Inspection on 06/06/06 for St Josephs

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Josephs 26/07/07

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 6th June 2006 09:35 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.V297616.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.V297616.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 Carefore Homes Limited Lorraine Hodges Care Home 51 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (26), Old age, not falling within any other of places category (25), Physical disability (2) St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: St Joseph’s is owned by Carefore Homes Ltd, and are registered to provide residential care for up to 51 people, from 55 years of age and over. Although the home can care for a maximum of 51 people, they have flexibility to take up to 25 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. An application is currently being processed to accommodate 1 named resident within the category of MH and DE. The home opened in August 2005, and is located within walking distance of the town of Sudbury, which offers a range of amenities. These include public rail and bus links, shops, restaurants, hotel, banks, post office and public houses. The home is located on 2 floors, which can be accessed by the 2 passenger lifts or stairs. All 51 bedrooms are of single occupancy and have en-suite toilet and wash hand basin, 22 of which, also have an en-suite shower. The home is divided into 2 units, one of which is a specialist dementia care unit, which has restricted access and a sensory room. Both units have their own lounges, dining rooms, assisted bathrooms and access to landscape gardens. The home has been decorated and furnished to a high standard throughout. There is a hairdressing room, and car parking is available at the front of the home. Fees per week (as stated by the home) are currently £595, which will be rising to £625 in August 2006, and includes all personal care, accommodation and meals. The home also offers short-term (respite) care, currently priced at £90 per day. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 8 ½ 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. The day of the inspection also coincided with the first time the home had been full (51 residents) since it opened in August 2005. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home at the beginning of May. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (8), joint relative/visitor (31), and staff (7) feedback cards have been included in this report. The home is divided into 2 parts ‘Main’, and the dementia care unit ‘Gainsborough’. Discussions with residents living in the main part of the home, during this, and previous inspections, and information given via the CSCI surveys, gave a good insight that they felt their care needs were being generally met. A complaint made to the CSCI (March 2006), and some comments written on relatives feedback cards, raised concerns as to whether there was enough staff, and social stimulation/activities, to meet the residents on Gainsborough unit needs. Taking this information into account, the inspector with the Gainsborough unit now fully occupied, decided that they would use this inspection to focus on the level of service that residents with dementia are receiving. Time was spent observing the daily routines, sitting, and talking to residents on the unit. Although the focus was on dementia care, time was also spent talking to a resident living in the main part of the home. Staff (Registered Manager, Operations Manager, Senior Care Officers, Care Assistants, Housekeeper and Chef) was helpful and cooperated fully throughout the inspection. A tour of the building, took in all the communal rooms and a sample of 4 bedrooms, bathroom, laundry and activities room. Records viewed included, care plans, staff recruitment and training records, Fire Risk Assessment, Statement of Purpose, Menus and medication records. Previous visits to the home identified that people living at St. Joseph’s preferred to be known as residents, this report respects their wishes. What the service does well: The home is well situated within walking distance of the Town Centre. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 6 On entering the home, you are made to feel welcome by residents and staff. The environment is homely and comfortable, furnished and decorated to a high standard. This was also reflected in comments made by relatives (CSCI Comment Cards) ‘This is a beautifully kept home’, ‘the whole ambiance of the home is lovely’, ‘Relatives always made to feel welcome’, and ‘very friendly smiling staff’. Residents are able to invite their guests to lunch, at no extra cost. Meals are well presented, varied and nutritious. Residents who had completed the CSCI comment cards wrote ‘everyone is very supportive’, ‘staff are all helpful, patient & cheerful’, ‘I am happy and content here’. Time spent with a resident during the inspection, identified that previous concerns that the level of service might drop as the home increased it’s occupancy, felt that this had not happened. Relatives who had completed the CSCI comment cards, had written additional comments, which included, ‘In general I have been very pleased with the care given’, ‘I would, and have, recommended St. Joseph’s to many friends and colleagues’, ‘excellent – couldn’t wish for a better home’, ‘ lovely caring environment’ and ‘we are so grateful and full of admiration for the loving care given – cannot fault it’. What has improved since the last inspection? What they could do better: Feedback from residents who had completed the CSCI comment cards was positive over the standard of care received in the main section of the home. To obtain feedback for the more vulnerable residents, who have differing levels of dementia, the inspector spent 25 minutes sitting and observing