Inspection on 26/07/07 for St Josephs

This inspection was carried out on 26th July 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 Josephs 06/06/06

St Josephs 30/11/05

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE St Josephs The Croft Sudbury Suffolk CO10 1HR Lead Inspector Jill Clarke Unannounced Inspection 26th July 2007 10:10 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 Josephs DS0000065099.V348956.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 Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Josephs Address The Croft Sudbury Suffolk CO10 1HR 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) 01787 888460 01787 888469 careforehomes@aol.com Carefore Homes Limited Lorraine Hodges Care Home 60 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (26), Mental disorder, excluding learning of places disability or dementia (1), Old age, not falling within any other category (33), Physical disability (2) St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To offer care and accommodation to 1 named person within the category of MD and DE, as per application V29740. 6th June 2006 Date of last inspection Brief Description of the Service: St Joseph’s is owned by Carefore Homes Ltd, and are registered to provide residential care for up to 60 people, from 55 years of age and over. Although the home can care for a maximum of 60 people, they have the flexibility to take up to 33 frail older people, up to 26 older people who have a diagnosis of dementia, and up to 6 people within the age range of 55 - 64 years, who have a physical disability or dementia. The home (part new build, part listed) opened in August 2005, and is located within walking distance of the town of Sudbury, which offers a range of amenities. These includes rail and bus links, shops, restaurants, hotel, banks, post office and public houses. In December 2006, following the conversion of the ‘convent’ building next door which is now linked to the home, they were registered for an additional 9 places. People can access the home by stairs or passenger lift. Some residents, due to their mobility needs, may find some areas of the home easier to access than others, therefore staff will discuss this on an individual basis, prior to allocating a room. All 60 bedrooms are of single occupancy with an en-suite toilet and wash hand basin. Some also have an en-suite shower. The home is divided into 3 main areas, and includes a specialist dementia care unit (Gainsborough), which has restricted access and a sensory room. Each of the 3 areas has their own lounge, dining rooms, assisted bathrooms and access to landscape gardens or patio. The home has been decorated and furnished to a high standard throughout. There is a hairdressing room, and limited car parking is available at the front of the home. Fees range form £645 per week to £665 per week for those requiring specialist dementia care, and includes all personal care, accommodation and meals. The home also offers short-term (respite) care, currently priced at £110 per day. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a unannounced key inspection, undertaken over 8 ¼ hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in May. This gave an opportunity for residents, relatives, visitors and staff, to give feedback on how they thought the service was run. There was a very good response, with 21 Service User, 40 relatives/advocates and 23 staff survey sheets being returned direct to the CSCI, information from which has been included in this report. To enable the inspector to gain feedback from people, who due to their mental frailty may be unable to complete a CSCI survey, the inspector completed a Short Observational Framework for Inspection (SOFI) record sheet. Developed in conjunction with the University of Bradford, this enabled the inspector over a period of 2 hours, to watch 4 residents sitting in the Gainsborough (dementia care) lounge. During this time the inspector was able to look, and record how the residents spent their time, how it affected their mood/well being, and how well staff engaged (interacted) with the residents. Observations made, have included in this report within the relevant sections. Prior to the inspection the home was required to complete their Annual Quality Assurance Assessment (AQAA). This enables the home to inform the CSCI on how well they are meeting the National Minimum Standards. The home is also asked to state what they feel they do well (and where able to provide evidence to back this up), and what areas they feel they could do better in. Information obtained from the AQAA, has also been included in this report. The Registered Manager, Lorraine Hodges was available throughout the inspection, and was very helpful in providing any required paperwork, and giving feedback on the service. A tour of the building took in the main communal rooms, and a sample of 2 bedrooms in the new conversion, a bathroom, disabled toilet, dining rooms and new kitchenette/diner on Gainsborough unit. Records viewed included, care plans, staff recruitment and training records, Statement of Purpose, staff rotas, Quality Assurance Survey and medication records. This and previous visits to the home identified that people living at St. Josephs preferred to be known as residents, this report respects their wishes. