Inspection on 26/01/07 for St Joseph`s Care Home

This inspection was carried out on 26th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Joseph`s Care Home 12/01/09

St Joseph`s Care Home 19/01/08

St Joseph`s Care Home 18/01/06

St Joseph`s Care Home 29/07/05

St Joseph`s Care Home 23/02/05

St Joseph`s Care Home 20/07/04

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

CARE HOMES FOR OLDER PEOPLE St Joseph`s Care Home St Joseph`s 38-40 Hindes Road Harrow Middlesex HA1 1SL Lead Inspector Clive Heidrich Key Unannounced Inspection 9:30 26 and 30th January 2007 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 St Joseph`s Care Home DS0000038579.V325619.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 Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Joseph`s Care Home Address St Joseph`s 38-40 Hindes Road Harrow Middlesex HA1 1SL 020 8863 2868 020 8427 2146 whughes@hazelwoodcare.co.uk 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) Hazelwood Care Limited Wayne H. Hughes Care Home 19 Category(ies) of Dementia - over 65 years of age (19) registration, with number of places St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18th January 2006 Brief Description of the Service: St Josephs is a privately-owned care home for up to 19 older people who have dementia or related conditions. There were no vacancies at the time of this inspection. The home is part of the Hazelwood Care Organization. The home is a conversion of two semi-detached houses that interlink on the ground and first floor. Service user accommodation is on the ground and first floor, with seven bedrooms downstairs including two double rooms. There is also accommodation provided on the second floor for four live-in staff. Access to the first floor is by stairs, or chair-lift on the house #40 side. The large lounge and dining area is split into two distinct sections. There is a private garden of a reasonable size to the back of the home. The home is situated close to local shops and transport facilities. There is a small, open forecourt at the front that has some parking facilities. Parking restrictions apply on the road outside the home. The Service User Guide and fee range are available from the home on request. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place across two weekdays at the end of January. It lasted just over eleven hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke with a number of service users during the visit, most of whom were able to provide some degree of feedback about the services in the home. A number of homes were sent CSCI service user surveys in early January. Eight of these were returned for this home at the time of drafting this report, some of which were filled in by friends or relatives. Additionally one social care professional wrote with their views of the home. The comments from these surveys have been included throughout this report. The inspection process within the home also involved observations of how staff provided support to service users, discussions with staff, checks of the environment, and the viewing of a number of records. The registered manager, Mr Hughes, was due to leave employment shortly after the inspection. He was present throughout the inspection. The inspector also met with the incoming manager, Mrs Vera Saunders, on the second day of inspection. She was receiving a week-long induction and orientation into the home. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: Comments such as, ”we are so happy with the care that our relative has been receiving since residing in the home”, and “there’s nothing to worry about here” were typical of those received from service users and their relatives. There are good standards of interaction between staff and service users, with service users generally being treated very respectfully. There was a good overall level of well-being and interaction of service users observed. There are good standards of activity provision, flexible lifestyles, and community contact including with friends and family. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 6 Service users’ health needs are generally addressed by the home, liaising with community health professionals where needed. Service users are protected by the home’s established medication procedures. Service users can expect to have their needs suitably assessed by the home before being offered admission. Management ensure that needs can be met before offering admission to the home. The converted building provides service users with a comfortable, warm and clean environment with reasonable communal space and washing areas. A number of environmental adaptations have been installed, including a walk-in bath and a chair-lift. Service users benefit from a good standard of leadership and management in the home. There are quality assurance systems in place to help ensure that the home in run in service users’ best interests. What has improved since the last inspection? What they could do better: Improvements are needed to the environment of the home, to make it easier for service users with dementia to identify their own rooms and toilets. At the time of the inspection, all doors to these rooms were the same white colour, and some lacked any sort of sign. This can cause service users to wander, and can result in incontinence, both of which can cause anxiety. Individual needs in respect of the environment must consequently be addressed, with the lingering offensive odours evident in two bedrooms must be permanently eradicated. Individual care plans were found to lack monthly updates. This can result in changed care needs not being recognised and addressed. The plans were also too vague in respect of continence needs, which can result in increased chances of incontinence. Care plans must be reviewed and updated in these respects. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 7 Whilst service users were generally treated very respectfully, one case of poor support with a manual handling transfer was observed. Management must ensure that manual handling manoeuvres are undertaken safely and with the service user’s awareness and involvement wherever possible. There are also requirements made about achieving suitable record keeping, addressing a few identified maintenance issues, ensuring that all staff have training in key areas that is up-to-date, and ensuring that the fire evacuation procedure is fully sufficient. A full list of requirements is at the back of this report. 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 Joseph`s Care Home DS0000038579.V325619.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 Joseph`s Care Home DS0000038579.V325619.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 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to have their needs assessed by the home before being offered admission. The process is seen to be suitably comprehensive, with the overall services at the home suitable for people with dementia. Hence service users can expect to have their needs met if offered admission. EVIDENCE: For each new service user checked on, there was a social services assessment document, and an assessment of needs by the home, in place. Dates showed that these were acquired before the service user moved in. The manager noted that before any admission, a meeting with staff is held to discuss the prospective person’s needs and decided on whether the home can meet these needs. This is good practice. The individual assessments of need by the home were succinct but detailed, capturing key needs across a range of areas. The manager noted that St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 10 additional information as per a previous recommendation, about social interests, religious & cultural needs, is now included. He was also able to demonstrate about how the assessment considers other factors beyond dementia that can cause confusion, albeit that the records do not easily convey this. The assessment should also include a record of who was consulted, and a detailed life history where possible. This would help provide a bigger picture of the service user, which can help with care planning and provision. It is positively noted that further assessments of need are undertaken by the home for service users who have been temporarily in hospital. Of the eight service user surveys received, six stated that the service user always receives the care and support they need, with two noting this as usually. Comments such as, “The home is very well run and meets my requirements,” and “I’ve never seen my relative so fit and happy” were typical. This reflects feedback received from service users during the inspection, such as “I’m very happy here,” and from social workers, such as “I have always been impressed with how her needs are met and with the care given to her by the staff.” In terms of the inspection, staff showed due knowledge of service users as individuals, and generally treated them respectfully and friendlily. There is a reasonable standard of training of staff, including in respect of dementia, although some improvements are needed overall as per standard 35. Service users were generally seen to have a good standard of well-being, many interacting with many other people in the home. It is consequently judged that the service at this home is able to meet the needs of people offered placement. St Joseph`s Care Home DS0000038579.V325619.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 good. This judgement has been made using available evidence including a visit to this service. There are good standards of interaction between staff and service users, with service users generally being treated very respectfully. Service users are protected by the home’s established medication procedures. Service users’ health needs are generally addressed by the home, liaising with community health professionals where needed. Improvements are needed with consistently recording about professional healthcare advice, as this was sometimes missing. The standard of care planning in the home is quite reasonable and efficient. Improvements are however needed, about keeping the plans up-to-date insofar as they did not always reflect the service user’s changed needs, and with being sufficiently clear about continence management as this could sometimes be too vague. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care plans are easily available to staff within a compact file about each service user. The plans include details on the health, personal, and social care needs of the service user, the objectives for care, and explanations of the support that staff should provide. The plans however lack life-history details that can help to provide insight into the behaviours of people that have dementia. The plans also lack evidence of consultation with the service user and their representatives. These are points for consideration. Most service users have however had formal review meetings involving social workers and family members, which enables formal input into the individualised care. Improvements are also recommended for the care plans in respect of providing more detail about the service user’s dementia care needs and how these are to be addressed, and specifically about how the service user communicates about pain. This is to provide more individualised guidance. The plans all date at latest from October 2006. They do not include any form of review, which is expected monthly under the National Minimum Standards. For a service user who was being cared for in their room, there was no update on their care needs, which could lead to care being provided inconsistently or incorrectly. Similarly, the care plan of a service user who is mobility-dependent referred to their propensity to wander at night. A system of regularly reviewing and updating care plans, based both on changed needs and recognition of developments, must be set up. Monthly reviews are recommended as the minimum. Risk assessments in respect of manual handling, and key care needs, were in place for each service user. These include about freedom of movement in the home with an attitude of encouragement, key health symptoms such as dizziness, and community support needs. A generic risk assessment against slips, trips and falls has also been undertaken, including