residents and staff going about their daily routines. It identified that when staff did spend time with residents, which was limited during this time, they were more alert and took an interest. When left alone, residents with nothing to do, some sat and fell asleep. One relative’s comment card stated ‘it would be great if there were more opportunities for social activity’. Another relative felt that at times staffing on the dementia unit was ‘below optimum levels’. This inspection St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 7 identified that staffing levels on the dementia unit does need to be reviewed, to ensure that staff can offer flexible care, around the residents timetable, ensuring their individual social, physical and mental health needs can be met. The home, now it has been open nearly 10 months needs to establish way of gaining feedback from all the people using the service, to be able to monitor the level of care being provided. The Statement of Purpose states how this will happen, but is not yet happening. Staff need to build up on the current range of activities, to ensure that they meet all residents individual social needs and interest. The manager, though their course in Dementia has identified some good practices, which would support residents with dementia, they now need to show how they can put this into practice. Better use of colour and signage could be used in the dementia unit, to support independence and help orientate residents. Staff need to be more vigilant in reporting any hazards, to ensure residents safety and comfort. 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. St Josephs DS0000065099.V297616.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.V297616.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given the information needed, to support them in identifying if St Josephs offers the level of service they are looking for. They have their needs assessed and are made aware of the fees, and Terms and Conditions of residency. More information on residents differing level of dementia, obtained prior to admission would assist the home in ensuring that they are not only able to meet the prospective person with dementia care needs, but have taken into account other residents personalities and complex care requirements. EVIDENCE: As part of the home’s application to take a younger resident who has dementia, the home has been asked to update their Statement of Purpose to reflect this and send a copy to the CSCI. The information given in the ‘Quality Assurance Program’ section does not reflect the actual quality assurance work being undertaken (see Management & Administration section of this report) and needs to be amended. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 10 Seven out of the 8 residents asked (CSCI comment cards) if they had been given enough information on the home, had replied ‘yes’. The Operations Manager said that normal practice was to send residents information on the home (Residents Brochure), prior to their admission. If in the case of an emergency admission, then the information pack would be given on their arrival to the home. The resident’s brochure gave people living at the home useful information, which included, meal times, laundry, hairdressing, housekeeping, Church, and Library services. When relatives were asked (CSCI questionnaire) if they had access to a copy of the home’s CSCI reports, 11 out of the 31 had replied ‘no’. This was fed back to the management who said that they had tried leaving a copy out on display, but found these went missing. To ensure everyone did have access, they now kept them in the Manager’s office, and signs had been placed on all the notice boards, informing residents and visitors where a copy could be obtained. From the 8 residents who had completed the CSCI survey, 5 had said that they had received a contract, 1 said a member of their family had been given a contract, and 2 residents said that they had not received them. This was fed back to staff who said that sometimes delays were caused through residents who were partly social funded, which the home did not have any control over. However, to ensure that all residents are aware of their terms of residency, a sample copy is attached their Statement of Purpose. A relative stated (CSCI survey) that during the admission period, which was a difficult time as a family, that they had ‘received support and useful advice from both management and staff at St. Joseph’s’. The manager confirmed that a pre-admission assessment is undertaken prior to prospective residents moving in. Concerns were raised at the last inspection on the quality of the pre-assessment; especially on gaining enough information around a resident’s dementia care needs. The care records (care plans) for a new resident, held a copy of Individual Needs/Assessment Plan, undertaken by the Manager, 3 days before the resident was admitted. The home does not use a recognised ‘dementia’ tool, which would support them in identifying the level of dementia, and capabilities at the time of admission, which can then be used as part of their on-going assessment. All residents are invited to look around the home prior to admission, some residents choose to take respite care first, so they can take a view on the level of service provided, and get to know the staff. During this and the last inspection, the Manager was seen to show relatives of prospective residents around the home, and answer any questions. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 11 St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be addressed by their preferred name and have their own care plan. However, there was insufficient information to be assured that resident’s (who have dementia), physical, social and mental care needs will be met. The home has systems in place for the safe administration and storage of medicines. However, not all staff are following these procedures, which could potentially put residents at risk. EVIDENCE: Time was spent talking to a resident over the level of support and care they received, which was positive; they liked the staff and had no complaints. The 8 residents who had completed the CSCI survey, when asked ‘Do you receive the care and support you need? 6 had replied ‘usually’ and 2 ‘always’. One relative prior to the inspection had raised concerns over the level of support given to a resident whilst they stayed on the dementia care unit Gainsborough. To look at the care on this unit 2 residents care was tracked St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 13 during the inspection, which involved spending time with the residents and reviewing their care notes. Care plans held a copy of the resident’s individual need/assessment Plan, which covered personal care, communication, likes and dislikes. The files held a monthly care plan review sheet, which had not been completed. Staff completed a record sheet to confirm when they have assisted residents with a bath/shower and changed their beds. One of the residents sheets, had several areas not completed for May, although cross referenced with the daily records, confirmed that residents were receiving personal care, and that staff had not fully completed the records. Staff had written a daily report on the resident’s welfare, and a record was being kept of Doctors and Community Nurse visits. Other records held in the care plans for staff to complete were ‘weight charts’, ‘Short Term Needs Assessment’, ‘Risk Assessment sheet’, and ‘Person’ Assessment. Time spent with 1 resident identified that they had fallen, sustaining minor injuries, and had problems with their mobility. Their care plan held a detailed ‘body chart’ which gave information on bruises and cuts sustained, although their falls risk assessment had not been completed. Staff assess resident’s mobility needs using a ‘Person Assessment’ sheet, which was looking more from a staff’s perspective, to minimise any risk of injury, rather than assessing the residents mobility needs. The home was asked to take immediate action to ensure that manual handling risk assessments were undertaken on all residents, assessing each daily living task (such as getting in and out of bed, bath, transferring from bed to chair). An entry in a care plan related to a resident falling out of bed, and ‘bouncing off’ a mattress, which had been placed on the floor next to the bed. When this had happened staff recorded that the resident had become entangled in the lamp wire and call bell. The home, to ensure the safety of the resident was asked to undertake immediate action to risk assess the situation. Care plans did not contain a copy of the resident’s photograph, however the Manager confirmed that they did hold photographs of all residents. Good practice was seen with staff risk assessing the condition of the resident’s skin on admission, to be able to take action to prevent the occurrence of pressure sores. ‘Weight Charts’ were held on file, which monitored residents monthly weight gain or loss, however 1 had not been completed. There was no nutritional screen tool used by staff to assess resident’s dietary needs on admission. Staff had systems in place to record all medication coming into, and out of the home, and to ensure medication was stored securely. The dispensing pharmacist currently sends the majority of residents’ medication to the home in ‘blister’ packs every 28-days. Liquid medications, and tablets that cannot be dispensed in the ‘blister’ packs are sent in the pharmacist’s original container. At the time of the inspection a Senior Care Officer was seen checking in the next 28-day supply of medication. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 14 The home completes a Medication Administration Record (MAR) chart for each resident. The MAR sheet gave details on how much medication was received into the home, when the medication is to be taken, and the prescribed dosage. The home’s policy for safe administration is for staff to initial or enter a code, on the MAR to confirm that the medication has been given to the resident, at the correct time. A sample check of the MAR charts for half the home, identified gaps where staff had not signed. A check of the ‘blister’ packs being returned to the pharmacist, identified that staff must have given the medication, but forgotten to sign the MAR sheet. However, for 1 resident, where staff had not signed to state medication given, the medication, which was not held in a blister pack, was counted. This identified that the medication had not been given for that night. A check of a second medication, which had not been signed for, could not be undertaken, as the home had not recorded the original amount of medication received. Concerns over staff not completing MAR records correctly, and not giving as prescribed, was raised during the last inspection, and the home asked to take immediate action. Staff recorded the room and fridge temperatures, to ensure medication was stored at the correct temperature. Opened eye drops containers, stored in the fridge had not been dated when opened; however a member of staff confirmed that this was normally undertaken. They also said that prescribed eye medication was thrown away every 28 days, on receipt of the next prescription. The homes controlled medication was not checked during this inspection, but checks undertaken during the last inspection (8/2/06) identified that staff follow safe practices in the recording and administration of controlled medication. The manager confirmed that they were still storing medication to be given rectally, in the event of a resident having a fit. They were aware that staff could not administer unless trained and deemed competent, and were still trying to access training. Staff were heard to address