CARE HOMES FOR OLDER PEOPLE
St Ives House Horton Road St Ives Ringwood Dorset BH24 2ED Lead Inspector
Catherine Churches Unannounced Inspection 23rd February 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Ives House DS0000026872.V330830.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 Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Ives House Address Horton Road St Ives Ringwood Dorset BH24 2ED 01425 473822 01425 489003 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) The Trustees of TH Russell Charitable Trust Mrs Rowena McDermott Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: St Ives House is a large detached property, which stands in ample secluded grounds and is situated approximately one mile from Ringwood. The home was formerly owned by T H Russell and on his death was placed in trust as a home for older people. (T H Russell Charitable Trust). A group of trustees hold responsibility for the business management matters related to the home, while the registered manager Mrs McDermott attends to the day to day running of the home. Accommodation is offered on both the ground and first floors of the home, with all bedrooms being single and offering en-suite facilities. A passenger lift is available to the first floor. There is a comfortable main lounge on the ground floor, with a separate dining room that leads into a large conservatory/sunlounge. There are communal bathrooms, with assisted baths, on both floors. There is also a large, attractive conservatory leading off the main lounge and this provides another useful area for service users. In addition, the home offers six flats, which are self-contained and situated in a connected ground floor wing of the house. The service users accommodated in these flats can use the facilities of the main house, and receive varying amounts of care and support as necessary. The home is registered to provide accommodation for a maximum of 23 service users in the category OP (older people). Fees are £2635 per calendar month. St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key, unannounced inspection undertaken on 23rd February 2007. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection was in February 2006. The purpose of this visit was to monitor the homes compliance with National Minimum Standards and compliance with recommendations made during the previous inspection. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. Prior to the inspection survey/comment cards were sent out to residents, relatives, GP’s, healthcare professionals and care managers. Twenty-two responses were received in total: 12 from residents, 5 from relatives and 5 from GP’s. Most responses were positive, some suggested changes with regards to the meals. Analysis is included within the relevant sections of this report. Some of the comments that were added to the surveys or received during the inspection were as follows: “Excellent well run home with helpful intelligent staff who know their clients” “I can heartily recommend St Ives House and the service and facilities it offers” “ The home has a very happy atmosphere and nearly all the staff are helpful” “ In this community I felt content from the day of arrival” “ We are well cared for without being hassled and our privacy and dignity are respected. Our mobility and independence are encouraged by well trained staff” “ All my visitors have been most impressed by the friendly reception and general feel at St Ives House. Both they and I are glad that I am here” This report refers throughout to “residents” meaning to include persons accommodated in the residential units of the home, patients in the nursing units and the overall term “service users”, which is the preferred term of the Commission. St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
All of the matters identified in this inspection are either recommendations or good practice issues. No requirements are made as a result of this inspection. Since the last inspection the home has introduced new documents for preadmission assessments. For the most part these are comprehensive but it was noted that no information is being gathered regarding a persons medication usage, mental state and cognition, and social interests, hobbies, religious and cultural needs. The home has been carrying out monthly reviews of residents needs as required. Any changes in need were being recorded on the review sheet and it was noted that these changes were not always transferred into instructions in the relevant care plan. Risk assessments are being undertaken as part of the care planning process. However, where risks were identified the home had not recorded the action they had taken to minimise these risks. Care plans for diabetics need to be more detailed as the information found during inspection meant that it was not clear who took responsibility for certain aspects of care or the actions to take should problems arise. St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 7 Records of the food provided for residents were not being kept. There had been a change in kitchen personnel, which could account for this. This lack of information means that it is not possible to demonstrate that residents are having a satisfactory nutritional intake. Minor improvements in the recording of medication administration are required in order to ensure that administration directions are correctly recorded and audit trails are in place. The emergency lighting system should be serviced every six months. The home has a contract for this but for some reason the company had not undertaken the work since August 2006 and staff at the home had not realised this. 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 Ives House DS0000026872.V330830.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 Ives House DS0000026872.V330830.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents needs are satisfactory. This means that residents can be certain that the home is aware of their requirements prior to their admission to the home and that the staff will therefore be able and prepared to meet these needs. Some further additions in the assessment process are required in order to ensure that a complete picture of residents needs is compiled. EVIDENCE: Documentation for three residents was examined as part of the case tracking procedure used during this inspection. All of the residents had been newly admitted to the home since the last inspection St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 10 All pre-admission assessments were viewed. The format has been improved following recommendations in the last inspection. They contained good information about each persons needs although it was noted that there was little or no information regarding current medication, social interests or psychological/emotional well-being. St Ives House DS0000026872.V330830.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and documentation of care needs for residents has improved since the last inspection as new systems have been introduced. This means that the home is now better able to demonstrate that it understands, and is aware of each person’s needs and can show how these are met. However, there are still a few weaknesses and further work in this area is required. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. In the main medication in the home is well managed. Improvements to record keeping are required to enable better auditing and therefore safety of medication handling. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled at the home and their privacy is respected.