with respect to each room in the house. Where an individual is considered to be at risk of falls, an individual risk assessment against this was also in place. It was encouraging to find that seven from eight survey replies stated that the service user always receives the medical support that they need. One person noted that when the service user “broke their dentures, a dentist was called immediately, and a new set quickly made.” Another noted that “I have watched her health improve, she has gained weight, and had generally blossomed since moving there.” The home has a weighing-chair with which to monitor service users’ individual weights. Checks are made on a monthly basis, and now including on admission following a recent complaint. These records are monitored by management. The records generally showed stable weights for everyone across the previous St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 13 twelve months. The manager could suitably explain exceptions to this. The system allows for easy monitoring of concerns, which benefits service users. Checks of the accident book found suitable entries in relation to service users. Cross-checks with individual service user records tallied. Care files were on this occasion found to sometimes lack information about the input of health professionals, despite there being a standard recording system in place for this. Information could be found on, for instance, individual service users’ CPN visits, memos to GP about particular health needs, and about optician appointment outcomes. However, records of GP visits including for medication reviews, continence nursing input, and dental support, were lacking. The manager agreed that this was insufficient, as it can lead to incorrect information being communicated, and can suggest poor health support. Health records must be kept up-to-date, with backdating taking place where needed. The manager noted that there has been recent training in catheter and continence care, which is encouraging. One service user’s care plan included guidance of ‘continence to be promoted’. Whilst the attitude is appropriate, there was no written evidence of how this was to be achieved. This connects with information under standard 26 about lingering offensive odours, and standard 19 about the sufficient provision of signs for toilets. Care plans must be audited with respect to continence needs, where applicable, to ensure that guidance is clear and detailed, and to ensure that obstacles to continence are addressed wherever possible. Plans must then be followed. A sample check of the medication cupboard and systems was undertaken. The home receives blister-pack dispensing systems from a pharmacy. These were seen to be securely stored within a medicine cabinet. The home has facilities for controlled drugs but there were none being stored or used on this occasion. The inspection checks found no concerns with the recording and administration of medications, including for the receiving of medicines from the pharmacist. All staff who administer medication have received training in this respect. The medication records included allergy information for each service user, but dated up to 2005. The information for newer service users was within their files, but the information within the medication file should be kept up-to-date, for ease-of-access. There was a high level of interaction and involvement from service users overall. This indicates a sustained standard of respectful and appropriate interactions from the staff team. Most service users were quite willing to chat with the inspector. Many service users chatted with each other, and it was clear that some made clear choices to sit with others. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 14 All eight surveys received noted that staff listen to and act on what the service user says. A typical quote was, “They make sure she is happy and well cared for.” The staff team were seen to interact in a friendly manner with service users during the inspection. Individual staff took the time to sit and chat briefly with many service users in-between undertaking other work. Over lunch, one staff member noticed that a service user was eating little. They spent time talking with the service user, then pointed out the concern to the shift-leader, who then also spent time with the service user. The inspector also observed staff to always make requests of service users, never to demand that the service user do something. The overall finding therefore is that there is a high standard of interaction and support from staff, which has a positive effect on service users. Care plans sometimes gave an indication of the clothing needs and wishes of the service user. The provision of familiar clothing, for instance, can help to orientate some service users with dementia. This includes also for such things as glasses and hearing aids, which were generally in place for individuals as needed. Service users themselves were wearing suitable clothing that was ironed, co-ordinated, and well-fitting, from the start of the inspection. There were also no concerns arising from observations of hair and nails. Finally, it is worth noting that the compliment book includes a recent entry from a social care professional about “excellent personal and health care by St Joseph’s staff.” St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 15 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are excellent standards of food provided, based on flexibility, choice, nutrition, and positive outcomes for service users. There are good standards of activity provision, flexible lifestyles, and community contact including with friends and family. Service users’ choices are generally respected. However, improvements are needed with ensuring that service users are appropriately involved in those manual handling manoeuvres that need staff support. EVIDENCE: Feedback through surveys found six respondents stating that activities are always arranged by the home that the service user can take part in. Two people clarified this as usually. Comments such as “the residents are stimulated,” and “the carers make a point of