residents by their preferred name, which for some residents was their first name, and at other times their full name. Whilst sitting in the lounge on the dementia unit, a member of staff was blow-drying a resident’s hair. This became a focal point for 2 other residents who had been walking around, and went to join the resident. This led to discussions with the management, that if the resident was not mentally frail, would they have wanted their hair dried there, instead of the homes purpose built hairdressing room. Although it was noted that the member of staff felt they were undertaking this, in what they felt was in the best interest of the resident, it identified further staff training needs. A resident was also seen to have a wet patch on the back of their skirt in the morning, which they were still wearing in the afternoon, however by then it had dried, when the inspector brought it to the staff’s attention. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 15 A resident described staff as “very good, very kind”. Relatives (31) who had completed the CSCI, all said that they were satisfied with the overall care provided. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a good standard of food, which is nutritious and well presented. Staff are committed to ensuring residents are supported to maintain links with their family and visitors. The home’s range of activities needs to be further developed to meet all residents needs and interests. EVIDENCE: Time spent talking to a resident in the main home, confirmed that they felt the routines of the home were flexible, and they were in control of what they did during the day. This reflected previous conversations with residents during the last inspection, who did not feel coming into a home, had lost them their freedom. Visiting is at any time, and residents are free to invite their visitors to lunch. This was appreciated by a relative who wrote (CSCI comment card) ‘I think the policy of allowing residents to invite any guests they choose for meals, without charge, is excellent and makes for a convivial atmosphere in the dining room’. Although breakfast is served 7 to 8.30 am, the Chef confirmed that residents could have breakfast at any time. One resident had their fridge in their bedroom and drink making facilities, to enable even more flexibility. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 17 All relatives/ visitors completing the CSCI survey, felt that staff made them feel welcome, comments made further reflected this, ‘Caring and attentive staff both to (name of the resident) and ME’, ‘the atmosphere is very welcoming and the food delicious’. Relatives felt the policy of residents being able to invite their guests to lunch, without charge was ‘excellent’ and made for a ‘convivial atmosphere in the dining room’. On admission residents (if able) or their representative, are asked to complete a ‘Residents requirement sheet’. This enables residents to choose from an extensive list including cereals, juices, preserves, cereals and cooked items for breakfast. The list also gives information of the resident’s preferred time, where they would like to have breakfast, like/dislikes and if they have ordered a newspaper. Resident (survey) ‘meals are well presented, colourful and adequate’. A complaint made to both the home and the CSCI, identified concerns that residents who are mentally frail, may be unable to alert staff if they have not received their breakfast. To ensure residents are not forgotten, the home has a system in place to double check meals have been served. This consists of a board in the kitchen, where each room number has a hook, and a tag attached, with the residents breakfast requirements. These are placed on the breakfast trays, and returned when the resident has been served. The Chef monitors the situation to ensure all ‘tags’ have been returned. The CSCI resident’s survey showed that 3 out of the 8 residents ‘always’ liked the meals provided by the home, 3 ‘usually’ like the meals and the remaining 2 ‘sometimes’. One resident commented that the ‘meals are well presented, colourful and adequate’; another felt the vegetables were ‘overcooked’. Another relative described the food as ‘delicious’. Residents living in the main home, are offered sherry before, and wine with their lunch. Lunch times (starting at 12.30pm) are staggered between the 3 dining rooms, which enables the Chef to supervise the meal provision. Lunchtime menu consisted of ‘Braised Pork Casserole with Apples & Grain Mustard sauce or Mushroom Stroganoff’, followed by Pineapple Upside down cake. Evening menu served from 5.30pm, consisted of ‘Soup of the Day’, Selection of Freshly made Sandwiches, Smoked Haddock Quiche served with salad. The menu stated that ‘A Cheese board & Fruit bowl are always available in the evening’. The Chef said that they walk around the home during the morning, to and ask residents their choice for lunch. The staff liaise with residents on Gainsborough unit, to ask their choices. A list in the kitchen, gives information on any resident’s specialist diets, likes and dislikes. Now the home is up to full occupancy, the Chef is looking to arrange a residents meeting, to enable ideas to be shared for the new menus. Residents were offered hot drinks throughout the day, and whilst sitting with the residents sitting in the garden, they were offered cold drinks. From the 8 resident’s who had completed the CSCI survey, when asked ‘are there activities arranged by the home that you can take part in? feedback was St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 18 mixed. One had replied ‘always’, 3 usually, 2 ‘sometimes’ and 2 residents had ticked ‘never’, 1 of whom had added ‘ not that I know of’. Another resident wrote that a ‘Pianist plays popular music Tuesday afternoons (which was heard during the inspection, and suggested ‘that more activities could be