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home has worked hard since the last inspection, especially in developing their dementia care, to promote more individualised care. Staff are now using knowledge gained from their specialist training, to enhance the lives of people with dementia. It is important that they continue this work, whilst keeping the positive team spirit, to ensure they continue to develop. For example they could review their lunchtime routines, and the way they remove an empty plate as soon as someone finishes, rather than perhaps wait for everyone at the table to finish. The home needs to look how they can gain feedback on the service from ‘stakeholders’, such as visiting Doctors, Paramedics, community hospital staff (where applicable) Social Workers, and Hairdressers, to gain their opinions on the home. Where residents may be unable to communicate their views, due to their mental frailty, the home should look at how they can gain feedback in St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 7 a constructive way, which can be measured. For example using their staff who have been trained to undertake dementia mapping, to produce a report. The new assessment tool, for assessing resident’s mental health on admission, could be further developed, to monitor resident’s abilities, regularly, over a period of time. This would enable staff to evidence/monitor any changes in resident’s mental health and abilities, such as a person being able to do their buttons up on admission, are now having difficulties doing this task. It could also show where improvements have been made, by staff supporting residents to regain life skills, especially if they have been in hospital for a long period. The introduction of the new information sheets, which show how the resident likes to spend their day, including any care intervention, and preferred times of getting up, going to bed, need to be completed for all their residents. 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 Josephs DS0000065099.V348956.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 Josephs DS0000065099.V348956.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): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents, have their needs assessed, and are given information on the home, to support them in identifying if St Josephs can offer the level of care and support they are looking for. EVIDENCE: Since the last key inspection, the home has addressed a previous requirement and amended the Statement of Purpose to reflect the actual quality assurance work being undertaken. The home confirmed that ‘all prospective residents or their representatives are issued with a contract, terms and conditions, Statement of Purpose and residents brochure’. The manager confirmed that if required, they would make an audiotape of the information, if a person is unable to read them. Also a relative had offered to produce any documents in Braille, if the need occurred. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 10 All but 2 of the residents completing surveys, said that they had been given enough information about the home before they moved in, to support them in deciding if it was the right place for them. Where they had said ‘No’, comments indicated that the move had been undertaken quickly. Other comments included ‘good brochure’, and ‘I visited and had lunch’. Relatives also commented on the ‘excellent brochure and introductory talk with the manager’. The home encourages prospective residents and/or (if unable) their family or advocates, to visit the home prior to admission. The home in their AQAA states, this ‘enables the resident to have a named contact and a friendly face on the day of admission’. The manager will visit all prospective service users, either at their home, or care setting, such as the local hospital, and undertake a pre-assessment. For residents with dementia, this also includes a mental health assessment. A new resident’s care records, held a copy of their completed pre-assessment. Some times a resident may be living some distance away, and the home is unable to personally meet them to carry out their own assessment. When this happens they will contact any Health or Social Care professionals involved in their care, as well as relatives and advocates, to gain sufficient information on the level of support required. This is to support the home in identifying if they will be able to offer the level of care/service that the person is looking for, and it falls within their registration category. Relatives, and advocates surveyed, said that the home was able to meet the needs of their friend / relative, comments included ‘tremendous level of care for my mother – especially as she has become frailer and in need of greater level of care’. St Josephs DS0000065099.V348956.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. Residents are treated with respect, and staff understand the importance of involving residents in developing their plan of care, to ensure it meets their individual needs and preferences. EVIDENCE: Since the last inspection, staff have continued to develop the contents of their care plans to make them more informative to the reader, and ensure that the contents fully reflects how the residents wish to be looked after. From the 2 care plans looked at in detail, both held ‘summary sheets’, which gave staff enough information to be able to provide a safe level of care. This included brief statements such as ‘requires assistance with personal care’, rather than giving more detailed information on what assistance was required – for example – requires help washing back and feet’. However, this was currently being addressed with the introduction of the ‘me – all about me’, section of the care plan. This was more informative, and gave a good ‘pen picture’ on how the resident liked to spend their day, and the level of assistance they required/wanted. This included how many carers they needed to support St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 12 them, and how much care to give, whilst supporting the resident to maintain their independence. For example ‘I require the help of 1 carer to wash areas I am unable to reach, and to help me dress and dry’. The manager confirmed that staff were working to ensure all the care plans were being reviewed to ensure they held the same level of good, personalised, information. In undertaking this, the home will be able to show that they have fully consulted with the residents; to ensure their