CARE HOMES FOR OLDER PEOPLE
St Georges St Georges Road Truro Cornwall TR1 3JE Lead Inspector
Ian Wright Unannounced 21 July 2005 10.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Georges Address St Georges Road Truro Cornwall TR1 3JE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01872 272554 01872 242162 Mrs Christine Elizabeth Little and Mr Rolf Little Mrs Elizabeth Julie Coon Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: An announced inspection was completed on 24th January 2005 Brief Description of the Service: St. Georges Hotel is registered to provide care for up to 22 service users who are elderly. The home is within level walking distance of the centre of Truro. The building and its grounds are well maintained, and the home has suitable facilities to meet the needs of service users. The registered providers are Mr and Mrs Little and the registered manager is Mrs Coon. The ground floor of the home is wheelchair accessible, and a chairlift links the ground floor to the upper floor. Date of last inspection St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over six hours. The inspection was carried out on an unannounced basis. The inspection focused on previous statutory requirements. Standards not inspected at the last inspection were also assessed. The inspector was able to speak to many of the service users, and the staff members on duty. The inspector examined the care records, and inspected the building. What the service does well: What has improved since the last inspection?
The home continues to provide a good standard of service. The requirement to improve administration and disposal of medication has been implemented so service users can be assured their medication is managed appropriately. All staff who commenced employment from June 2004 have a Protection of Vulnerable Adults check as is now required by regulation.
St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 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 Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4, 5 Suitable information is provided to enable service users to make an informed choice to move in to the home. Suitable measures e.g. a pre admission assessment, and links with external professionals are in place so the registered provider can ensure staff can meet the needs of service users. Service users are provided with a suitable contract /statement of terms and conditions of residency when they are admitted to the home. EVIDENCE: Copies of pre admission assessments and statement of terms of residency / contracts were kept on service user files inspected. Pre admission assessments are completed before the service user comes to live in the home. A suitable care plan is subsequently developed from this. From discussion and records it appears there are suitable links with external professionals such as general practitioners, community psychiatric nurses and district nurses. The inspector spoke to a district nurse who was positive about the care given by staff. The inspector spoke to service users who said they were able to visit before formal admission was arranged.
St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 Service users personal and health care needs are met appropriately. EVIDENCE: All service users have suitable care plans. These contain satisfactory information to enable staff to deliver care. Care plans are reviewed appropriately. Mrs Coon described suitable links with GP’s, district nurses, and interventions by health care professionals are documented. The registered provider operates a satisfactory medication system. There is a suitable system of medication storage, administration and disposal of medication. Records are kept appropriately. The inspector spoke to several service users who said their rights were respected, and generally were treated with dignity by staff. However several service users expressed concerns regarding the attitude of one member of staff. The member of staff has been suspended. The registered persons are dealing with this matter appropriately through their disciplinary procedure. Staff were observed working with service users in an appropriate manner for example knocking on bedroom doors before entering.
St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14 Appropriate arrangements are in place to enable service users to exercise choice and control over their lives. Routines and activities are tailored according to individual service users lives. Service users can receive visitors in the home when they choose. EVIDENCE: Service users said they could get up and go to bed when they wished, and have autonomy how they organised their time. Some structured activities are arranged e.g. bus trips, entertainers etc. Several service users go out on their own and one person has a voluntary job. The home is ideally suited for the town centre. A range of games / paints etc. are available for service users to entertain themselves. Suitable arrangements are in place for service users to receive visitors. Service users can meet with their visitors either in their bedrooms, the dining room or one of the lounges. An Age Concern representative visits regularly to check service users are being cared for appropriately. Appropriate systems and records are in place to maintain small amounts of service users monies. Otherwise service user monies are handled by either their families or legal representatives. Appropriate information is provided
St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 11 regarding advocacy e.g. in the service user guide. Suitable arrangements are made to assist service users to vote. St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16-18 Appropriate arrangements are in place so any complaints are resolved effectively and service users are protected from abuse. Service users legal rights are protected. EVIDENCE: The registered persons have received one complaint from a service user which is being resolved appropriately. Service users receive appropriate information how to make a complaint. A complaints comments book is situated in the lounge which seems a good idea as it is accessible to service users. The registered manager has ensured appropriate arrangements to enable service users to vote. Suitable information is also provided regarding advocacy services e.g. in the hallway and the service user guide. Age concern also visit the home on a regular basis. The registered provider has a suitable adult protection procedure. All staff have a Criminal Records Bureau check, and where appropriate, staff have received a Protection of Vulnerable Adults check. Staff are required to read the home’s policy regarding adult protection when they commence employment. St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 St Georges Hotel provides suitable accommodation to meet the needs of service users living there. The home is clean, pleasant and hygienic. EVIDENCE: The property is very well maintained, appears to be safe, is very comfortable and homely. Furnishings and decorations particularly in the communal areas are of a high quality. The home has two lounges where service users can choose to relax. In one lounge there is a large TV and a water cooler. The other lounge is used for relaxing, reading or activities. Other facilities such as bathrooms and toilets are suitable. The home was clean and hygienic on the day of inspection. Bedrooms are suitable for purpose, and pleasantly decorated. Some bedrooms are on the small side, but service users all said they were happy with their accommodation. Bedrooms are lockable and service users are provided with a key where this is appropriate. Appropriate moving and handling equipment is provided. The home also has a stairlift which is suitably maintained.
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The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 Suitable staffing levels are provided to care for service users. The registered persons have a suitable approach of ensuring at least 50 of staff have a national vocational qualification in care by 2006. EVIDENCE: Suitable staffing is provided. At least three staff are on duty between 0800 and 1100, and two staff are on duty throughout the rest of the remaining day. One waking night staff and one sleep in member of staff are on duty during the night. Auxiliary staff e.g. a cook and a cleaner are employed. Mrs Coon said five staff have either NVQ 2 or 3. Copies of NVQ certificates must be kept on staff files, as the Commission for Social Care Inspection will be formally assessing whether 50 of staff have NVQ 2 from January 2006. No new staff have as yet been recruited in 2005. All staff have received a Criminal Record Bureau check (and Protection of Vulnerable Adults check as applicable). St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35, 36, 37, 38 Service users benefit from a home which is suitably managed and run in their best interests. EVIDENCE: The registered persons provide appropriate day to day supervision of the staff team, and the team appears well developed, caring and effective. Management seemed approachable and friendly with other staff. The registered persons have conducted a satisfaction survey among service users and their representatives. Service users the inspector spoke to were generally positive about life in the home although concerns were expressed regarding one member of staff. This matter is currently being resolved by the registered persons. St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 16 Records examined regarding the management of the home, and in regard to service users care are appropriate. Suitable records are kept regarding service user monies. Health and safety precautions are satisfactory for example in regard to servicing of moving and handling equipment, electrical equipment etc. However records regarding testing to ensure the prevention of Legionella could be developed further. St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 3 3 x 3 3 3 3 St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 18 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 Regulation Requirement Timescale for action 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 38 Good Practice Recommendations Develop records regarding the testing of Legionella St Georges D52-D04 S41932 St Georges V227171 210705 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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