of the main fitting with a newer unit is positive what is needed is more lighting in rooms to allow service users choice about where they sit and to allow them to read and watch television in comfort. Whilst not all bedrooms were seen on this visit it was noted that many would benefit from redecoration, something which was also highlighted in the providers own regulation 26 reports. These reports also identify the need to replace some areas of carpet and the inspector was told that this matter was in hand. One other significant area in which the environment fails to deliver good outcomes for service users is that of the heating system. In no areas of the home are radiators individually thermostatically controlled . Whilst the time of year of the inspection did not allow the inspector to experience this first hand it was clear from discussion with all of the stakeholders involved that this can present a real problem, with the home being too hot, or too cold and no choice for service users as to how they would like their rooms to be. Despite the negative aspects the building does have a good range of communal space which is generally bright clean and comfortable. People spoken to commented positively about how clean and fresh the home is and the inspector found this to be the case during his visit. Since the last inspection all water temperatures have been regulated and although the work was not yet finished a new shaft lift was near to coming into use. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Improved staffing seems likely to ensure service user need is better met, however this will be better judged when occupancy increases. Evidence was provided of a robust recruitment process which offers protection to service users. EVIDENCE: At the time of this inspection the service was operating significantly below its registered numbers and as such judgements about the adequacy of staffing were difficult to make. Previous inspection has resulted in requirements to provide adequate staffing and to have a suitably robust recruitment process. In the case of the latter the inspector was shown an audit trail which demonstrated that all necessary checks were now in place before employment and staff awaiting the results of a full criminal records bureau check were appropriately supervised. The service management confirmed that new staffing rota’s were shortly to be introduced and that these included an increase in overall care hours. It was also the case that vacancies were now almost completely filled and as such agency cover was only necessary in extreme circumstances. Service users and staff all reported that they felt the staffing situation was much improved from that of a few months ago leading to better outcomes for those looked after. No requirements are made in respect of staffing on this occasion, however as occupancy increases and new staff rota’s are introduced this issue will be reevaluated and the manager is reminded of the need to ensure adequate staffing to meet need at all times. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 18 The service has an induction process in line with the expectations of skills for care and although the service does not currently meet government NVQ targets the situation is improving and the inspector was shown records indicating the likelihood of meeting these targets in the foreseeable future. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Residents benefit from a home that is well led and managed. Their financial interests are protected and the home is run in a manner which seeks to put their best interests first. Whilst the general approach to health and safety is sound the service management must ensure that issues referred to central services are monitored to ensure action is carried out in a timely way. EVIDENCE: The service users and staff spoken to felt the home was well managed and the manager was both approachable and provided leadership. The current manager is qualified and experienced. The manager acknowledges that the service has had problems, but feels that these are now being addressed and that the home is on an upward path. This view is consistent with the findings of the providers regulation 26 visitor whose last report identified a real sense of improvement. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 20 Service users spoken to felt that there views were listened to and the inspector looked at the minutes of a recent service user meeting which indicated that there was a forum for people to influence events in the home. The manager confirmed that they were in the process of collating results from the annual resident survey and that these would translate into a plan of action. On this occasion the inspector did not look at records relating to service users financial transactions, however these were inspected recently and found to be satisfactory. The service has received a recent fire inspection which had resulted in requirements for issues to be addressed. The manager confirmed that all had been referred to the providers central building and supplies section for action, however she was unsure of when work would be carried out. Given that the fire officer had attached a one month timescale for the work it is important that the registered manager continues to monitor that the work will happen within the given time. St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 x x 2 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 22 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 OP3 Regulation 14 Requirement The registered persons must make alternative arrangements and not continue to offer accommodation where it is identified the service is unable to meet need. That the service management review the process of addressing complaints to ensure that all complaints are fully investigated and that the services record of complaints demonstrates that a full investigation has taken place and appropriate action taken in response. The registered persons must review lighting arrangements in residents’ rooms to ensure that the lighting is adequate for safety and for residents to engage in preferred activities. Timescale for action 30/06/06 2. OP16 22 30/06/06 3 OP24 23, 13(4) 30/06/06 St Edmunds DS0000035075.V292637.R01.S.doc Version 5.1 Page 23 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 OP1 Good Practice Recommendations That the management review its admission systems to ensure that it can evidence that all necessary information is provided to prospective entrants to the home. That the management monitor the provision of food to ensure that service users are consistently happy with the provision. DS0000035075.V292637.R01.S.doc Version 5.1 Page 24 2 OP15 St Edmunds 3 OP19 That the provider develops an improvement plan for the environment which addresses issues such as poor heating and outdated windows. 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