arranged – e.g. exercises’. The information board gave details of activities arranged each afternoon. A relative spoken with felt that staff did not interact enough with residents on the dementia unit. The relative felt more time was needed for staff to be able to sit and speak to residents, they said that when they had spoken to residents, they had told them that they were bored. Another relative had written (CSCI survey) ‘it would be great if there were more opportunities for social activity’. Information on church services were displayed around the home. The inspector joined the residents for approximately 25 minutes sitting in Gainsborough (Dementia care) lounge, to observe social interaction. During this time, interaction was very limited, with staff walking through the sitting area, carrying on about their duties. When staff did take time to acknowledge residents, the response was positive. An example seen included the Operations Manager acknowledging residents by name when they walked past carrying seat pads for the garden furniture. This resulted in a positive response, with 2 residents offering to help carry the seat pads outside, which they did. A housekeeper when passing, also gently ‘tapped’ a resident’s shoulder, and waited whilst the resident turned around and smiled at the acknowledgment. One carer was seen to dry a resident’s hair (see previous section ) and on completing the task the 8 residents were left alone, 4 residents when left alone closed their eyes. One resident who was asleep, awoke and asked 2 other residents if it was lunch time yet?, they replied it would be “a long time yet”. The resident then responded by saying “well I go asleep again”, this was repeated again after 10 minutes. Shortly after member of staff walked in and started to organise residents with playing a game of ‘connect’ or ‘dominos’. The inspector left the lounge, and on-returning 10 minutes later, the lounge had a busy atmosphere, with 1 resident watching sitting looking at a game of ‘patience’ being played on a laptop. The resident who had been asleep – only waking to ask if it was lunch time, was now looking at a newspaper. Residents were also seen in the afternoon to be playing balloon games. The dedicated activities room showed samples of residents ceramic work, and greeting cards they had made during craft sessions. Photographs on the walls showed residents potting up plants, and a notice board gave information on arranged afternoon activities and church services. St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect any concerns to be listened to, and staff take action to resolve them. EVIDENCE: The home has a clear system in place to record and monitor complaints, or concerns received. In the period dated 28/3/06 to the 10/5/06, the home had received a total of 5 complaints, 2 made directly to the CSCI concerning the standard of care a resident with dementia received whilst they were at the home, and the second related to the homes security. Three other complaints made directly to the home, had been resolved. From information taken off the staff-training matrix given during the inspection, this showed that 26 (66.67 ) of the 39 staff had received abuse awareness training. Six out of the 7 staff completing the CSCI surveys, confirmed that they had received training, and 1 stated that they were new, and were awaiting their training. St Josephs DS0000065099.V297616.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect a home, which is comfortably furnished and decorated to a high standard. Staff are committed to ensuring the environment is kept clean and odour free. Health and Safety hazards are not always being identified, which could potentially put residents at risk. EVIDENCE: During the last inspection a member of staff raised concerns that they felt that there were not enough hoists and slings to meet the residents transfer needs, which had resulted in residents having to wait. Prior to this inspection, 1 resident had commented (CSCI survey) that ‘on 1 or 2 occasions’ that they had ‘to wait to use the commode and hoist’, and that they found it ‘very difficult’. During this inspection the home provided a list of all the residents who require transfer aid, including if applicable the size of the hoist sling. The list showed that out of 51 residents, 4 people were assessed as requiring a ‘stand aid’, or St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 21 hoist. The home was also asked to supply a list of manual handling equipment, which showed that the home had 2 hoists (1 was for the specific use of a resident) and a ‘stand aid’, which should be sufficient for the residents needs, to ensure that they are not kept unduly waiting. It was noted that the home did not have any large slings, and held only 1 medium and small sling for each of the hoists. The home confirmed that large slings were not required at the present time. Prior to the inspection, discussions with a relative identified that resident’s bedrooms did not always have towels or flannels when they visited. This was also reflected in a resident’s comments (CSCI survey) ‘would suggest that clean flannels & towels should be brought before removing the soiled ones to ensure flannels and towels are always there’. Bedrooms visited during the inspection, all had towels and flannels. Residents (8) when asked (CSCI survey) if they felt the home was kept clean and fresh, 4 had ticked ‘ always’, with 1 resident commenting ‘Excellent, very thorough’, and 3 had stated ‘usually’. Whilst walking around the home, bedrooms visited and communal areas were found to be clean and odour free, however an armchair in Gainsborough lounge had stains down the side. Management confirm that staff regularly clean the chairs, which led to discussions that other cleaning methods, such as steaming may need to be used. The home has been furnished and decorated to a high standard