CARE HOMES FOR OLDER PEOPLE
St Ives House Horton Road St Ives Ringwood Dorset BH24 2ED Lead Inspector
Catherine Churches Unannounced Inspection 10:30 27 February 2006
th 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 DS0000026872.V284994.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. DS0000026872.V284994.R01.S.doc Version 5.1 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 DS0000026872.V284994.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2005 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/sun-lounge. 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). DS0000026872.V284994.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the morning of 27th February 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. This report should be read in conjunction with that from the inspection in September 2005 as all key inspection standards are reported on in these two reports. The purpose of this visit was to monitor the homes compliance with requirements and recommendations issued at the last inspection, to check that the home continues to 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 and staff. What the service does well:
St Ives House provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is well presented and has beautifully maintained gardens that residents reported they enjoyed very much. The staff group is stable and were observed to be respectful, helpful and caring. A good standard of care is provided. Prior to the inspection comment cards were sent to residents, relatives, GP’s and others who have involvement with the home. Responses were received from 14 residents, 5 relatives and 3 GP’s. Responses to the questions were mostly positive with some suggestions for further improvements. Such suggestions have been fed back to the manager of the home. The following quotes are taken from comment cards: “If I were not entirely satisfied in every respect I should not be here” “Excellent care” “I have found St Ives House to be a warm and friendly community and am glad to be living here” “Excellent atmosphere here” “ Very caring. Good communication. React quickly to concerns the family express. Very clean, no smell in the house. Very high standard of care given by all staff”. “ I cannot praise the staff enough. Excellent friendly care” DS0000026872.V284994.R01.S.doc Version 5.1 Page 6 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. Pre-admission assessments must be carried out prior to each period of time spent by a person in the home. This applies to respite visits as well as a readmission to the home following a stay in hospital. During the last inspection it was required that the home ensure care plans are detailed and up to date. This was evidenced during this visit. However, both the Manager and Deputy Manager acknowledged that the actual system that is in place is could be improved to make it easier for staff to use and keep up to date. A recommendation is made to this effect but it should be noted that this is regarding the system and the actual information found during this inspection was satisfactory. Nutritional assessments and risk assessments for residents regarding such things as moving and handling need to be more detailed and clearly show the outcomes and actions taken following an assessment. When employing new staff, one of the written references is from the applicants’ most recent employer. Colleagues from the most recent place of work are not satisfactory. The results of the Quality Assurance audit undertaken in the home should be publicised in accordance with the requirements of the National Minimum Standards.
DS0000026872.V284994.R01.S.doc Version 5.1 Page 7 Where the home holds cash for a resident, when a transaction takes place the resident as well as a staff member should sign the record to confirm or when the resident is unable, a second staff member should sign. 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. DS0000026872.V284994.R01.S.doc Version 5.1 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 DS0000026872.V284994.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Prior to admission, the needs of each prospective resident are assessed to ensure that the home will be able to properly meet them. The assessment is comprehensive but the documentation and methodology used to support this process is unwieldy. Improved systems would make processes simpler and therefore provide better evidence that the standard is complied with. Pre admission assessments must be undertaken prior to each admission to the home either for respite or following a stay in hospital. EVIDENCE: Pre-admission assessments for 3 residents, accommodated in the home, were examined. After careful analysis and discussion, it was found that the required information was available although the methodology and documentation used by the home was at times hard to follow. In the case of a resident receiving respite care it was noted that pre-admission assessments were not being undertaken prior to each stay in the home. DS0000026872.V284994.R01.S.doc Version 5.1 Page 10 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): 7,8 and 9 Systems for care planning and resident consultation are in place but could be reviewed and improved to provide more effective information and therefore further enhance evidence that the home meets the needs of residents. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. Documentary evidence regarding risk assessments and nutritional assessments need to be improved. Residents’ medication at this home is well managed, therefore promoting good health. EVIDENCE: Care Plans and related documentation regarding care for 3 residents were examined. After careful analysis and discussion, it was found that the required information was available although the methodology and documentation used by the home was at times hard to follow. Evidence was available on file and through discussion that GP’s, district nurses, specialist nurses and other health professionals are called upon whenever the