preferences and choices have been reflected throughout the care plan. The home had introduced a nutritional health assessment, and are awaiting staff training (undertaken by the hospital/community nutritionist) to enable staff to use the new assessment to monitor residents nutritional needs on admission, then throughout their stay. Until the training is in place, staff regularly monitors resident’s weight, and where they have concerns over dietary needs, they contact the nutritionist as required. Care plans also showed that staff are monitoring residents physical and mental health needs, and seeking further advice from health and social care professionals, when residents needs changed. The introduction of the new ‘traffic light system’ manual handling assessments, has addressed the shortfalls identified during the last inspection (see report dated 6/6/06). Using the system alerted staff to the resident being independent (green) requires some assistance (amber) and requires hoisting/transfer aid (red). The assessments took in all activities that a resident may undertake during the day, for example transferring from bed-to-chair. It gave staff clear guidance on how many staff were required, and were applicable which mobility aids to use. The assessment also gave information on any history of falls, condition of skin and any communication /behavioural needs the resident may have. Residents surveyed were asked if they received the care and support they needed, 15 replied ‘always’ and ‘6 ‘usually’. This reflected the response from relatives/advocates surveyed who felt that the home gave the level of support that they had expected/agreed with the home. Comments made included ‘when in doubt about any issue there is always someone available to help and point you in the right direction’ and ‘they are very good to me’. The manager confirmed that they had high expectations from their staff, to ensure residents are looked after as if they were their “own” grandparents. Residents spoken with, and time spent observing staff interaction during the inspection, confirmed that staff treated residents with dignity and respect. However, there was 1 shortfall during lunch, when a member staff twice, informed another carer in the room, that a resident (using their name) had just gone/come back from the toilet. Staff were heard to address residents by their preferred name/title. Where staff did use endearments such as “my love”, it included the person’s first St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 13 name, and the resident was seen to react positively to how they were being addressed. Whilst undertaking the SOFI, 1 resident informed a carer that they had a headache, the carer said they would go and ask the senior if they could have some Paracetamol. The member of staff then came back, and said that they would give the medication when they came round at lunchtime. Although it was a short time before the staff started the lunchtime medication (around 15 minutes) systems should be in place to provide painkillers, outside medication rounds, unless otherwise stated on the MAR chart. The medication round took place prior to residents going into lunch, with 2 staff giving out medication, following safe practice. This involved the checking of the medication held in ‘blister’ packs or pharmacist container, against the information given on the Medication Administration Records (MAR) sheets, prior to removing the medication from it’s container and giving to the resident. Whilst this was happening, 1 member of staff stayed by the open medication trolley. On completion of the medication round, the sample of MAR sheets looked at showed that they had been fully completed, and gave a clear audit trail of medication received into the home. A sample check of 2 residents medication, not supplied in the 28-day monitored dosage ‘blister pack’ from the pharmacist was checked, and the amount held by the home, corresponded to the information held on the MAR chart. To address previous regulatory shortfalls, the home has been undertaking ‘audit’ checks of the MAR charts, to ensure staff have been completing them correctly. An audit undertaken in May 2007 identified missing signatures/codes, nearly all during 1 medication round. Further investigation identified that it was an administration error, and the residents had been given their medication. The staff concerned had been made aware, and further monitoring put in place. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their life style, and supported to maintain their life skills, through organised, and 1 to 1 activities. EVIDENCE: In the home’s AQAA they stated that their programme of activities had continued to ‘go from strength to strength’. Residents surveyed were asked if there was activities arranged by the home that they could take part in. The majority of the replies fell into the ‘always’ and ‘usually’ categories, with 3 saying ‘sometimes’. Comments included ‘activities are not always to my taste, but I do take part in ones I enjoy like exercises and outings’. Another resident observed that ‘the majority of residents show little enthusiasm to participate in activities in spite of the efforts of the staff’. The homes own survey asked residents to rate (from excellent to poor) the ‘number of, and variety of activities on offer’. From those who had replied, 10 said ‘excellent’, 9 ‘very good’, 8 ‘Good’, and 8 scored it as ‘adequate’. 