throughout. Bedrooms were personalised, and time spent talking with a resident confirmed that the room met there needs, it was comfortable and they were able to freely get around. The hot water temperature to resident’s wash-hand basins was not measured, although when run, it felt comfortable to the hand. A Health & Safety hazard was identified in the upstairs (Gainsborough unit) bathroom, where the switch had come away from the wall, although a resident would need to reach up, revealed wires. The home was asked to ensure the area was covered over, and immediate action was taken to address the situation. The colours of the walls in the dementia care unit, were light and fresh, however, the colour system used did not support residents to be able to identify the different areas. The unit has a specialist sensory room, although no residents were seen to use the room, 2 residents had taken notice of the changing lights lying on the floor, which led to a discussion of which ‘picture’ they preferred. Residents were seen to be able to move freely around the home making use of the lifts, and wheelchair accessible gardens. Time was spent sitting with the residents in the enclosed garden leading off the dementia garden. The garden had a continuous walkway, and seats and table had been set out points of interest to draw their attention to. Staff were asked to remove the stinging St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 22 nettles and thistles, which had grown quite high, before residents had the discomfort of touching them. Throughout the home residents have access to courtyards and gardens where they can sit out. On arrival time was spent talking to a resident who was sunbathing, they said they loved the opportunity to be able to be outside, and was enjoying their stay at the home. Discussions with relatives before the inspection and comments made in the CSI surveys, praised the location and the environment. Comments included ‘lovely surroundings which are kept neat and tidy at all times’. Whilst sitting in the lounge, (Gainsborough unit), twice a member of staff, wearing disposable gloves, was seen walking past the residents seating carrying dirty linen, rather than transporting it in a suitable container. Housekeepers were seen using their new storage trolleys, which they said were easy to manoeuvre. This enabled staff to take the trolleys into the bedrooms, keeping an eye on cleaning fluids, preventing any risk of a resident accidentally getting hold of them. St Josephs DS0000065099.V297616.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People in the home can expect staff to have received training and receive regular supervision. However, with the current staff levels, not all residents’ needs may be met, and must be reviewed. EVIDENCE: Residents who had completed the CSCI survey were asked ‘Do you receive the care and support you need?, 2 had replied ‘always, and 6 ‘usually. Comments made included ‘everyone is very supportive’, ‘sometimes a long wait for toilet attention’, ‘a retired nurse from a hospital to take overall charge of health matters would be helpful’. Discussions with a relative also felt that the home should have a member of staff trained and “experienced in caring for residents with dementia, in-charge of the day-to-day care” of Gainsborough Unit. Relatives (31) asked (CSCI Survey) if in their opinion are there always sufficient numbers of staff on duty?, 24 replied ‘yes’, 3 ‘No’ and the 4 remaining had written comments, indicating there was not a clear yes or no answer. These comments included ‘it differs’. ‘light at weekends’, ‘because this is a dementia unit, staffing sometimes seems below optimum levels’. ‘noticeable lack of staff when training sessions are in progress’. One relative spoken with felt information on being short staffed could have ‘only come from staff themselves’. The manager confirmed that staffing levels were not St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 24 affected during training sessions, as staff were not rotated to work when they were on a training day. Residents asked if staff were ‘available when you need them? 2 had replied ‘always’(‘even run – quick to respond) and 6 ‘ usually’. One resident felt that the home needed ‘extra staff at peak times’, for example in the mornings and at bath times. Staff had raised no concerns during the inspection or from completed feedback cards over the staffing levels. During the last inspection concerns were raised over the staffing levels at night. The home has since recruited new staff, and increased the staffing level to 3 at night. Staffing rotas looked at for the period from 15 May to 4 June 2006, identified the normal staffing levels as 7 in the morning, and between 6 to 7 in the afternoon/ evening till 9pm. Asked how staff are allocated across the home, the inspector was informed that when there are 7 carers on, 3 are allocated to the 2 sections of the home, with another member of staff ‘floating’ between the 2 units. In addition, there is a Senior Carer Officer on duty, who will oversee the running of the 2 units. However, rotas showed that sometimes they are also included in the ‘7’, along with the manager when covering staff sickness. Discussions with a relative prior to the inspection, raised their concerns that they did not feel the staffing levels in the dementia unit was sufficient. They were also concerned that staff move around, and that the residents would benefit from having dedicated staff that know the residents well. The manager stated that staff are trained to work on both units, as they feel it is more beneficial to have staff able to work with both client groups. A relative felt that staff had a good ‘understanding of elderly residents’, which was supported by their training. Another relative felt that staff abilities and knowledge was mixed, in respect of dementia care, and felt more training was