talking to service users individually” were typical, whilst the barbeques and the pantomimes organised by the home were positively referred to by a number of people. Comments from service users about activities were also positive. The inspector observed staff encouraging a singing session that service users joined in with, including through simple musical instruments such as tambourines. Staff were also seen St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 16 to encourage some service users with simple tasks around the home, such as laying the table, whilst one service user assists the cook with such things as giving out biscuits to other service users. Visitors also confirmed that staff coax service users to join in, but that no one is forced to. Care plans positively noted the individual activities that service users enjoy. An overall activity diary is kept, noting the activities provided & those service users that participated. It showed that activities such as singing, dancing, bingo and board games are provided twice a day across the week. A hairdresser and a musician also visit regularly. Records and observations confirmed that service users receive visits from family and friends. This included a portable phone being used to pass on calls to service users, and service users being offered private areas to take such calls if so wished. Staff were seen to keep service users informed about visits due to take place. The manager asked one service user if they wished to go along with him for an errand, and there was feedback that another service user goes out independently. Much positive feedback was received by visitors about being made welcome into the home. This includes about visiting at different times, always finding carers very welcoming, and “they are like a big, happy family.” From the start of the visit, eleven service users were present in the lounge. This represents a majority of service users, and hence shows that there is sufficient support to follow morning routines. Staff confirmed that service users choose when to get up, noting for instance that it can cause resentment and challenging behaviours if service users’ choices are not respected. Team meeting records also affirmed that service users can choose to delay breakfast, and for it to be supplied later. Care plans were found to include reference to restlessness at night where applicable, and how night-staff are to respond to this. The responses were suitably enabling, such as with trying to settle the person in the lounge with the staff member. Staff also explained about how good knowledge of when individual service users like to bathe can help with the chances of the service user agreeing to have a bath. This is suitably individualised care based on respecting choices. Staff generally supported service users appropriately to walk around at their own pace where support was needed. However, the support provided to one service user to move from a wheelchair to a chair involved the service user not being spoken to, lifting the service user up from under their arms, and an adjustment of the manoeuvre after staff realised that the initial positioning of the wheelchair was poor. The overall effect was of the manoeuvre being done to the service user, rather than in a safer manner with their involvement. The inspector also considers that the manoeuvre put the service user at significant St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 17 risk of an accident. The manager was aware of these shortfalls during concluding feedback, and agreed to address the issues as required. The inspector observed one service user being supported by staff to eat their lunch. The service user needed the support as their efforts to spoon the food to their mouth were largely unsuccessful. However, the service user showed by their continued actions that they wanted to carry on by themselves, with some interventions by the staff causing consequent irritation. This was discussed with management, who agreed that adapted cutlery could enable the service user to eat independently. A review of service users’ independence with eating is recommended, with adapted cutlery and crockery to be acquired where identified as benefiting individual service users. Care plans had a general attitude of providing and enabling service users to make choices, such as for meals and clothing, and with promoting independence. Management explained that the cook asks service users about their meal choice in the morning, but that if at lunch the service user changes their mind, there is generally enough food to cover this. The inspector saw that a few portions of the main meal were still available after lunch on the first day of inspecting. There was space for twelve service users to eat meals at two tables in the dining room. Other service users ate at coffee-tables pulled up to their lounge chairs, with support being provided by staff where needed. The meals were fish in sauce with mashed potato, or battered fish with chips, all served with peas. A dessert was also served. Condiments were available at the tables, and were made available in the lounge. The meal was seen to be eaten by most service users, with comments from service users about it being positive. Feedback though surveys found seven out of eight people stating that they always like the food provided. The eighth reply was also positive. Comments such as “my mother enjoys her food and eats everything given to her. They have a choice of menu and an excellent cook,” were typical. A service user noted that they get “plain and simple food, as I like it.” There was nothing negative fedback about the food. Care plans also included details about dietary needs, such as for the degree of vegetarianism where applicable, and about how people like their tea. Service users were seen to be provided with drinks and snacks regularly, and on request. A visitor noted that their relative is provided with drinks and snacks the same as them when visiting, and that adjustments in their relative’s diet have been accommodated when requested. Staff fedback that the menus have been considered in terms of nutrition, and that for instance, less people now use laxative medications due to better nutrition. Menus were seen to be suitably nutritious. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 18 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. There are suitable systems in place to help protect service users from abuse, including policies, care philosophies, and staff training. Incidents of aggression between service users are appropriately resolved through staff support. Service users and their representatives can be confident that any complaints will be suitably addressed. However, improvements are needed with ensuring that any complaints made are recorded about in the complaint book. EVIDENCE: The CSCI have received no complaints about the home since the last inspection. There has been one formal complaint within the home during this time. The investigation of this by the manager was shared with the inspector. The minutes of a ‘Safeguarding Adults’ meeting held by the involved service user’s funding authority were also supplied, at which the provider organisation’s independent advocate attended. The investigation report found the complaint to be partly upheld, and highlighted improvement actions for the home to undertake. This includes for the checking of a new service user’s weight on admission, improving the ease with which new service users can be helped to recognise their rooms (see also standard 24), and better checks of waste baskets in case personal items have been erroneously placed there by service users. The investigation is overall seen as extensive and transparent. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 19 The complaint is referred to within the open complaint book kept in the reception area of the home. Specific points are not divulged, as is appropriate in an open area. A further verbal complaint was referred to within a memo to staff. The manager explained the circumstances around the complaint, noting that it was not upheld. It was not referred to within the complaint book, which can lead to complaints being refused or lost. The registered provider must ensure that all complaints made about the services in the home are recorded about within the complaint book. Service user surveys found that all respondents always know who to speak to if the service user is not happy. This concurs with the good relationships generally observed between service users and staff, and the good availability of management to service users. Staff meeting minutes included brief discussions on examples of poor practice and abuse. Staff were able to explain suitable whistle-blowing procedures to the inspector, for scenarios of witnessing abuse. Training records showed that fourteen of the twenty-one staff have received training in abuse awareness, with plans in place to address this for the remaining staff including new staff. The home has an established record of acquiring Criminal Record Bureau disclosures before new staff start working. One visitor confirmed to the inspector that the manager had openly told them about an incident of aggression towards their relative from another service user, which they appreciated. One service user was able to confirm that staff sort out arguments between service users, and that “staff are lovely.” During the inspection, staff were observed to suitably attend to the occasional episodes of verbal aggression from one service user to another. Care plans referred to the behaviours of service users that can challenge the service, including with an attitude of positive resolution rather than confrontation, as is appropriate. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 20 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): All of them. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides service users with a comfortable, warm and clean environment with sufficient communal space and washing areas. Most bedrooms are single-use, and have sufficient facilities. A number of environmental adaptations have been installed, including a walk-in bath and a chair-lift. Improvements are needed with the accessibility of bedrooms and toilets, as all doors are white thus looking similar, and some lack sufficient signage. This could prevent some service users from accessing appropriate rooms independently. Bedroom locks, where used, must include emergency override facilities, to help ensure safety and privacy. There were some bedrooms with lingering offensive odour, which compromises dignity. These issues must be addressed. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home comprises two converted, former-residential properties. Some adaptations have been made to make it more suitable as a care home, including a chair-lift on one set of stairs, a walk-in bath, and a large communal area split into two lounges and a dining area. It consequently retains an oldstyle residential ambience but is generally not wide enough for independent wheelchair use. Additionally, there are a couple of steps at the entrance to the home, which should be considered in terms of access under the Disability Discrimination Act. Comments from service users about the environment were generally positive, including that it is “warm, but that’s how I like it.” Observations of the environment included that all the doors in the home are white, as are most walls. Whilst names of service users, room numbers, and toilet signs can all be attached to the doors, some service users may not be able to understand these and may consequently find the consistent white colour very confusing. Additionally, some doors lacked signage, such as for the toilet near the front door. These issues may be contributing factors for some service users wandering inappropriately, and to occasional service users being incontinent. An audit of individual service users’ needs with respect to doors is required, based on abilities and histories, so that signage and door colours can be coordinated to best meet their needs. Checks of a few hot-water outlets in the home found water to be at a suitable temperature. Other equipment to protect health & safety, such as windowrestrictors upstairs, grab rails, and adapted toilets, were in