1 resident acknowledged that ‘activities are becoming more varied and numerous’. This was reflected during the inspection, with staff looking at more St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 15 ‘person centred’ activities, which were meaningful, and also supported hobbies. For example baking, gardening, folding napkins or helping to serve drinks. Whilst talking to residents, 1 said they had enjoyed their recent trip to the beach, where they had ‘Fish and Chips” which had been organised by the home. For another resident, who has dementia, it brought back good memories, especially seeing shops that they used to “buy their Christmas turkey”. Discussions with the manager identified that they were not able to support all residents to be able to go on the trip, and were looking to see how they could bring the experience of going to the beach – into the home. Residents to be able to take part with domestic chores if they wished, or pursue Relatives asked if they felt the home supported people to live the life they choose, all but 5 had replied either ‘always’ or ‘usually’, 1 had answered ‘sometimes’ and the others left blank. A relative felt that ‘there could be more opportunities to get out as well as carers being available to supervise individuals who want to get out occasionally, for example trips to the cinema. During the last inspection, time spent sitting with residents on Gainsborough unit, identified that during the 25-minute period, social ‘interaction was very limited’. To evidence how the home had improved over the last 12 months, the inspector sat in the Gainsborough lounge, completing a SOFI observation record over a 2-hour period. This focused on the interaction between staff, and 4 of the residents. During this time, the interaction was seen as very good, with all the residents observed seen to receive mental stimulation (through games, conversations and 1 to 1 time with staff), which had a positive affect on their well-being, and quality of life. Staff encouraged residents to join in with a soft ball game. The 2 members of staff each sat in the middle of a small group of residents to play the game and to enable good eye contact. They spoke to residents as they threw the ball, promoting discussions. Those who did not wish to take part, joined in by watching. 1 resident, aware the ‘inspector was observing’ took this as a sign of them wanting to join in with the game, and was not happy until the inspector, had thrown the ball back at least twice. This demonstrated a positive level of alertness, stimulated by the interaction, and when staff briefly moved away, residents continued to hold conversations with each other. Staff were quick to pick up when a resident asked what was for lunch, to develop this into a conversation about favourite dishes, which resulted in residents linking this with childhood memories. They also supported an ‘impromptu’ singing session, which was stimulated through another discussion about favourite songs. None of the activities seen came over ‘as just another task’ for staff to complete, instead, staff seemed to be enjoying the interaction, and adapted what they were doing to meet individual residents abilities and level of interest. This reflected on the positive atmosphere, and the resident’s responses. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 16 During the observation up to 5 care staff were seen in the lounge, to support the 13 residents involved. The manager confirmed this was a normal occurrence. Another resident was having a hand massage in the relaxing sensory room, by a visiting aromatherapist. As part of the SOFI observations, the residents being observed were followed into the dining room, to gain a view of their experiences during lunchtime. The dining room, with its co-ordinated furniture, and table settings, gave residents a ‘homely, comfortable atmosphere’, to eat in. There was not a lot of space to get around the tables. However, with 3 entrances to the dining room, this enabled wheelchair users, and people using mobility aids to easily access the dining room, without having to negotiate in-between the tables. Residents were not assisted into the dining until just before the meal was served. Some residents choose to walk in later, and were given a warm welcome by staff. Whilst waiting for the meals to be dished up, 1 member of staff asked a resident what they would be having, when they could not decide they reassured them by saying “wait until you see and make your mind up”. As each table were served, residents were shown both dishes on offer, so they were able to pick. 1 resident who did not eat meat was informed they were having “Quiche today”. The home’s AQAA, confirmed that they are able to meet residents different cultural and diversity needs by ‘catering for all dietary requirements whilst ensuring food is of an excellent nutritional value’. They also, ‘only use fresh ingredients, including seasonal vegetables and local suppliers’. Staff walked around the dining room and offering assistance as required. One resident was seen to have problems, as their dish kept slipping off the table mat, resulting in some food falling onto the floor. When this was fed back to the manager they said that they were aware, and they were addressing it by ordering some ‘non– slip’ matting, which would stop the bowls/plates moving. Trays were made up with paper doilies and plate covers for residents having their meals in their bedroom. As residents finished their main meal, staff automatically cleared the plate away, regardless if others at the same table were still eating their food. This at one stage left 1 person eating their main course whilst the other 3 waited for them to finish. Also 1 of the residents being observed, seemed to take the removal of their plate as a signal to leave the table, returning later for their desert. Where 2 residents at another table had finished their meal quite early, 1 tapped their fingers impatiently – waiting for the second course to be served. Once everyone had finished, dessert was served, table-by-table. Good practice was seen again, with residents being showed the dessert (Jam RolyPoly and custard) to support them in deciding if they wanted this. Where a resident looked hesitant, staff asked, “can I get you something else” such as cheese and biscuits or yoghurt. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 17 As people finished their plates the sound of staff scraping and clearing plates away, whilst others were eating, deflected away from the mostly relaxed dining room experience. The CSCI residents surveys, showed that the majority of residents said they either ‘always’ or ‘usually’ liked the meals served at the home, with only 4 saying ‘sometimes’. Comments made included ‘on the whole I think it is very good’ and ‘great care is taken that our daily intake is nutritious. Residents asked their views during the inspection described the food “as lovely”. A relative praised that fact that residents could invite their visitors to dine with them, another said that they provided ‘suitable food when unwell’. The homes AQAA, states that residents are involved in planning the menus through their residents meetings. As part of their on-going improvement, they were also looking to produce a ‘pictorial guide’ using photographs of different breakfast items to support residents, who are unable to fully communicate their needs, to choose what they would like from the breakfast menu. The location of the home enables residents to access the local community, which includes a range of shops and services (including places of worship). Relatives surveyed felt that the home supports residents to live the life they choose. This was further evidenced during the SOFI observation, discussions with the manager and information given in the AQAA. This showed that the home had taken note of issues raised in the last report, especially on the dementia care unit, with staff using every day tasks such as bathing, to turn it in to a ‘therapeutic activity thus raising the residents well being and empowering them to be part of their care’. Information on local advocacy services and community links was available in the entrance hall. St Josephs DS0000065099.V348956.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. The home has a complaints system in place to ensure any concerns are listened too, and the appropriate action taken by staff to resolve them, and safeguard the resident’s interests. EVIDENCE: The home has a complaint procedure, which ensures all complaints are investigated fully, and responded to, within 28 days. The procedure is displayed in large print in the entrance hall, and if required could be produced in Braille, or on an audiotape to help people with sensory loss. Residents surveyed, in response to the question - did they know who to speak to if they were unhappy, all but 2 had ticked the ‘always’ or ‘usually’ box. The remaining 2 people had not completed this section. Feedback from residents surveyed, also identified that they knew how to make a complaint, with 1 resident, who had not ticked a box , saying ‘I would go to the boss – but I don’t know their name’. All but 2 (who said they could not remember) of the relatives/advocates asked, also confirmed they knew how to complain if they were not happy with the care provided. Staff said they were aware of the home’s complaint procedure, which is discussed during their induction. All but 2 of the staff asked, said that they had received training in the home’s abuse (safe guarding) policy. The home’s AQAA states as part of their ‘plans for improvement’ said they were looking to ‘improve the type and style’ of St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 19 their vulnerable adult training. Residents surveyed, were asked if staff listen and acted on what they said, all except 1 had answered ‘yes’, with 1 resident writing ‘sometimes’. Other comments included ‘listen – but can’t say they always act’ (unfortunately no examples were given) and ‘staff do listen – very happy with the way things are run’. People asked during the inspection said that they were “very happy” and “had no complaints”. Discussions at this, and previous inspections evidenced that the manager was aware of their responsibilities in reporting any incident or suspicion of abuse. St Josephs DS0000065099.V348956.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): 19, 20, 23, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home offers a homely, clean, safe environment, which meets the personal and mobility needs of the current residents, whilst promoting independence. EVIDENCE: Words used by relatives to describe the environment at St Josephs, which has been opened nearly 2 years, included ‘comfortable, clean, tidy and homely’. In response to residents being asked if the home was kept clean and fresh, 12 said ‘always’ and 5 ‘usually’. They said it was ‘very well cleaned’, ‘a lot of time and effort goes into keeping the house comfortable’ and ‘the home is beautifully warm’. This reflected the findings on the day, with no unpleasant odours. Whilst walking around the home it was positive to see that the washable continence covers, where no longer automatically being put on all the armchairs in the dementia unit, instead only being used where there had been an identified need. The dementia unit also evidenced better signage to support people in locating different rooms such as the toilets. Since the last St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 21 inspection the activities room has now been changed to kitchenette / dining room, which residents were using in the afternoon to bake cakes. 