CARE HOMES FOR OLDER PEOPLE
St Gregory`s House Preston Patrick Kendal Cumbria LA7 7NY Lead Inspector
Jane Strawbridge Unannounced Inspection 2nd March 2006 11:15 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 Gregory`s House DS0000022702.V281351.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 Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Gregory`s House Address Preston Patrick Kendal Cumbria LA7 7NY 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) 015395 67543 St Gregory`s House Ltd Mrs Tracey Diane Bindloss Care Home 29 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (29) of places St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 29 service users to include: up to 29 service users in the category of OP (Old age, not falling within any other category) up to 16 service users in the category of DE(E) (Dementia over 65 years of age) may be accommodated within the overall number of registered places. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 30th September 2005 2. Date of last inspection Brief Description of the Service: The home is a large detached three storey Victorian house, which was formerly the local vicarage. It is situated in beautiful open countryside on the edge of Preston Patrick, a small village between Kendal and Kirkby Lonsdale. Modern extensions have been added to provide bedrooms, communal living spaces and an office. An extension is currently being built to provide a new dining room for the residents. The house has a passenger lift to provide easy access to all floors including the basement, and there are assisted bathing facilities. The home has its own attractive grounds with seating areas and car parking. Additional land adjoining the property has been purchased to create extra car parking spaces and a secure garden. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home that took place during a late morning and into an afternoon. Mrs Tracey Bindloss, the home’s registered manager, was present throughout the inspection. The inspector spent some time talking with the residents either in small groups or individually, with their visitors and with the staff on duty. The inspector looked around the home and saw records relating to the care of the residents and the day-to-day running of the home. What the service does well: What has improved since the last inspection?
There had been changes to the senior staff to reflect the way in which the business was developing. Tracy Bindloss had been promoted to General Manager and Anne Sharp previously Head of Care had been promoted to Deputy Manager. Staff in the home were also working to become recognised as an Investor in People and they hope to achieve the award during the next financial year. The new dining room was reaching completion and will provide much needed extra space for residents. There will also be additional space attached to the dining room where meals can be served directly to residents instead of being transported already plated from the kitchen. The kitchen has been refurbished to provide a clean and efficient environment to work in. The new enclosed garden adjacent to the dining room had been marked out and should be ready for the residents to enjoy during the coming summer months. Work had been completed to establish the formal supervision sessions for all staff to meet the shortfall identified during the previous inspection. In January
St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 6 2006 the senior managers introduced a programme of staff meetings and plan to hold them every two months. The home has also invested in an electronic management system using hand held “Palm Tops” devices that are linked to the main computers. 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 Gregory`s House DS0000022702.V281351.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 Gregory`s House DS0000022702.V281351.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): 2, 4 This home has procedures in place to enable potential residents and their families make important decisions about their future. EVIDENCE: All admissions to this home are planned so that potential residents have an opportunity to visit prior to moving in which means that they can see for themselves what services are available. New residents are offered a trial period after moving in so that they can make an informed decision about taking up permanent residence. At the end of the trial period residents sign a contract which includes the terms and conditions of residency. If anyone has difficulty reading the standard contract it is possible, with 48 hours’ notice ,for important documents to be made available in different formats to aid communication and understanding. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 11 The home has a clear and consistent care planning system to ensure that the residents’ health and social care needs are met in a way that promotes their privacy and dignity. EVIDENCE: The home has an effective care planning system that is used to identify health and social care needs and uses the information to develop a plan that aims to meet them. The records held for each resident included medication records, individual interests and hobbies and their expectations and wishes during and after final illness. All care plans were in the process of being reviewed and the ones that had been completed had been done to a high standard. Some had been signed by the appropriate resident or their representative to show that they had been involved in the review and that they had agreed with what had been planned. However in some cases it was not always possible to see that the resident or their representative had been involved in the process, therefore more work is needed to build on this good practice. This home provides a range of training courses for staff to equip them to look after residents during final illness. Courses to enable staff to provide support and care of the dying and to cope with bereavement are held twice each year.