place. It was established that there are not emergency override facilities for the few service users with locks on their doors. These locks were previously provided following an audit of capabilities, in response to privacy issues. One notification to the CSCI from 2006 noted about an incident of aggression between two service users, one of whom had wandered into the other’s room. On this inspection, it was found that the service user’s room lock had been blocked due to safety concerns for that service user when they locked it. Locks with working override facilities would allow the service user to lock the room and prevent incidents, whilst still allowing staff to check on the service user if needed. The registered provider must ensure that locks with emergency override are fitted to the rooms of service users who would safely use them. A few maintenance issues were apparent during the inspection. The carpet in the lounge near the kitchen had significant tears on the edge near the dining area. This was explained in terms of the behaviour of a service user, with arrangements being made to replace the carpet. The manager also explained about how recent high winds had caused some areas of damage in the home. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 22 A couple of broken windows in stairwells had been boarded up. Fencing that had been blown down was already replaced. The registered provider must ensure that these issues for repair are addressed. The home was seen to be reasonably clean from the start of the inspection. The staff team were at the time working to cover the sick leave of one cleaner, however another cleaner continued to work. Surveys found all respondents stating that the home is always fresh and clean. Service users spoken with during the inspection also confirmed this. Comments received included that “whenever we visit, it is always clean and fresh and tidy.” The laundry area, as situated remotely round the side of the house, was seen to have a new washing machine and tumble drier compared to the last inspection. The room was seen to be sufficiently clean, and with suitable facilities for disinfection and sluicing. Lingering offensive odours were evident in a couple of bedrooms, from the tour of the home. The manager noted that carpets have been deep-cleaned. Lingering odour nonetheless suggests that further consideration of continence needs is required, to ensure that the rooms become odour free. In one case, it was noted that the communal toilet just along the corridor lacked signage, which could be a contributing factor. Bedding in the room was checked however and found to be suitably clean. The kitchen area was seen to be suitably clean and tidy, including within cupboards and the microwave. It stocked a reasonable amount of food, with an additional storage shed also being used. Weekly hygiene checks are recorded about, along with daily temperature checks of cold storage areas and cooked meats. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 23 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by a capable staff team. Staffing levels continue to be sufficient, based on previous agreements. There are reasonable levels of training amongst the staff team, including meeting the 50 expectation of NVQ (or equivalent) qualified staff. Improvements are however needed with ensuring that the whole staff team have received up-to-date training in some key areas, such as for fire safety and emergency 1st aid, as this was missing for some staff. Service users are generally protected by the home’s recruitment procedures. However, improvements are needed with ensuring that reference requests are appropriate and with acquiring a full employment history, as there were partial shortfalls in these areas. EVIDENCE: The rosters checked indicated that there continue to be four care staff on duty in the morning, three in the afternoon, two in the evening, and one between 9pm and 7am with others available on-call on the premises. This meets the general staffing level requirements agreed for this home. No agency staff were used within the rosters checked on. The roster includes a cook scheduled to work between 7am and 1pm, and two people employed as domestic staff. Additionally, one student on work placement was seen to be interacting with St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 24 service users on the first day of inspecting. The manager noted that students are regularly used at the home. Feedback and observations generally found the staff team very capable. One entry in the compliment book noted that staff “take very good care” which led to the service user being “always happy and contented.” Survey comments included that “you can talk to staff anytime,” and “I cannot praise the staff highly enough for their care and dedication to all the residents of the home.” The surveys also found five respondents stating that staff are always available when needed, with three finding this to usually be the case. Records showed that the clear majority of staff have had formal training in, for instance, manual handling, food hygiene, and for senior staff, medication management. Shortfalls were identified due to not having attended, or having out-of-date training, in the areas of emergency first aid, health & safety, and fire safety, as these each accounted for a majority of staff. This could leave service users being supported by staff across a shift whose knowledge in these areas could be either lacking or out-of-date. The registered provider must address this. Additionally improvements could be made to providing formal training in abuse awareness due to a third of staff lacking it, and in dementia care, as per the home’s registration, as the majority of staff have not had update training within the last year. Having the staff team up-to-date on these courses helps to ensure that service users are both better protected from abuse and are supported by appropriately-skilled staff. 