1 resident said that the gardens are kept ‘nice’, and that ‘the trees are lovely’. Concerns were raised at the last inspection (see CSCI report 6/6/06) over the thistles in the dementia garden, which residents could grab hold of. This had been addressed, and the use of bright coloured objects and plants gave residents points of interest, which they could touch, feel and smell. Bedrooms were personalised, and met people’s needs. Residents were observed freely walking around the dementia unit, making use of the lounges and gardens. Following an accident, residents no longer had access to one set of stairs, which are in the old part of the building. Since the last inspection, the home has converted an old convent next to the building into 9 extra bedrooms, bathroom, lounge and kitchen, which is linked to the main part of the home. Time spent talking to 2 of the residents living in the new extension, showed that they were pleased with the standard of the accommodation, which they felt was to a high standard. A relative had commented on their survey that there ‘was no particular way of signalling an emergency, rather than a need for a carer that is not urgent’ when using the call bell. The manager confirmed that pressing the call bell twice – rather than once would alert the staff that there is an emergency situation. They felt this concern had been addressed, with the resident being shown again how to use the call bell system. The relatives/advocates CSCI surveys asked people how they thought the home could improve, 2 relatives commented that towels were being taken away to be washed – but not always being replaced at the same time, which resulted in the person being left without a towel to dry their hands. This has been raised previously with the home. The manager confirmed that there is more than sufficient towels to ensure staff replace with a clean towel straight away, and they would remind staff again. Another relative felt that ‘carers do not always relay message/requests’ re maintenance problems to the senior member of staff ‘who is able to solve the problem’, for example if a call bell is not working, which could lead the resident to ‘panic’. This was fed back to the manager, who produced a ‘maintenance book’ from the cupboard in the office. They said that staff are expected to record in the book any problems – and leave it on the desk to alert the manager that something had been written in. Where there is a health and safety risk, staff would speak to the manager as well record in the book. The manager said they always monitor the building and identify/ address any maintenance issues. During the inspection whilst walking around the home, it was noted in the easy access toilet downstairs, the paintwork was starting to show signs of wear and tear. The manager said that they did not employ a maintenance person but used the services of a building firm, linked to the owner, who are prompt in St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 22 addressing any issues. They would look at the areas in need of redecoration and arrange for this to be carried out, as part of their on-going re-decoration works. St Josephs DS0000065099.V348956.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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure required recruitment checks are carried out, and staff receive induction training, to ensure they have the required skills and knowledge to undertake their role. EVIDENCE: Residents surveyed were asked if staff were available when they needed them, had all replied ‘always’ or ‘usually’. Comments included ‘always – nothing is too much trouble – day or night’, ‘can’t say always’, and ‘there are loads of them’. Residents said staff were ‘helpful and caring’. One relative felt that during the morning ‘staff are often under stress with main workload – temporary help during 8 – 11am would relieve the strain’. The current staffing levels given by the home are 11 care staff in the morning (across the home), which includes the senior in charge, and 9 in the afternoon for up to a total of 60 residents. However, the manager said that they would shortly be increasing both shifts by an extra carer. Rotas supplied for the 2week period (9th – 22nd July 2007), showed that staff worked a mixture of shifts covering the day and evening period. The rota for 9th – 15th July showed that on some mornings, the level had dropped to 10 carers, plus the manager who works extra to the rota. At night, there are 4 staff on duty in the building. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 24 From the 23 staff who were asked if they felt the ‘current staffing levels are sufficient to meet residents needs’, 20 had replied ‘always’, 2 ‘no’, and 1 had indicated both ‘yes’ and ‘no’. From those who had replied ‘no’, there were no care issues raised, to give any further information may lead to people being identified. During the SOFI observation, staffing interaction was seen as good for those observed (see Daily Life and Social Activities section of this report). During the 2 hours, up to 5 staff were observed in the lounge, with a minimum of 2 carers always around. The manager confirmed that they were aware that residents dependency needs can vary throughout the day/week. To support them in identifying/monitoring that they have allocated staff correctly across the home, they spend time on the units each morning, to assess the situation and identify any residents who may require more 1 to 1 time. For example someone who is terminally ill, or very agitated due to their varying mental health needs. All but 2 of the staff felt that the home has a good training and development programme to support staff. However, all 23 felt that they received sufficient training to undertake their role. Staff spoke positively of the ‘happy and friendly atmosphere’ at the home, and felt they worked well together. This reflected the information given in the AQAA, where the manager states ‘our commitment to continuing personal development encourages staff to want to learn and progress through to more senior roles, which raises staff morale and ensures that staff feel valued’. They also write in the section ‘how we have improved in the last 12 months’, that they have ‘listened to our staff and understand that it is not simply the mandatory training that is required. Many of them wish to undertake other training, which although may not be directly linked to their role, improves their understanding and adds to their personal development’. Also, from information supplied by the home showed that 15 of their 30 care staff have obtained a National Vocational Qualification (NVQ) level 2 or above, with a further 7 currently on the course. Following the last inspection a requirement was made to ensure that the home was in receipt of 2 written references, prior to staff commencing their employment. A sample check of the newest member of staff’s recruitment paperwork, confirmed that this was happening. The personnel file also held all other the required paperwork to validate the person’s identity, and copies of training certificates to prove they had obtained the qualifications, that they had listed on their application form. At the time of the inspection, 1 person was receiving their ‘local’ induction, which gives them an insight into the layout of the home, daily routines, emergency procedures, and a chance to meet residents and other staff on duty. Where staff do not hold a NVQ, and are new to care, they undertake Skills for Care common induction training, through a local training centre. If St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 25 they do not qualify for this free training it will then be undertaken ‘in-house’ by the companies Operations manager. As part of the staff’s induction, they will work “1-2 weeks supernumery”, the manager confirmed that this would be extended if needed, or could be reduced, if the person is an experienced carer. St Josephs DS0000065099.V348956.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, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, and staff are committed to working in the best interest of the residents. EVIDENCE: The positive feedback given in the CSCI staff surveys showed that there is a very good team spirit at the home. Staff praised all aspects of the Registered Manager, Lorraine Hodges - work and values. They felt that there had been a ‘real turn around’ during the ‘last 12 months’, saying ‘Lorraine works hard and spends a lot of time supporting staff’. The company ‘stepping back’, and allowing the manager to gain confidence, and prove their management abilities has helped this. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 27 Other comments made by staff included ‘the care home is well managed’ , ‘the manager is very approachable and very supportive – I am happy here’, and the ‘really happy and friendly atmosphere makes it a pleasure to work here’. This positive atmosphere, which helps ‘staff work well as a team and strive to give their best to residents’, was observed during the inspection, and mentions during conversations with residents and their relatives. Staff confirmed that they received regular 1 to 1 supervision, and were given ‘good support’. Information supplied by the home (AQAA), and records seen during the inspection, confirmed that monthly unannounced visits were now being undertaken, by the company’s Operations Manager. During the visits, as part of their quality monitoring, they sample check records, such as MAR charts (see Health & Personal Care section of this report), and gain feedback from residents and staff. At the end of the visit, they complete a report of their findings and give feedback to the manager. Since the last inspection the home has carried out their own quality assurance survey in May 2007, which has been analysed, and will shortly be made available for people to read. The home had a good response to their surveys with 43 out of the 54 residents, and 40 out of the 56 relative surveys being returned. Questions asked on both set of surveys were the same, and covered different aspects of the service, including management, standard of care, cleanliness and food. Several comments such as a request for ‘an overnight room’ for relatives, had also been written on the CSCI relative surveys, therefore will be answered by the home as part of their feedback. There was no feedback from ‘stakeholders’ (such as Doctor, Community Nurses, Social Workers) who come in contact with the home, and could give feedback from their visits, and level of support given. This and previous inspections have confirmed that the home has systems in place for the safe keeping of residents’ personal spending money, if they do not wish to look after it themselves. This includes keeping each resident’s money in individual containers, with records of all deposits and withdrawals. A sample check of 1 resident’s monies held against the homes records was correct. Although not checked at this inspection, the home confirmed in their AQAA that they have all the required policies and procedures in place, to ensure the safety of both people living and working in the home, which were last reviewed in July 2006. St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 3 N/A 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 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X X 3 3 4 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 4 3 X 3 3 3 3 St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 29 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. 1. Refer to Standard OP8 Good Practice Recommendations The home should further develop their mental health assessment tool, to support them in monitoring residents mental health and abilities, which will enable staff to identify any changes – and where applicable take appropriate action. Where it was identified that the resident has a headache, systems should be in place to make sure, taking into account their MAR chart, they are given the Paracetamol straight away. The home should further develop their Quality Assurance surveys, to included feedback from people who have contact with the home in their professional role, and those residents who are unable to complete a survey, or fully communicate their views of the service. 2. OP10 3. OP33 St Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Area Office 1st Floor Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Josephs DS0000065099.V348956.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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