St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 10 Each member of staff is given a workbook containing additional information to supplement what they have learnt on the course. Support and counselling is made available to help anyone who has been seriously affected by the death of a resident or colleague. Staff in this home have developed a tradition of working closely with community based nurses and other health care professionals so that residents, who are in the final stages of life, have the opportunity to stay in the home if they choose to do so. If necessary the district nurse liaison team put in a high level of nursing care and they are able to provide specialist equipment to make nursing easier to manage. The home has four hospital type beds than can be used when necessary. Staff members are encouraged to attend funerals and represent the home. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 11 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 This home encourages residents to be involved in making the decisions that affect their daily lifestyle. EVIDENCE: Residents are offered choices throughout their daily living activities. The home has a flexible approach to daily routines and aims to enable all residents to assert their right to choose for themselves from a range of options. For example people are offered to opportunity to visit their preferred optician or hairdresser even though the home offers these services in-house. Residents are offered their own door keys and can choose to use these whenever they wish. The residents had recently been involved in choosing the colour scheme for the new dining room and had selected new dining chairs from a range of furniture that suppliers had taken into the home for them to try out. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The home has a satisfactory procedure in place to ensure that the legal rights of residents are protected. EVIDENCE: The home’s service user guide has a section in it with information about local advocacy services. The manager and senior staff recognise the right of each resident to make their wishes known and if necessary will arrange to introduce them to an advocate who will speak on their behalf. They were aware of the local advocacy service that could be used by residents who were unable to speak for themselves or who did not have a family member or friend who could take on the role. In the past they had successfully enabled residents to use this service. The home has facilities available for the use of anyone who required privacy for consultations. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 This home continues to maintain its high standards of housekeeping and maintenance so that its residents live in an environment that is safe and comfortable. EVIDENCE: Since the previous inspection there had been a number of improvements to the property. A new feature window in the original style had been fitted in a bedroom to provide more light and improve energy efficiency. The room had been redecorated and was bright and airy. New windows are planned for some bedrooms at the rear of the property to improve standards and the comfort of the occupants. Considerable financial investment for the extensive kitchen refurbishment has improved the working conditions for the chef and other staff who work there. The work was almost complete at the time of this inspection with only a few minor jobs requiring completion. The chef said that he was pleased with the results and had managed to work through the improvements because the
St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 14 major jobs had been completed with the minimum of disruption to his work to prepare meals for the residents. The new dining room was nearing completion and as stated earlier the residents had been involved in choosing colour schemes and furnishings. They said that they were looking forward to being able to use it because the current arrangements for meals were cramped and too warm in the summer. There are plans to create a serving area close to the new dining room so that meals can be served direct to the residents. St Gregory’s House has ample bathroom and toilet facilities situated throughout the home to serve the 29 residents. There are three bathrooms and a shower room and three of the bedrooms have en-suite facilities. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 15 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): 28 This home has competent and trained staff on duty at all times. EVIDENCE: The home’s training records demonstrate the commitment of senior staff to deliver training and development opportunities for all of the staff. They show that mandatory training is given to newly appointed staff and subsequently the home gives all staff refresher training courses as part of a rolling programme. The home has three members of staff who are currently involved in on- site training for NVQ level 2 and 3. The home’s training programme shows that courses on adult protection and challenging behaviour have also been planned for this year. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, 36 The registered manager provides adequate direction, guidance and leadership for the staff so that residents are given consistent quality care. There are procedures and practices in place to protect the rights of the residents and to ensure the health and safety and wellbeing of the residents, staff and visitors. EVIDENCE: The home’s financial affairs are handled professionally. The home has the required types of insurance in place and a credit control analysis had recently been completed successfully. The registered manager has the necessary qualifications and experience in residential care to enable her to manage the home effectively. There was evidence that the home was run in an open, positive and inclusive manner. The manager valued the opinions of residents and their views and those of their representatives had been sought through a customer satisfaction questionnaire. 28 forms had been sent out and 17 had been returned. There
St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 17 were many positive comments written on the forms including the following three statements: “It is a long time since dad has looked so good” and “your staff are first class and conscientious.” “Mum is 100 better. Her health has improved and she has peace of mind.” There are plans to hold a staff survey as preparation for the home to become recognised as an Investor in People. Progress had been made to ensure that all staff had been given the appropriate levels of supervision to meet the National Minimum Standards. All care staff had been given at least six supervision sessions during the year, including one appraisal. The sessions were structured and recorded and they included a section to discuss individual training and development needs. In addition since January 2006, a programme of team meetings had been implemented and were planned to take place every two months. These developments had been possible because the responsibilities for staff supervision had been delegated to the head of care and the recently appointed night staff supervisor. St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 18 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 3 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 3 3 3 X X X X X STAFFING Standard No Score 27 X 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 3 3 X X St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 19 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. 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. Refer to Standard Good Practice Recommendations St Gregory`s House DS0000022702.V281351.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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