6 staff have NVQ qualifications in care, including a number at level 3 where the minimum expectation is at level 2. There are also four people with nursing qualifications, and two with degrees in healthcare subjects. This accounts for just over the National Minimum Standard of 50 of qualified staff, which is encouraging. Induction booklets based on the national induction standards (Skills for Care) were being used for two newer staff members. The manager confirmed that the induction booklet includes relevant information about dementia. Both booklets were close to being completed, in terms of the staff member and the supervisor signing the relevant sections. Checks were made of the recruitment records of two newer staff members. These showed that application forms are used, personal identification is checked, and that two written references and Criminal Record Bureau (CRB) disclosures are acquired, all before employment starts. Improvements with recruitment are however needed. In one case there was no professional reference from the staff member’s last care-employer. The expected reference could raise concerns about the person’s abilities, and hence St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 25 is needed to establish whether or not this is the case. There was also one case of no documentation to clearly show that the person is eligible to work in the UK. At a procedural level, the application forms ask for ten-year employment histories, when the legislation now expects full histories. A full history would allow a better exploration of any employment gaps. The registered provider must address these issues as applicable. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 26 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. This judgement has been made using available evidence including a visit to this service. Service users benefit from a good standard of leadership and management in the home. This includes through a smooth handover of management responsibilities between managers at the time of the inspection. There are quality assurance systems in place to help ensure that the home in run in service users’ best interests. The home has good overall systems of handling health & safety issues, providing staff with supervision and support, and safeguarding service users’ finances. Improvements are only needed with ensuring that fire-exit doors are suitably accessible. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager has been in post since late 2004, having previously been the assistant manager in the home. He was successfully registered by the CSCI in January 2005. Dealings with the manager during this visit, and since the last inspection, have found him to be honest, conscientious, and knowledgeable. He achieved the NVQ level 4 qualification in management in 2005. The registered provider notified the CSCI about an imminent change of manager before the inspection. The registered manager was working his notice period at the time of the inspection, with an incoming manager present on a week’s induction during the second inspection day. The incoming manager has previously managed homes for older people with dementia, and so should be suitably experienced to take on the manager’s role for this home. She was also aware of the need to apply for registration with the CSCI. Surveys received by the CSCI included comments such as, “I am very sorry the manager is leaving.” Staff also fedback positively about the manager, and management in the home. Staff meetings continue to be held. The last minutes dated from late October 2006. They included about employment issues, health & safety clarifications, and consideration of how the home might currently be seen should an inspection occur. The minutes showed that both staff and management raise issues, which suggests open communication. Checks of two staff member’s files found that individual supervision sessions has been undertaken and recorded about in January 2007, and that supervisions are regularly held. The manager noted there had recently been a quality audit in the home, involving questionnaires being sent to service users and their families. A report from this was due to be made, in conjunction with a business plan for the year that would be overseen by the incoming manager. There is an independent person, employed by the provider organisation, who oversees the analysis of the questionnaires received, which is good practice. Management continue to look after small amounts of money on behalf of a few service users. Records are kept of the money and about any transactions including receipts. Checks of these raised no concerns. There was evidence of the proprietor additionally checking these records. Money was also seen to be securely stored. The manager provided a professional report about how safely water is managed within the water piping in the home. The action points from this report should be addressed. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 28 Documents showed that professional checks have been suitably and recently undertaken in respect of the gas systems, the portable electrical appliances, the fire systems and equipment, the chair-lift and hoists, the wheelchairs, and for the water systems against legionella. The manager was open that the electrical wiring certificate has expired, and showed evidence that a professional check of it had been booked. The home has a suitable fire-safety risk assessment, written by the manager, dating from August 2006. It includes the need for exit procedures in the event of fire to be reconsidered. At the time of visiting, the exit key for the back door escape route into the garden was being stored in one service user’s room, to prevent another service user from using it unsupervised. This however intrudes on the former service user’s privacy, and could lead to difficulties leaving the premises in the event of a fire. The registered provider must ensure that fire evacuation exits can be easily used in the event of a fire, without the set-up compromising service users’ rights of privacy. Another key point of the assessment was about the occasional service user inadvertently operating the fire-alarm via one of the emergency panels around the home. Plans were being made to address this through flip-up panels, which are recommended in key areas of the home. This should minimise the risk of a false alarm through inappropriate activation by a service user. Records are kept of weekly checks of the fire system and fire doors. Only professional checks are made of the emergency lighting, on a three-monthly basis. Internal checks should be considered, to help highlight any faults with the lighting in advance of professional checks. A thorough slips and trips risk-assessment was undertaken in writing in October 2006, in response to a requirement from the previous report. It includes an assessment of each room, and produced an action plan that was seen to have been addressed where checked on. This is encouraging. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 29 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 30 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. 1 Standard OP7 Regulation 15(2) Requirement A system of regularly reviewing and updating care plans, based both on changed needs and recognition of developments for the individual service user, must be set up. Care plans must be audited with respect to continence needs, where applicable, to ensure that guidance is clear and detailed, and to ensure that obstacles to continence are addressed wherever possible. Plans must then be followed. Individual service users’ health records must be kept up-to-date, with backdating taking place where needed. The registered provider must ensure, where service users need manual handling support, that staff enable the service user’s awareness of and involvement in the manoeuvre wherever possible, and that the manoeuvre is undertaken safely in line with up-to-date training. The registered provider must ensure that all complaints made DS0000038579.V325619.R01.S.doc Timescale for action 01/06/07 2 OP8 15(2) 15/04/07 3 OP8 17(1a) s3 pt 3(k, m) 13(5) 01/04/07 4 OP14 01/04/07 5 OP16 17(2) s4 pt11 01/04/07 St Joseph`s Care Home Version 5.2 Page 31 6 OP19 23(2)(a, e) 7 OP19 23(2)(b) 8 OP24 23(2)(e) 9 OP26 16(2)(k) 10 OP29 19 s2 pt 3, 6. 11 OP30 18(1)(c) about the services in the home are recorded about within the complaint book. An audit of individual service users’ needs with respect to doors is required, based on abilities and histories, so that signage and door colours can be coordinated to best meet their individual needs. The following maintenance issues must be completed: • Replacement of the lounge carpet near the kitchen due to significant tears on one edge. • Replacement of broken and boarded windows within the two stairwells. The registered provider must ensure that locks with emergency override are fitted to the rooms of service users who would safely use them, so that those particular service users may lock their rooms if they wish. The lingering offensive odours, evident in a couple of bedrooms, must be fully and permanently removed. The registered provider must ensure that the following recruitment checks are always pursued before employment begins: • One written reference must be from the last employer, in a care capacity, of at least three months’ duration. • Full employment histories are acquired. The former issue must be addressed for the specific staff members checked on during the inspection. The registered provider must ensure that formal training in emergency first aid, health & DS0000038579.V325619.R01.S.doc 01/06/07 15/04/07 01/07/07 01/04/07 01/04/07 01/08/07 St Joseph`s Care Home Version 5.2 Page 32 12 OP38 23(4)(b) safety, and fire safety, is provided for any staff lacking such training or for whom the training has become out-of-date. The registered provider must ensure that fire evacuation exits can be easily used in the event of a fire, without the set-up compromising service users’ rights of privacy by leaving evacuation keys in a nearby service user’s room. 01/04/07 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 the home’s written assessment of prospective service users include reference to: • Other factors beyond dementia that can cause confusion; • A detailed life history where possible; and • Those who were consulted as part of this process. Individual care plans should include: • Life-history details, to help to provide insight into the behaviours of people that have dementia; • More detail about the service user’s dementia care needs and how these are to be addressed; • How the service user communicates about pain; and • Clear evidence of consultation with the service user and their representatives. Individual care plans should be reviewed monthly, to help ensure that changed needs are considered and addressed. The allergy information for newer service users should be kept up-to-date within the medication file, for ease-ofaccess. A review of service users’ independence with eating is recommended, with adapted cutlery and crockery to be acquired where identified as benefiting individual service users. Wire radiator covers should be replaced with more homely DS0000038579.V325619.R01.S.doc Version 5.2 Page 33 2 OP7 3 4 5 OP7 OP9 OP14 6 OP19 St Joseph`s Care Home 7 8 9 OP19 OP29 OP30 10 11 12 OP38 OP38 OP38 versions. The two steps at the entrance to the home should be considered in terms of access under the Disability Discrimination Act. There should be clear evidence in writing of eligibility to work in the UK where any employee is not from the EU. The registered provider should ensure that all staff have up-to-date training in the areas of abuse awareness and dementia care, as this was lacking in some cases. This would help service users to be better protected from abuse and receive care that is appropriately skilled in dementia. The action points, from professional report about how safely water is managed within the water piping in the home, should be addressed. Flip-up panels should be installed over fire-alarm activation points in the home, to help prevent service users from inadvertently using the activation points. Internal checks of emergency lights should be considered, to help highlight any faults with the lighting in advance of professional checks. St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Joseph`s Care Home DS0000038579.V325619.R01.S.doc Version 5.2 Page 35 - 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!