Inspection on 21/10/08 for St Hilary

This inspection was carried out on 21st October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Hilary 13/11/07

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

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Trevaylor Manor

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Hilary Bramble Hill Bude Cornwall EX23 8DG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Dennis     Date: 2 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: St Hilary Bramble Hill Bude Cornwall EX23 8DG 01288352754 01288359077 mail@cornwallcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cornwall Care Ltd Name of registered manager (if applicable) Miss Emma Louise Davies Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Total number of service users not to exceed a maxumum of 38 Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 27 0 0 0 Over 65 28 28 10 care home 38 Brief description of the care home 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. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place on the 21st. October 2008 over a seven hour period. We met with the Manager, two care co-ordinators, a selection of staff and 4 residents. During the course of the inspection we observed groups of residents engaged in a number of activities. Staff were observed to be tending to peoples 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. Continence assessments are and have been done by the Community Nurses. Quality Care Homes for Older People Page 6 of 27 assurance surveys have also been completed. A number of new staff have been appointed in the last twelve months and those spoken with seemed enthusiastic. They told us that they were enjoying the work at St. Hilary’s and that there was a good team spirit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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: Four 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. 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 Care Homes for Older People Page 10 of 27 Evidence: information is provided by way of the Statement of Purpose and 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 is in place. Standard 6 is not applicable as the home does not provide Intermediate Care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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: Four 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. The system of recording the care plan information has changed to the Standex system. This appears to be working well. 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 Care Homes for Older People Page 12 of 27 Evidence: disciplines frequently visit the home to provide for general health care, for example, Community Nurses, Opticians, Dentists and General Practitioners. 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. Four 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. The system of recording the care plan information has changed to the Standex system. This appears to be working well. 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, for example, Community Nurses, Opticians, Dentists and General Practitioners. 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. Care Homes for Older People Page 13 of 27 Evidence: Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 residents in the home are able to participate in the day care activities, which are held in the day centre three times a week. The homes policies and documentation demonstrate that they aim to encourage residents to pursue their hobbies and interests, and individual 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. Care Homes for Older People Page 15 of 27 Evidence: 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. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. A recent complaint was made to both the home and to the CSCI. This complaint has been satisfactorily dealt with. 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 and Service User Guide details that complaints should be made to management of the home or to the Care Homes for Older People Page 17 of 27 Evidence: purchasing authority. 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. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 at 9:30am on the morning of the inspection. There were no unpleasant odours present. The home provides a safe and wellmaintained environment for the people who use the service. The decor is of a domestic and homely nature. The manager discusses refurbishment and development issues with the company annually or as required. 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 Care Homes for Older People Page 19 of 27 Evidence: appeared clean and hygienic on the day of inspection. Laundry systems are in place to promote the control of infection. Protective equipment, for example gloves and aprons were observed to be available for all staff throughout the home. We noted that one of the two industrial washing machines is out of order, causing some problems for laundry staff. The home has policies and procedures in place that are available to all staff and in accordance with relevant legislation Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The position of care practitioners has been established. One Care cadets is 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 senior member of staff. The manager informed us that a number of additional care staff have been employed. It is of interest to note that nine males are now employed to compliment the majority of female staff. We spoke to two of these gentlemen who were at work for their first day. During the morning they received their initial induction from the manager and later were seen to be participated under the watchful eye of experienced staff. Recruitment policies are robust and adhered to as confirmed by some staff spoken Care Homes for Older People Page 21 of 27 Evidence: with. References and CRB checks were evidenced. 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 they felt supported and were enjoying the work environment. They confirmed that training provided was still a priority. The atmosphere between work colleagues appeared to be much improved. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 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. A subsequent application to be the Registered Manager was successful. She is a qualified R.M.N. with experience as a Charge Nurse and Ward Manager in various elder care psychiatric hospital settings. She has recently been granted maternity leave. An experienced employee has been brought in for twelve months to fulfil the managers role. Care Homes for Older People Page 23 of 27 Evidence: A full independent quality assurance review has been carried and the results analysed. The Annual Quality Assurance Assessment required by the CSCI has also been completed. 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 have changed the format for the recording of care plans to the Standex system. This seems to be working well. The fire records were seen to be up to date. 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. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 36 18 All staff must receive 01/02/2009 supervision at least six times a year with documented evidence to support Supervision is being undertaken but not consistently evidenced Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!