needed. The home’s matrix showed that only 4 of their carers had not commenced their dementia training. Where they had not undertaken the training, the matrix showed that this had been identified as being ‘required’. A resident wrote that although ‘staff work very hard’, that they felt ‘extra staff during peak times e.g. mornings, bath times, would be appreciated’, as they felt it delayed them in being able to leave their bedroom earlier. Time spent on the dementia unit, identified that staff were busy all the time, and did not always have the time to interact with the residents (see ‘Daily Life and Social Activities’ section of this report). From the completed (7) staff CSCI feedback forms, all felt that the home had a good training programme to support staff, although 2 out of the 7 felt that they had not received sufficient training to undertake their role. The home’s St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 25 training matrix showed the ‘core’ training that care staff undertakes which included Induction and Foundation training, Moving & Handling, and Dementia care. The homes training matrix showed that 50 of their staff held a National Vocational Qualification (NVQ) 2 or equivalent, 5 of whom had also achieved their NVQ 3 award. Five of the 7 staff completing the CSCI surveys, confirmed that they received regular supervision. One of the staff stating that they did not receive 1 to 1 supervision was not a carer, therefore it was not known if the other person stating ‘no’, was also ancillary staff. Records seen at a previous inspection identified that all staff are regularly ‘booked’ in for supervision, and records kept of the meeting. To ensure the home is following safe recruitment procedures, a sample of 2 staff’s recruitment records were looked at. Records showed that the home was obtaining information on the applicant’s physical and mental health, and undergoing Criminal Record Bureau checks, prior to staff commencing employment. The application form asks for the applicant to supply a full employment history since leaving school. Records also had ‘Post it’ stickers attached, which held extra notes to supplement and/or clarify information given on the application form. One file only held 1 written reference, however there was an audit trail identifying what action the home had taken to obtain the second reference. The manager said that although they had received a satisfactory verbal reference from the applicant’s previous employer, besides sending 2 further requests, they had still not obtained the written reference back. This led to discussions that the home, to meet regulations must still obtain 2 written references prior to staff commencing employment. Where homes have a problem, which was evidenced by the letters sent to chase the reference, the home would need to seek a reference from another suitable source. St Josephs DS0000065099.V297616.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are committed to providing a good level of care. However, without quality assurance systems in place, it cannot be assured that peoples views on the home are being heard, and where appropriate, actioned taken. Staff receive training to support residents safety, however, hazards are not always being identified, which could potentially put residents at risk. EVIDENCE: The Registered Manager Mrs Lorraine Hodges, is currently undertaking a 1 year Dementia Care Diploma, which they are due to complete in November. Discussions with Mrs Hodges identified good practices, to support residents with dementia that they would like to/are looking to introduce. This led to discussions that although the inspector was aware that 2 members of the management was on the course, they were hoping to see this more reflected in St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 27 the unit. Especially in the use of signage, wall colourings, and tactile items to create places of interest and support residents with dementia. Six of the 7 staff asked (CSCI comment card) felt that the home was well run, which included the comment ‘Mrs Hodges is a very approachable manager, always willing to listen and very supportive’. The member of staff who had replied ‘no’, had given no further information as to why they thought this. A relative had written that the home had ‘really supportive staff, sometimes far beyond expectations’. The Manager confirmed the Responsible Individual was now undertaking monthly, unannounced regulation visits, and had completed a report, but the manager or the Commission had received a copy. It was acknowledge that the Responsible Individual is in constant contact with the home, and visits regularly. The home which has been opened nearly 10 months, had just reached full occupancy. The Statement of Purpose gives information on the home’s ‘Quality Assurance program’ which includes ‘regular residents meetings, and feedback from quality assurance surveys can be found in the hallway of St.Joseph’s. Although a copy of the home’s quality assurance questionnaires are contained in their Statement of Purpose, the home has not undertaken any formal surveys to gain feedback from people using the service. However, the CSCI has been notified that the company has appointed a part time Quality Assuance Manager, who is due to start in July. The CSCI had asked the home to enable as many residents, relatives/visitors and staff to complete the comment card/survey as possible. The home had been proactive in undertaking this, by sending the surveys out which resulted in a very good response from Relatives/Visitors (31), compared to February when 7 were received. The accounting and storage systems used for looking after residents money held for ‘safe keeping’ was not reviewed during this inspection. However this was fully reviewed during the home’s first inspection undertaken on the 30/11/05, which identified that the home had safe systems in place for the handling and safe keeping of residents’ monies, held for safe keeping. Care plans and medication records viewed, showed that staff were not always completing records fully. Fire records showed that regular checks are undertaken of the homes fire call system to ensure it is in full working order. The home training matrix identified that training courses had been arranged for staff in Fire Safety and Food Hygiene. Staff receive training in, manual handling as part of their induction training. As stated in other areas of this report (see Environment & Health and Personal Care) health & safety hazards are not always being identified. St Josephs DS0000065099.V297616.