St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care Plans and related documentation regarding care for 3 residents were examined. Files were well laid out and risk assessments had been undertaken. Where risks had been identified, the action taken to minimise risks had not been recorded. Reviews were being undertaken on a monthly basis or more frequently if changes dictated this. In some cases it was noted that where changes in need were identified, the care plan had not always been updated. Evidence was available on file and through discussion that GP’s, district nurses, specialist nurses and other health professionals are called upon whenever the need arises. One person was diabetic. It was noted that the care plan lacked information regarding the monitoring of blood sugars, acceptable ranges and action to take if levels are outside of acceptable ranges. Nutritional assessments were being undertaken. However, it was noted that food records are not being kept so the home was not able to fully demonstrate that nutritional needs were being met. Medication systems were examined. Appropriate recording systems are in place and all staff responsible for administering medication have received up dated training. Medication was stored and secured appropriately. Some medication administration records for new prescriptions had had to be handwritten; these entries had not been counter signed and checked by a second member of staff. It was also noted that start dates on boxed/bottles of medicines was not recorded and a running balance on controlled drugs was not being kept. During conversations with a number of residents, they confirmed (where they were able to) that they were happy with the care they received and that either they or their representatives are involved in reviews. They also confirmed that they feel respected by staff and are able to maintain their privacy when receiving personal care or visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. St Ives House DS0000026872.V330830.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social, cultural and recreational activities are dependent on individual preferences and the resident’s capacity for involvement. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and needs. EVIDENCE: Residents are encouraged to continue any interests that they followed prior to moving to the home. The activities diary showed a detailed programme of events has been planned for the year. The home has good support from a
St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 14 group of volunteers known as the “Friends of St Ives House” and staff also spend time organising in house activities such as card and board games. There are plans to employ an activities organiser for 30 hours per week as it has been recognised that this would be of value to the residents. Residents confirmed that they could receive visitors whenever they wish and that the staff will also assist them to prepare for trips out to shops or to visit people and help with calling taxis etc. Examination of the visitor’s book also reflected that there is an almost constant stream of visitors to the home. Question 7 of the resident’s questionnaire sent out prior to the inspection asked “Are there activities arranged by the home that you can take part in?” 8 people responded “Always” 3 people responded “Usually” 0 people responded “sometimes” 0 people responded “never” 1 person left this blank. Discussion with residents and staff as well as examination of records evidenced that residents are assisted appropriately to exercise choice and control over their lives. Residents confirmed that a suitable and varied diet is provided in the home. Lunch was observed as part of the inspection. It was noted that this was a sociable occasion with staff and residents all interacting with one another. Residents had the opportunity to control their portions and request alternatives. Question 8 of the resident’s questionnaire sent out prior to the inspection asked “Do you like the meals at the home?” 4 people responded “Always” 5 people responded “Usually” 2 people responded “sometimes” 0 people responded “never” 1 person left this blank. St Ives House DS0000026872.V330830.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 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a satisfactory system for making complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be taken seriously and that matters of concern will be acted upon. Arrangements for protecting service users from abuse were satisfactory. This means that St Ives House is a safe environment that will protect residents from abuse. EVIDENCE: The complaints procedure is included in the Service Users Guide/Terms and conditions of residence that is given to all residents/representatives. No complaints have been made to CSCI or to the home since the last inspection. Question 9 of the resident’s questionnaire sent out prior to the inspection asked “Do you know who to speak to if you are not happy?” 9 people responded “Always” 2 people responded “Usually” 1 was left blank
St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 16 Question 10 of the resident’s questionnaire sent out prior to the inspection asked “Do you know how to make a complaint?” 7 people responded “Always” 4 people responded “Usually” 1 was left blank Policies and procedures for adult protection and whistle blowing were checked and found to be satisfactory. Staff have all had copies of the homes policy and procedure for recognising and preventing abuse as well as specific training in this matter. St Ives House DS0000026872.V330830.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well presented: it is nicely decorated and furnished and has a homely atmosphere. The grounds are also very well maintained, providing lots of colour and interest as well as a variety of places to sit and relax. The home maintains a good standard of hygiene and all areas seen were clean and free from offensive odours. EVIDENCE: A tour of the premises confirmed that the home is nicely decorated and furnished. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements.
