Inspection on 14/11/05 for St George`s (Banstead)

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St George`s (Banstead) 10/12/07

St George`s (Banstead) 15/06/06

St George`s (Banstead) 15/08/05

St George`s (Banstead) 24/01/05

St George`s (Banstead) 09/08/04

Similar services:

Thorndene

Southfields

Insight - Eastchurch

Magenta

Seabourne House

Dovedale Court

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

CARE HOMES FOR OLDER PEOPLE St George`s (Banstead) 58 Fir Tree Road Banstead Surrey SM7 1NQ Lead Inspector Sandra Holland Announced Inspection 14th November 2005 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 George`s (Banstead) DS0000013800.V249513.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 George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St George`s (Banstead) Address 58 Fir Tree Road Banstead Surrey SM7 1NQ 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) 01737 370224 Prospect Housing and Support Services To be confirmed Care Home 8 Category(ies) of Learning disability (1), Learning disability over registration, with number 65 years of age (7) of places St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 2 PERSONS 58-65 YEARS AND 6 OVER 65 YEARS OF AGE 15/08/05 Date of last inspection Brief Description of the Service: St. Georges, Fir Tree Road, is registered to provide accommodation, support and care to up to eight people who have a learning disability. The home is a large detached property which is on a main road, with limited car parking on the front drive. There are eight individual bedrooms on the ground and first floors. Bedrooms on the upper floor and one bedroom on the ground floor, have their own shower rooms. A bathroom is available on the ground floor which is fitted with an easy access bath. A spacious lounge is divided into two areas, with a television available in both areas. An air conditioned conservatory is used as the dining room. The rear garden is well maintained, is mostly level and access is provided from the house by steps. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the second to be carried out in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. As the inspection was announced, everyone at the home should have been aware that it was to take place. Mrs. Sandra Holland, Lead Inspector for the service carried out the inspection. Ms. Renate Castle, Manager and Ms. Diane Czako, Head of Learning Disability Services were present, representing the service. A tour of the home was undertaken and a number of records and documents were examined, including individual plans, staff files and service user finance records. All of the seven service users were spoken with or met with and three members of staff were spoken with. The inspector does not share the communication methods of one of the service users, so information was obtained by speaking to staff, looking at records and observing the facial expressions of the service user. Information about the service was also provided in the completed pre-inspection questionnaire, which was returned to CSCI. To fully assess how the home is meeting the requirements of the National Minimum Standards (NMS), it will be necessary to read the reports of both inspections. What the service does well: What has improved since the last inspection? Where they are able, service users have signed their care plans to show that they have been involved in the drawing up of the document. A written record is maintained if complaints are received. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 6 A manager has now been appointed. Regular servicing of equipment is taking place. The easy access bath had not been serviced previously due to a problem in the service contract. This has now been resolved and the bath was due to be serviced two days after the inspection. Only a small number of “bank” (relief) staff are employed to work at the home, to cover vacant shifts. What they could do better: Contracts need to be reviewed and revised to ensure they contain all the required information. Where a service user has not been able to sign their care plan to show they have been involved, a representative has not been asked to sign on their behalf. Individual care plans need to be updated to guide staff to the current needs of the service users. Assessments of risks to service users need to be updated and must include known areas of risk. The menu of food to be served should be displayed in a format that meets the service users needs. This would enable service users to have choice and to anticipate their meals. Specific details of any special dietary needs must be included in service user’s individual plans to ensure all staff are aware of the requirements. The newly appointed manager should apply for registration with CSCI as soon as possible. Any procedure or policy in the home which is explained to service users, should be recorded in their individual plan and signed and dated by the person giving the explanation. The container for disposing of sharp items which was stored in the ground floor toilet must be moved. (This was moved at the time of inspection). St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 7 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 George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 8 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 George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 and 6. Statements of terms and conditions are provided to service users and these state most but not all of the required information. Prospective service users are offered trial visits to help them decide if the home is right for them. EVIDENCE: Each service user is provided with a statement of the terms and conditions of living at the home and these are known as tenancy agreements. These are signed by the service users if they are able and list the individual room to be occupied by the service user and detail the shared space available. The tenancy agreements seen, state the weekly rent and the weekly service charge, but do not state who will be paying these, in what amounts or how. For one service user, a copy of the contract held with a local authority, to provide residential support for the service user, was held on file. This had been signed by a representative of the organisation managing the home and by a representative of the local authority, but had not been signed by the service user, although she had signed another document. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 10 The manager stated that any prospective service user would have the opportunity of a number of visits to the home to see if it suited the person’s needs. They would be introduced very gradually to the other service users and the home, to ensure that the present service user group was not unsettled by the newcomer. Intermediate care is not available at the home, the manager advised. A requirement has been made. