CARE HOMES FOR OLDER PEOPLE
St Johns House Parker Lane Kirk Hammerton Nr York North Yorkshire YO26 8BT Lead Inspector
Mrs Maggie Coxon Key Unannounced Inspection 29th January 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 Johns House DS0000061599.V328773.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 Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Johns House Address Parker Lane Kirk Hammerton Nr York North Yorkshire YO26 8BT 01423 330480 01423 331619 CliftonStAnn@aol.com www.residential-homes.net Clifton St Annes Personal Care Services Ltd. 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) Mrs Andrena Piggins Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: St John’s House is registered to provide accommodation and personal care for up to 36 service users over the age of 65 years. The home is a large manor house converted and extended for its current use. The home is set within its own grounds and is situated on the outskirts of Kirk Hammerton village mid way between Harrogate and York. Clifton St Anne’s have owned the home since November 2004. Thirty-four of the thirty-five bedrooms are for single accommodation and the one double room is currently also used for single accommodation and would only be used as a double at the expressed wish of the people who would be sharing the room such as a married couple. These rooms along with the communal rooms are sited on the ground and first floors. The home has a stair lift, a full passenger lift and has level access from outside. Current information about services provided at St John’s House in the form of a statement of purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection are available by contacting the home. Information provided by the registered manager on 11th December 2006 indicated that the current range of weekly fee for the home is from £308 to £450. Additional costs include hairdressing, chiropody and newspapers. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is what was used to write this report: • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the visit, this is called a pre-inspection questionnaire. A visit to the home that they didn’t know was going to happen. This lasted for six hours and included talking to ten residents, care staff, senior care staff, the deputy manager and the registered manager about how the home is run. Most areas of the home were seen and records that the home has to keep were checked. Residents’ medication was also checked to make sure that it was being properly looked after for them. Telephone conversations with five relatives. Personal conversations with two relatives during the visit. • • People living in the home have expressed a preference to be known as residents. What the service does well:
Before moving in individuals meet with the manager to talk about the help they need and to find out about the home. This means that residents can decide whether or not they want to move into the home. Each resident is then involved in drawing up his or her care plan with input from a representative where appropriate. They also attend regular review meetings to update the information. This way residents can be confident that all their personal needs including health care needs will be continually met. Residents are helped to be as independent as possible and to make as many choices as they want to regardless of their age, gender or needs, they are all treated equally and respectfully by the staff. Residents and staff get to know each other very well and residents and their relatives said that staff are kind and friendly so residents can be confident that they will get consistently good support. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 6 Residents enjoy lots of different activities, both inside and outside of the home, that they choose themselves. Residents are able to develop and maintain relationships with family and friends thereby meeting many of their social and emotional needs. Residents have a good choice of food and drinks at mealtimes and special diets are catered for. This ensures that they have a varied diet of their choosing and can enjoy their meals, which are home made and nutritious. Residents see their GP, dentist, optician and chiropodist whenever they need to. This means that they can stay as healthy as possible. Residents are asked to say what they think about the service they get at St John’s House. This gives them the chance to ask for any changes and to have a say in planning services in the future. Residents and their relatives said they feel comfortable discussing any concerns with the manager and staff and staff are aware of the need to safeguard the residents from abuse so residents can feel safe and well listened to. The owners are making continued improvements to the environment and the home provides residents with a clean, comfortable and safe home in which to live. The home is well managed. Residents can feel safe and be confident that the manager and staff are always looking for ways to improve the service and thus improve their quality of life. What has improved since the last inspection?
The manager of the home has become registered so the service complies with current legislation. Several of the bedrooms have been redecorated and refurbished and new assisted baths have been fitted in two bathrooms, one on each floor. Staff have done more training so residents get even better help. Staff have made more progress with keeping care plans updated so residents can be confident that information concerning them is well kept. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Johns House DS0000061599.V328773.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 Johns House DS0000061599.V328773.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): 2 and 6. Quality in this outcome area is good. A detailed assessment process ensures that the needs of residents are identified and planned for before they move into the home so they can be confident that they will be well supported. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Case tracking identified that the registered manager meets with prospective residents and their families/ carers prior to any admission being made, when she undertakes a full assessment of the individual’s needs and how these can best be met. Intermediate care is not provided.
St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. Residents are able to stay as healthy as they can by being helped to attend regular health appointments and by being helped to take their medication. They are also well supported when having their personal care needs met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Residents’ care plans are well detailed and clearly describe the needs of the individual concerned and how these can be best met. Staff were seen to provide support in a way that promoted the residents’ privacy and dignity. Residents and relatives confirmed this to be the case. The registered manager explained that all staff are instructed in respecting residents’ rights to privacy and dignity during their induction.
