Inspection on 13/11/07 for St Hilary

This inspection was carried out on 13th November 2007.

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 Hilary 21/10/08

St Hilary 12/12/06

St Hilary 18/08/05

St Hilary 18/04/05

St Hilary 18/10/04

St Hilary 14/04/04

Similar services:

Fairfields Country Rest Home

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Trevaylor Manor

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

CARE HOMES FOR OLDER PEOPLE St Hilary Bramble Hill Bude Cornwall EX23 8DG Lead Inspector Mike Dennis Unannounced Inspection 13th November 2007 10:00 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 Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Hilary Address Bramble Hill Bude Cornwall EX23 8DG 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) 01288 352754 01288 359077 mail@cornwallcare.org Cornwall Care Limited vacant post Care Home 38 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (28), Old age, not falling within any other category (10) St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of service users not to exceed a maxumum of 38 Date of last inspection 12th December 2006 Brief Description of the Service: St Hilarys Care Home is run by Cornwall Care Ltd. which is a registered and charitable organisation, whose management team offer support regarding the running of the home. Members of the company visit regularly. St Hilarys Care Home provides accommodation and care for thirty-eight people in need of care due to dementia, mental disorder or old age. There is also a busy day care centre on the premises. St Hilarys is a purpose built home close to the town centre and amenities of Bude. The accommodation is offered on three floors, with wide staircases and lift access to each floor. The home is split into four units, known within the home as wings, with each wing having a personalised name. Each wing has a kitchenette - which allows simple food and drink preparation - dining area, sitting room and adequate bathing and toilet facilities. Main meals are prepared in the central main kitchen, located within the day centre, and are transported to each wing by a heated food trolley. For social events, involving all service users, the large day room situated within the day centre can be used. Activities are arranged within the home and service users can also partake of activities and functions arranged by the day centre if they choose. Service users are supported to maintain social contacts and leisure activities in the community with either the support of family and friends or staff at the home. The home has a central outside area that has been developed into a sensory garden, providing stimulation, relaxation and seating for service users to enjoy the warmer summer months. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 13th. November 2007 over a seven hour period. We met with the Manager, two care co-ordinators, a selection of staff and 4 service users. During the course of the inspection we observed groups of service users engaged in a number of activities. Staff were observed to be tending to service user needs whilst respecting their dignity. Various records, policies and procedures were inspected. We visited all parts of the building and noted a satisfactory standard of hygiene and maintenance. Residents commented favourably on the overall service received. This home also received a random inspection on the 11th. September 2007 following which a number of recommendations were made. We are pleased to report that progress is being made to address these recommendations. Continence assessments are and have been done by the Community Nurses. Quality assurance surveys are being prepared and management are being proactive in their efforts to recruit staff. What the service does well: Service users stated that St.Hilary provides good quality care and accommodation. They made various comments about staff such as; they are ‘kind’ and ‘caring’. All service users commented that they felt that their care needs were met at all times. Cornwall Care prioritises staff training and is keen to continue to develop staff skills. Continued training is being provided to improve the quality of service. This inspection was generally positive and the inspector would comment that Cornwall Care Ltd is an organisation that wants to achieve a high standard of care to all its service users and provide appropriate training and support to its staff group. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Management need to be committed to ensuring that the following requirements are adhered to and maintained. Care plans need to be regularly reviewed at monthly intervals with evidence that any changes in care requirements and delivery is clearly stated. Supervision of ALL staff has to be carried out at approximately 2 monthly intervals in order to comply with the requirement of staff receiving supervision at least 6 times per year. Records need to be in place to evidence that this has occurred. All staff must receive fire training. Day staff at no more than 6 monthly intervals and night staff at no more than 3 monthly intervals. Records need to be in place to evidence that this has occurred. The CSCI need to be informed as to the companies intentions with regard to the registration of the manager. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 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 Hilary DS0000009068.V350201.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive the information they require in order to make an informed choice about residing at St. Hilary and their needs are assessed so that they can be assured that the home can provide the care required. EVIDENCE: Five residents’ files were inspected and case tracked. All contained information pertaining to pre-admission assessment. The information provided was comprehensive and included risk assessments and general details of daily care requirements, medication and health care requirements. Contracts or Statements of Terms and Conditions were also present. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 10 Residents informed us that they were given the opportunity to visit the home prior to admission. Several had attended for day care or respite care before permanent admission. They also informed us that written information is provided by way of the Statement of Purpose/Service User Guide and Brochure prior to admission. The Statement of Purpose has been improved to ensure it is up to date and fully reflects the services the home provides. In particular information as to how to make complaints and to whom has been reviewed. Standard 6 is not applicable as the home does not provide Intermediate Care. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are set out in individual plans of care which are regularly reviewed and amended. Medication procedures were appropriately followed EVIDENCE: Five Individual Plans of Care were inspected. They were seen to contain full and relevant information, to include Risk Assessments, pertaining to the health, personal and social care needs of that individual. The records indicated that these plans of care are reviewed but not all had received an update at the required monthly intervals. Management are currently in the process of changing to a new system of recording the care plan information. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 12 Residents confirmed that information is gathered regarding their past life experiences and interests. This information is used to promote an Active Care programme for that individual. Appropriate professionals from other disciplines frequently visit the home to provide for general health care, ie. G.P’s, Community Nurses, Opticians, Dentists etc. The home has full medication policies and procedures. The manager, deputy and care coordinators are the nominated persons who administer medication. The majority of the medication is in ‘blister packs’. All medication including controlled drugs was recorded correctly as received, administered and disposed. Recorded evidence confirmed that medication received is signed into the home allowing us to determine who was responsible for this operation. The controlled drugs were stored to comply with drug regulations. An audit of controlled drugs was undertaken and proved to be correct. Residents informed us that they were treated with dignity and respect. We observed that this was the case. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to follow a lifestyle, which accords as far as possible with their own choices and preferences. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: From discussions with residents and their representatives they commented that there is ‘enough to do’ during the day. Residents recalled a variety of activities that are provided. These matched the interest and hobbies section of the care plans in respect of that individual. All service users in the home are able to participate in the day care activities, which are held in the day centre. We observed a variety of activities occurring during the inspection, which included a group being taken out for a pub lunch. The home’s policies and documentation demonstrate that they aim to encourage residents to pursue their hobbies and interests, and individual St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 14 interests are recorded in the residents care plans. Residents meetings are held and documented. Relatives were not spoken with during this inspection but the visitors book indicated that they visit frequently. We met the chef and viewed the preparation of a midday meal. Menus are varied and offer choice. The residents were seen to be enjoying their lunch. Management are endeavouring to employ additional catering staff and when this is achieved will alleviate some of the pressure placed on the current staff in this department. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse. EVIDENCE: A comprehensive complaints policy and procedure is kept within the home. This procedure includes timescales and who will deal with the complaint. The home also keeps a complaints log for ease of reference. Residents indicated that they were aware of the procedures. The home has a comprehensive policy and procedure in place to protect residents Staff are made aware of these procedures during the induction period. The management team is also aware of the local social services procedure within “No Secrets” to investigate any complaints regarding the suspected abuse of any resident The information given to residents in the Statement of Purpose/Service User Guide has been reviewed and details that complaints should be made to management of the home and/or to the purchasing authority (Dept. of Adult St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 16 Social Care). Information may also be relayed to the Commission for Social Care. CRB and POVA checks are undertaken, with Cornwall Care being the umbrella body to obtain these checks. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and provides a safe environment. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: We toured and inspected the building. The home provides a safe and wellmaintained environment for the people who use the service. The décor is of a domestic and homely nature. The manager discusses refurbishment and development issues with the company annually or as required. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 18 A new reception area has been constructed and redecoration continues throughout. There are plans for a new conservatory and improved lighting to public areas. Day to day maintenance is carried out as required. Bedrooms are redecorated and re-carpeted as they become empty. Residents commented that they were happy with the accommodation provided. Rooms were personalised according to the individuals taste. Bathing facilities were observed to be satisfactory with suitable aids supplied. The home has a large and attractive sensory garden with wheelchair access. The home appeared clean and hygienic on the day of inspection. No offensive odours were noted. Laundry systems are in place to promote the control of infection. Protective equipment i.e. gloves and aprons were observed to be available for all staff throughout the home. The home has policies and procedures in place that are available to all staff and in accordance with relevant legislation St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures support and protect the service users. Staff are trained and competent to meet the needs of residents. The staffing levels are improving. EVIDENCE: The staffing structure for this home consists of Manager, deputy manager, 3 care coordinators, care staff, domestics, catering staff, driver/maintenance personnel, and an administrative clerk. At some point in the future the role of care practitioners may be established. Care cadets are also employed. The staff rota indicated that a care coordinator plus 6 or 7 care staff are on duty during the day followed by 3 care staff at night and an ‘on call’ manager. This represents a slight improvement in staff cover since the last inspection. The manager informed us that a number of additional care staff have been employed. Their start dates are dependent on satisfactory receipt of CRB clearances. Recruitment policies are robust and adhered to as confirmed by some staff spoken with. References and CRB checks were evidenced. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 20 Trainees and all new staff are put through a pre-determined induction training course. The home has exceeded the target of having at least 50 of staff holding NVQ awards. Comments from staff indicated that some felt they were still under work load pressure at times whilst others felt that working conditions were improving. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 37, 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider has appointed a qualified manager who is working towards improving the care delivery to meet the homes stated purpose and objectives. The health and safety of residents and staff is promoted. EVIDENCE: A new manager was appointed to St. Hilary and took up her post on the 30th. October 2006. No application has yet been received for her to register with the Commission. It is important that an application is received or, at the very least, a communication from Cornwall Care Ltd. Stating their intentions. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 22 She is a qualified R.M.N. with experience as a Charge Nurse and Ward Manager in various elder care psychiatric hospital settings. A full independent quality assurance review has not been carried out this year but we understand that one is being planned for. There was however a review of staff opinions and comments. We met with the administrative clerk and are pleased to record that all financial dealings relating to service users is in order. Supervision of staff does occur but in respect of some staff more regular sessions are required. Record keeping, policies and procedures are generally good. Management are changing the format for the recording of care plans to the Standex system so at present some information is held on the new system whilst some is still to be found on the old. The fire records indicate that some staff have not received their ‘in-house’ training at the required time intervals of 6 months for day staff and three monthly intervals for night staff. Insurance and maintenance documentation is in order. Evidence was presented to demonstrate that health and safety issues are taken seriously and that maintenance contracts are in place. St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 23 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 2 3 St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement Care plans must be reviewed at monthly intervals. An extended time scale has been given for this requirement. Evidence must be available to indicate that supervision of all staff occurs at least 6 times per year. Timescale for action 01/02/08 2 OP36 18 01/02/08 3. OP38 23 Staff must receive fire training at 01/02/08 6 monthly intervals for day staff and at 3 monthly intervals for night staff An application to register the manager is required, or, The Registered Provider must communicate with the CSCI to state reasons why an application has not been submitted. Section 11 of the Care Standards Act applies. 01/02/08 4 OP31 8 St Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 25 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 Hilary DS0000009068.V350201.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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