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 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 1 St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4 Requirement The information given in the Statement of Purpose relating to Quality Assurance work undertaken could be seen as mis leading, and must be amended to reflect actual quality assurance work being undertaken. The home must have systems in place to be able to assess resident’s psychological health on admission, and thereafter monitored regularly, evidencing any preventive and restorative care provided. The home must establish and maintain a system (which takes into account all residents ability to be able to take part) for reviewing at appropriate intervals, the quality of care provided. Results of which should be fed back to people using the service in an appropriate format. To ensure the safety of residents, the home must have DS0000065099.V297616.R01.S.doc Timescale for action 01/09/06 2. OP3 OP7 OP8 14 (1) (2) 01/08/06 3 OP1 OP33 24 (1) (2) (3) 01/10/06 4 OP7 OP38 13 (5) 06/06/06 St Josephs Version 5.2 Page 30 manual handling risk assessments in place. This must include any mobility aids and number of staff required to undertake each task. 5 OP7 OP38 13 (4) Where a resident is at risk of falling out of bed, a full risk assessment must be completed, and action taken to reduce/ eliminate any risk of injury. The home must ensure that medication is given out as prescribed, and records are completed correctly. (repeat requirement from the 08/02/06) 06/06/06 6. OP9 OP4 13 (2) 17 06/06/06 7. OP10 OP4 12 (4) (a) 30/06/06 To ensure the dignity of residents the home must : • make arrangements for residents to have their hair dried/styled in the privacy of their own bedroom or hairdressing room, unless they have made an informed choice not to do so. • Monitor residents with continence care needs, to ensure clothing is changed as required. The home should consult with residents about the programme of activities, internal and external, that they would like arranged by the home, which should include ways to support residents to keep mobile. To ensure residents safety and comfort the electrical socket switch in the bathroom (upstairs) must be repaired and action taken to remove nettles and thistles from the (dementia DS0000065099.V297616.R01.S.doc 8. OP12 OP4 16 (1) (m) 01/10/06 9. OP19 OP38 OP4 13 06/06/06 St Josephs Version 5.2 Page 31 care) garden. 10. OP26 13 (3) The home as part of their infection control procedures must ensure soiled linen is transported through communal areas, in a suitable container. The home must review their staffing levels on Gainsborough unit, to ensure all residents physical, social and mental care needs can be met. 30/06/06 11. OP27 18 (1) (a) 10/07/06 12. OP29 19 (1) (b) Schedule 2 (3) The home must be in receipt of 2 30/06/06 written references, prior to staff commencing their employment. 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 OP1 Good Practice Recommendations To enable visitors to freely access a copy of the CSCI reports, the home should look at different ways the report could be displayed, which would not lead people to think that they can take the copy away with them. The home to ensure that Social Funded residents have been given information on costs payable, should liaise with Social Care Services, so they are able to record on the pre-admission paperwork, the date (and any reference number) when the information was given to the resident, as proof, whilst awaiting a copy of the contract. The home should introduce behavioural and communication sheets/charts, to support staff in monitoring a residents behaviour, in identifying any ‘trigger’ points or communication difficulties which might result in the resident becoming frustrated or distressed. Repeat recommendation from last inspection. DS0000065099.V297616.R01.S.doc Version 5.2 Page 32 2 OP2 3 OP7 St Josephs 4 OP8 OP7 The home to support them in monitoring residents’ nutritional needs, should introduce a nutritional screening tool undertaken on admission, and updated regularly. Although the home holds a photograph of residents on their office files, they should consult with the resident to have a copy also placed on their care plan and medication records, to support new staff in identifying residents. Where staff have written in the daily records what assistance they have given with personal care, this should also be reflected in the home’s daily monitoring sheets. The home should consult with specialist Agencies, such as Alzheimer’s society, to gain further knowledge in activities for residents who have dementia. To make the dementia unit and garden, more interesting and stimulating for residents with dementia, staff should look at what points of interests and colourings can be used. Staff should look at formally recording information on staff records, rather than use ‘post it’ notes, which could lead to information getting lost. 5 OP7 6 OP8 7 OP12 8 OP19 9 OP29 St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Josephs DS0000065099.V297616.R01.S.doc Version 5.2 Page 34 - 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. 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