St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 11 Case tracking identified that each resident has had a detailed health assessment undertaken and is registered with a GP. They have medical support as and when they need it from their GP and District Nurse who visit the home on request. They also have regular appointments with opticians, dentists and chiropodists again as needed. Staff also undertake relevant health related training and residents’ health records are well kept. All of the residents have their medication administered by staff mainly via a monitored dosage system. All medication is securely stored. Administration is well recorded and audited. All staff had either undertaken or are currently undertaking detailed medication training. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is excellent. Residents enjoy lots of different activities that they choose themselves. They are well supported to develop and maintain relationships with family and friends. Meals are home made and nutritious so residents can enjoy tasty, healthy food. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Conversations with residents and staff, observations of staff interaction with residents during the visit and care records show that each resident is encouraged to make as many choices and decisions in their daily lives as possible and to take reasonable risks after a risk assessment has been undertaken and recorded. A designated activity organiser is employed who discusses activities with individuals on a daily basis and other events such as outings are discussed at monthly residents’ meetings. Residents and relatives confirmed that activities
St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 13 are arranged every day but there is no pressure to join in if that is the resident’s preference. Several also said that they spent a lot of time in the garden in the summer enjoying the wildlife and sometimes visiting the local pub. Residents are well supported to keep in touch with family and friends. Relatives talked to say that they are made welcome at the home at any time and are given refreshments during their visit. A number of them also said that they are kept well informed about their relative should a need arise. One commented ‘I couldn’t wish for a better home for my mother’. Designated catering staff cook all the meals using high quality, fresh ingredients. Residents have a choice about what they eat and where. Records of meals eaten show that meals are varied and nutritious and provide residents with a healthy diet. Special diets are catered for on an individual basis. Lunchtime was very relaxed and informal and support provided by staff was done so in a respectful way that promoted the individual’s dignity. Drinks and snacks were available throughout the visit and a birthday cake had been made to celebrate a resident’s birthday. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 14 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. Systems and procedures are in place for dealing with complaints and for safeguarding the residents from abuse and staff are well trained so residents can feel safe and well listened to. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a comprehensive complaints procedure that is on display within the home. One complaint has been made to the CSCI since the last inspection. This was investigated fully by the registered person and a satisfactory outcome was reached. There is also an appropriate adult protection procedure in place, which reflects the agreed multi-agency adult protection procedure currently in operation in North Yorkshire. This states that the NYCC adult protection team lead on all adult protection investigations. Staff all undertake vulnerable adults training provided by an external trainer contracted by the organisation. The registered manager explained that there is a policy of no use of physical restraint in the home. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 15 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): 19,20,21,22,23,24,25 and 26. Quality in this outcome area is good. The standard of the environment is good and provides residents with a clean, comfortable and safe home in which to live. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The environment is maintained to a high standard. Many structural improvements have been made to the home since the current registered persons took over its ownership. These include a reduction in the number of bedrooms on the ground floor to enable the remaining rooms in this area to have private en suite facilities. These rooms have also been redecorated and refurbished.
St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 16 Communal areas are well maintained and very pleasantly decorated and furnished. These consist of various dining areas, lounge, kitchenette, conservatory and quiet areas. Several of the residents showed me their bedrooms. These again are well maintained, decorated and furnished. They have been able to bring their own furniture and say they are very happy with their rooms most of which now have en suite facilities. Many of the bedrooms are on the ground floor whilst others on the first floor are accessible by stairs, chair lift or full passenger lift. There are also sufficient communal bathrooms and toilets well situated throughout the home. Appropriate aids and adaptations have been purchased to help the residents maintain as much independence as possible. These include new assisted bath fitted on both floors. A full time maintenance person ensures that the home is well maintained throughout. A ceiling leak to one of the bedrooms that occurred in the recent heavy rains had been repaired as soon as possible and the ceiling had been refurbished. All bedroom doors have an automatic door closers fitted so that if residents want to, they can keep their doors open in safety. The home was clean, warm and tidy throughout. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 17 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. The home is well staffed by individuals who are both trained and experienced. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Sufficient staff were on duty at the time of the visit to meet the needs of the residents who, along with staff rosters confirmed that this is always the case. Residents and relatives said that staff respond to requests for help promptly. They also said that staff are always friendly and helpful and several mentioned the happy atmosphere that the home has. The personnel records of three new employees showed that CRB checks are undertaken and written references taken up. A newly appointed carer explained that he received induction training when first appointed. All staff regularly update their training on adult protection, manual handling, health and safety, first aid and food hygiene. Topic specific training is also provided as part of a rolling programme and over half of the care staff have completed an NVQ to level 2 or above.
St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 18 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): 31,32,33,35,36 and 38. Quality in this outcome area is good. The home is well managed. Residents can feel safe and be confident that the manager and staff are always looking for ways to improve the service and thus improve their quality of life. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The recently registered manager has many years experience of managing care homes and is appropriately qualified. Residents, relatives and staff say that both she and the deputy manager are very approachable and helpful.
St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 19 The home has comprehensive quality assurance and monitoring systems in operation which include residents and relatives being surveyed by an external service contracted by the organisation who provides them with feedback as to the strengths and weaknesses and makes any recommendations as to how quality could be improved. The home then draws up and implements an action plan. The residents also have monthly meetings where they can put forward views about how the home is run. Residents are encouraged to look after their personal finances with support from their relatives where required and relatives are billed for any monies spent on residents by the home; all these transactions are well recorded. Personnel records identify that all staff have regular supervision from the registered manager. Staff say that they feel well supported. Regular health and safety checks are undertaken and fire safety is well maintained including regular fire safety training for all staff. Other health and safety systems and records are well maintained including those detailing fridge and freezer temperatures; hot food temperatures as well as hot water storage and delivery temperatures. A tour of the premises identified no health and safety issues to cause concern. St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 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 3 3 X 3 3 X 3 St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 21 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Johns House DS0000061599.V328773.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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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