DS0000026872.V284994.R01.S.doc Version 5.1 Page 11 need arises. It was noted that risk assessments for areas such as moving and handling and nutrition are not always undertaken or it is not recorded that assessment resulted in no requirements. Medicines in the medication cupboard were examined together with administration records. These were found to be satisfactory. Staff have undertaken required training. DS0000026872.V284994.R01.S.doc Version 5.1 Page 12 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 and 15 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: Examination of records evidenced that residents are assisted appropriately to exercise choice and control over their lives. It was noted from documentation and observation of rooms that residents are encouraged to bring their own items of furniture and to personalise rooms etc. Choices are also promoted with encouragement to make decisions regarding food, clothing, social activities etc. Food records and discussions with residents confirmed that a suitable and varied diet is provided in the home. Stocks were also inspected and it was found that there was a variety of different foods available with plenty of fresh, frozen and dried goods. DS0000026872.V284994.R01.S.doc Version 5.1 Page 13 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): 16 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 can feel confident that they would be listened to and matters of concern will be acted upon. EVIDENCE: The home has a satisfactory complaints procedure that is displayed in the home as well as included in the Service Users Guide, which is in every bedroom. 13 of 14 comment cards from residents confirmed that they were aware of the complaints procedure. One card was returned but this question was not completed. 4 of the 5 comment cards returned by relatives/visitors confirmed that they were aware of the complaints procedures. No complaints had been made either to the home or the Commission since before the last inspection. DS0000026872.V284994.R01.S.doc Version 5.1 Page 14 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): Neither of the key standards were assessed on this occasion. Both have previously been assessed as met. EVIDENCE: DS0000026872.V284994.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 and 29 There is an ongoing staff training programme and close to 50 of staff have now achieved an NVQ level 2 qualification. Such training has lead to an increased level of competency and motivation amongst the staff. Recruitment and employment practices have improved since the last inspection therefore providing greater protection for residents. One further issue was identified surrounding recruitment, which must be implemented to further reduce the risk of employing unsuitable staff. EVIDENCE: Seven of the sixteen care staff have now achieved NVQ level 2 in care and a further 4 are currently undertaking this qualification. Once they are qualified the home will have more than the minimum requirement of 50 of care staff trained. The home is committed to providing training for staff and currently one person, having completed level 2, has gone on to study level 3. Files for two recently employed staff were examined. Both staff had completed application forms, been interviewed and given job descriptions and contracts of employment. All of the required checks and references had been obtained, although in both cases, neither had provided a reference from their most recent employer. DS0000026872.V284994.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): 31, 33 and 35 Mrs McDermott holds appropriate management qualifications as well as having many years experience in the care of the elderly. She is a competent, approachable and committed manager. This results in a consistently well run home where residents, staff and visitors feel supported and consulted. This is also reflected in the homes quality assurance systems. Resident’s finances are safeguarded with clear policies and procedures and management guidance. EVIDENCE: Since the last inspection, Mrs McDermott has completed a quality monitoring review of the home, which involved questionnaires to residents and relatives. The results of these questionnaires have been analysed. As a result of the analysis an informative report has been written and actions taken where issues have been identified. The report had not been made available to residents and relatives.
DS0000026872.V284994.R01.S.doc Version 5.1 Page 17 The accounts clerk 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. It was noted that in most cases only one member of staff signs a transaction. DS0000026872.V284994.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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X X DS0000026872.V284994.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 OP3 Good Practice Recommendations It is recommended that pre-admission assessments are carried out or updated prior to every admission to the home for a period of respite care or following a hospital admission It is recommended that systems for care planning and resident consultation are reviewed and amended so as to provide greater compliance with the National Minimum Standards as well as easier use for staff. Nutritional screening must be undertaken on admission and on a periodic basis, a record maintained of nutrition, including weight gain and loss, and appropriate action taken. One of the two references required from applicants must be from the most recent employer Residents should sign for any financial transactions. Where this is not possible a second signature should be obtained from a member of staff who must witness the transaction.
DS0000026872.V284994.R01.S.doc Version 5.1 Page 20 1. 2. OP8OP7OP 3 3. 4. 5. OP8 OP29 OP35 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000026872.V284994.R01.S.doc Version 5.1 Page 21 - 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!