St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 18 Bedrooms are nicely furnished and residents have brought personal items such as furniture, pictures, photographs, ornaments and other items to help them personalise their rooms. The lounge and dining room and other communal areas are nicely decorated and furnished with a choice of seating available to residents. Staff had a good understanding of infection control procedures and the relevant protective clothing was available. There was a detailed infection control policy in the home that covered all of the required areas. Training records were available to demonstrate that most staff have undertaken appropriate training and a plan was in place for those still requiring training. Question 11 of the resident’s questionnaire sent out prior to the inspection asked “Is the home clean and fresh?” 11 people responded “Always” 1 was left blank. St Ives House DS0000026872.V330830.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, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well staffed ensuring that residents receive the care and attention they need in an unrushed manner. Staff clearly enjoyed working in the home, there was a positive atmosphere and residents had a happy, relaxed relationship with the manager and staff. Staff have experience in caring for the elderly, a number have already achieved the minimum vocational qualification and others are undertaking training to further develop their abilities and competencies. This means that the home meets the requirement of 50 of staff to be trained and demonstrates that the home is committed to staff development and providing good care for its residents. Recruitment procedures are satisfactory and this gives further protection to residents. Induction of new staff is undertaken within the timescales and to a good standard. This means that staff have the necessary skills to enable them to undertake all aspects of their role competently. St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 20 EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the needs of residents. Staff and residents spoken with confirmed that they were satisfied with staffing levels. Thirteen of the twenty-two care staff have achieved NVQ level 2 or 3. Staff records were examined for three members of staff. These demonstrated that appropriate recruitment practices are in place: application forms were completed; interviews documented and appropriate evidence of identity and qualifications had been obtained. References, Criminal Records Bureau and POVA checks had also been completed as required. The new Skills for Care induction programme has been implemented in the home and evidence that new staff were undertaking this was available. St Ives House DS0000026872.V330830.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, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has completed the necessary training and has many years experience in caring for the elderly. She is a competent, committed and approachable manager and both residents, visitors and staff confirmed this. The home regularly reviews aspects of its performance through a well thought out programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Resident’s finances are safeguarded with clear policies and procedures and management guidance. The health, safety and welfare of residents and staff is protected by the systems that the home has in place for staff training, maintenance and risk assessment.
St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 22 EVIDENCE: Mrs McDermott has managed St Ives House for a number of years and prior to this has experience in other care settings. She has also completed her NVQ4 in management and care. The home has detailed policies and procedures for the promotion of quality assurance in the home. The deputy manager showed the inspector the results and analysis of the 2006 survey and confirmed that annual surveys and analysis is due to be undertaken again later in the year. The deputy manager confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. The home holds cash for some residents. Records and cash balances for three residents were checked and found to be satisfactory. Fire records, staff training records and accident books were examined and found to be up to date and detailed. St Ives House DS0000026872.V330830.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 24 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 St Ives House DS0000026872.V330830.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. 1. Refer to Standard OP3 Good Practice Recommendations It is recommended that pre-admission assessments should contain details of a person’s medication usage, mental state and cognition, and social interests, hobbies, religious and cultural needs. It is recommended that any changes in need highlighted through the programme of regular review be incorporated into the care plan. It is recommended that where a risk assessment indicates the presence of a risk, the action taken to minimise the risk should also be recorded. It is recommended that detailed care plans are developed for residents with diabetes to ensure that there is clear information about acceptable blood sugar ranges, who is involved in providing specialist care, sugar level testing etc and the action to be taken if blood sugars are outside of acceptable ranges. Food records must be kept in order to demonstrate that a satisfactory level of nutrition is provided for residents. A running balance of any controlled drugs must be kept. The opening date of any medicines not supplied in Monitored Dosage packages should be recorded to enable proper audit of medicines. Hand written entries on Medication Administration Records should be signed and then checked and counter signed by a second person. 2. OP7 3. 4. OP7 OP8 5. 6. 7. 8. OP8 OP9 OP9 OP9 St Ives House DS0000026872.V330830.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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