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 11 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, 10 and 11. Individual plans are in place but need to be updated. Service users healthcare needs are well met. Service users are treated in a dignified way and their privacy is respected. EVIDENCE: Although individual plans are held for each service user, those seen had become dated and did not provide enough detail about the service users present needs. It would be difficult for a member of staff to know the support and care needs of service users from the information available and the way that it is presented. The manager acknowledged this and stated that it is one of her priorities now that she has been appointed. It is required that service users or their representatives are consulted about their individual plan, both when it is drawn up and when reviewed or updated. It is recommended that wherever possible, the service user signs their individual plan to show they were consulted. Where a service user is not able to sign, their representative should sign on their behalf. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 12 From the records seen and from speaking to staff, it is clear that the service users’ healthcare needs are well met. A number of healthcare professionals are involved in the support of the service users, including general practitioner (G.P.), continence specialist, dietician, physiotherapist, speech and language therapist. Staff were observed to speak to and interact with service users in a relaxed but appropriate manner. Service users’ bedrooms were not entered unless the service user was present or had given their agreement. Staff were seen to offer personal support to service users in a discreet and sensitive way. The manager stated that the home has a policy on the care of service users who are dying and on death and that this is being developed to include the ageing process. The staff at the home are committed to looking after service users until the end of life whenever possible, and a service user who died in hospital in recent months, was supported by those at the home. Other service users and staff visited their friend in hospital and attended her funeral. The family of the service user who had died, returned to the home after the funeral for tea with the service users. They have also donated a garden bench to the home in memory of their relative and have requested to continue to visit the home to maintain contact with those who live there. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 13 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): 14 and 15. Service users are supported to make choices and well-balanced meals are served. EVIDENCE: Staff advised that service users are encouraged to be as independent as possible and are supported to make choices in their daily lives. One service user was having a lie-in at the time of inspection, as preferred. Service user’s bedrooms that were seen had been individually decorated and the service users said they had been involved in choosing the colour scheme. Service users are supported to take part in day-to-day activities outside the home, including attending clubs and classes at day services. Menus covering a two week period were supplied with the pre-inspection questionnaire. These were seen to be well-balanced and offered healthy options. The menu is listed on a chart in the kitchen, but is not displayed for service users to see. It is recommended that this is made available to service users in a way that is suited to their needs, as looking forward to meals is part of the enjoyment of them. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 14 The manager stated that three service users have received advice about their diet from the dietician, following routine blood tests. From the individual plans seen, it was clear that one service user follows a diet for religious reasons. This is referred to in her individual plan, but the specific requirements are not noted. It is required that these are provided to ensure that all staff are fully aware. Staff stated that another service user has difficulties with eating, drinking and swallowing and has been supported by a speech and language therapist. The therapist’s recommendations have been followed and two reviews of the service user’s needs have been carried out this year with the therapist, to monitor any change in need. It was noted that a assessment regarding the risk of choking by the service user above, had not been carried out. A requirement and a recommendation have been made. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 15 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 and 18. A complaints record is now held. Staff are aware of their responsibilities in the protection of service users. EVIDENCE: The manager stated that she has introduced a system of recording complaints, using numbered, loose leaf forms. These could also be used to record compliments and any form of compliment received by the home was being kept in the file. Two cards had been received from the family of the service user who had died recently, thanking the home and the staff for their support and kindness. Any completed complaint forms would be stored to protect confidentiality, and the file is checked on a monthly basis the manager advised. Staff spoken to stated that they would report any concerns they had about the service users or their support or care, to the manager or deputy. In their absence, they would report to the on-call manager. Staff said they are provided with training in the protection of vulnerable adults and are trained to be aware of possible abuses from the beginning of their employment, during their induction. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 16 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): 22, 24 and 26. Specialist equipment has been supplied to meet service users’ needs and service users’ bedrooms have been individually decorated and arranged. EVIDENCE: The manager stated that following assessment by the appropriate specialist, aids and equipment have been provided to assist service users to be independent or to assist staff to continue supporting a service user. As one service user likes to go into the garden independently, an additional hand rail and an extra step have been fitted to the door from her bedroom to the garden. Another service user has a doorbell fitted to her bedroom door which causes a flashing light to operate inside her room, as she cannot hear the bell. For another service user who requires assistance with all activities of daily living, a number of aids have been obtained, including an electrically operated St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 17 bed, a hoist and a specialist armchair. Records were seen of the involvement of various healthcare professionals, regarding the equipment provided. It was noted that an assessment of the risks involved in the use of some items of equipment had not been carried out as required. The use of an electrically operated bed for instance, carries risks to the service user, to staff and to anyone who may be close to the bed when it is activated. Each of the service users’ bedrooms had been made personal with the occupant’s belongings, including ornaments, pictures, plants and photographs. Three service users showed their bedrooms, of which they were justifiably proud. It was pleasing to see that many service users had their own artwork and awards displayed in their rooms. One service user was keen to show her collection of photos of happy days out, parties and holidays. A requirement has been made. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 18 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): 29. The recruitment of staff is appropriately carried out. EVIDENCE: From the staff files seen, all the required records and documents had been obtained, including references and Criminal Record (CRB) disclosures. Contracts, or statements of terms and conditions of employment were not available in the staff files, but were kept at the service headquarters the manager stated. It is recommended that a copy of the contract of employment is kept in the staff member’s file. A recommendation has been made. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 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, 37 and 38. A manager has now been appointed. Service users’ finances are managed appropriately. EVIDENCE: The acting manager at the home has now been appointed to the manager’s post. Service users said they were pleased as they enjoyed having the acting manager to support them. The manager stated that she has applied for an application pack, in order to apply for registration with CSCI. It is recommended that this is completed and returned as soon as possible, in order for the process to be carried out. The department head who was visiting the home stated that the organisation carries out an annual survey of the quality of the service provided. This covers all the required standards and asks service users their views on the home and the service. The survey had been drawn up based on the quality assurance St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 20 methods of the British Institute for Learning Disabilities (BILD). A sample copy of the survey will be sent to CSCI for information. It is required that a summary of any quality review is sent to CSCI. The manager stated that visits to the home to assess the service are made under the requirements of Regulation 26. This regulation requires organisations which run a number of services to appoint someone to visit the home on an unannounced basis each month. At the visit, the person carrying it out should speak to service users and staff, look around the premises and write a short report on their findings. A copy of the report must be kept in the home. Monies held for safekeeping for service users were checked and the amounts present accurately matched the record held. Staff check the monies held at each shift changeover, sign to show this has been done and access to this is restricted to the shift leaders. Most service users are supported to manage their financial affairs and risk assessments have been carried out in respect of this. It is recommended that where an explanation of a procedure or policy is given to a service user, because that is the best method of conveying it to them, this should be recorded. The person giving the explanation should give written details in the service user’s individual plan of what was said, and sign and date the entry. A box for the disposal of sharp items was noted in the ground floor toilet. This was mentioned to the manager and was immediately removed to a more appropriate place of storage. Requirements and a recommendation have been made. St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 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 x 2 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x 3 x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x 2 2 St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 22 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 OP2 Regulation 5 (1) (b & c) Requirement Timescale for action 10/02/06 2 OP7 15 (2) 3 OP33 24 (2) 4 OP38 13 (4) (a) Service users must be provided with the terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees. A standard form of contract for the provision of services and facilities to be provided by the registered provider to the service user must also be provided. The registered person must keep 12/12/05 the service user’s plan under review. Where appropriate and unless it is impracticable to do so, the service user or her representative must be consulted before any revision of the plan is made. Any revision of the plan must be notified to the service user. The registered person must 10/02/06 supply to CSCI, a report in respect of any review of the quality of care provided at the care home and must make a copy of the report available to service users. The registered person must 14/11/05 DS0000013800.V249513.R01.S.doc Version 5.0 St George`s (Banstead) Page 23 & (c ) ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. 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 OP15 Good Practice Recommendations Specific details of any diets required for religious or health reasons, should be recorded in the service user’s individual plan. It is recommended that the menu be displayed in a format suited to the needs of the service users. It is recommended that a copy of the contract of employment or statement of terms and conditions are held on the file for each member of staff. It is recommended that the manager submit her application for registration with CSCI as soon as possible. It is good practice to record any explanations of policies or procedures that are made to service users, in their individual plans. The record should be signed and dated by the person giving the explanation. 2 3 4 OP29 OP31 OP37 St George`s (Banstead) DS0000013800.V249513.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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