CARE HOMES FOR OLDER PEOPLE
St Judes Residential Home Front Street Nympsfield Nr Stonehouse Gloucestershire GL10 3TY
Lead Inspector Sharon Hayward-Wright Unannounced 27 April 2005 10:00 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 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 Judes Residential Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service St Judes Residential Home For The Elderly Address Front Street, Nympsfield, Nr Stonehouse, Gloucestershire, GL10 3TY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01453 860682 Mr Paul Morgan Mrs W Morgan Care Home - Personal Care Only 10 Category(ies) of Old Age not falling within any other category registration, with number (10) of places St Judes Residential Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 9/11/04 Brief Description of the Service: St. Jude’s is a small, family run care home providing personal care for older people. The accommodation is on two floors. However, service users whose rooms are on the upper floor need to be able to climb stairs as the home does not have a lift. All but one room is single occupancy and the majority have ensuite facilities. There are bathrooms on each floor with the ground floor bathroom offering an electric bath hoist to assist with bathing. The communal areas consist of a lounge and dining room. The outside area is accessible, however, service users who have limited mobility will require assistance from the staff in the home to access the terrace which is up some steps. St Judes Residential Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours, on one day in May. The Registered Manager and Registered Provider were spoken to, as were 2 other staff members. Six service users were spoken to directly to gain their views of the care they receive and the home in general. Of these, the care of 2 service users was looked at in detail by examining their care plans, talking to staff and the service users involved. Care records and the management of medications. As well as the records for food, complaints, staff supervision, servicing of equipment and records for the management of service users monies were examined. A part tour of the home took place and the staff was observed going about their work and interacting with service users. Six requirements remain outstanding since previous inspections and the home must address these before the next inspection. The areas these concern are medication, record keeping and quality assurance. Warning letters have been sent to the Registered Provider and Registered Manager for these issues to be addressed immediately or the Commission for Social Care Inspection may consider further action. What the service does well:
The home is a family run business with a very low turn over of staff resulting in continuity of care for the service users. Staff morale is high, resulting in an enthusiastic workforce that works positively with service users to improve their whole lives. The staff demonstrated a good understanding of the needs of the service users and this was evident from the positive relationships, which have formed and were seen between the staff and service users. A varied activities programme is available for service users should they wish to participate, otherwise they are free make their own arrangements. The home maintains strong links with the local community and many activities involve the service users from the home and residents from the village. St Judes Residential Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Judes Residential Home Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection St Judes Residential Home Version 1.10 Page 8 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 standard(s) 2, 3 & 5 The home must ensure they can meet the needs of proposed service users prior to their admission. EVIDENCE: All service users have received a revised copy of the homes terms and conditions. A recently admitted service user had an assessment completed by Social Services. Although Records were maintained of the service users visits to the home prior to admission, an assessment by the home had not been completed. St Judes Residential Home Version 1.10 Page 9 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 standard(s) 7 ,8 ,9 & 10 There is no clear or consistent care planning system in place to adequately provide service users with an individual plan of care to meet their needs. Progress has been made in the systems of administration of medication but further improvement is needed. EVIDENCE: A number of care plans were examined. Additional information about the care needs of the service users is required. These include care plans for personal care, incontinence and the management of medical conditions e.g. diabetes. Staff spoken with, were however, aware of the needs of the service users. No re-assessments of the service users have been undertaken by the home, although copies of Social Services re-assessments are included in the service users care plans. It is recommended that all service users be re-assessed by the home to assist in ensuring that the care plans, reflect current needs. The home is now involving service users in their care plans. Evidence of health professionals’ involvement in service users care was seen.
St Judes Residential Home Version 1.10 Page 10 The home has completed risk assessments on a generic basis but not for individual service users as required. The home has made improvements in their medication procedure with the home providing medication training for staff. Records of medication received, administered and returned (if any) are kept. The medi-dose system is used, however a lockable facility is required when transporting medication around the home and the MAR (medication administration record) must be included in this process. Service users are able to self medicate and lockable facilities are provided. An assessment of the service users ability to self medicate must be undertaken. The home maintains records of stock control for service users that selfmedicate. Medication stored in the fridge must be stored in a sealed container and any creams must be stored separately from insulin in a different sealed container. St Judes Residential Home Version 1.10 Page 11 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 standard(s) 12, 13 & 14 Links with the community are good and support and enrich service users lives and social opportunities. A varied activities programme is offered by the home allowing service users the choice to participate or undertake their own activities. EVIDENCE: During the inspection a keep fit sessions was taking place and a number of service users were due to go on an outing in the afternoon. A varied activities programme is provided that actively involves service users in community life. Personal effects can be seen in individual rooms and around the home. Service users said they are able to choose how they spend their time each and confirmed they can receive visitors at any time Information about advocacy services is on the homes notice board. St Judes Residential Home Version 1.10 Page 12 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 standard(s) 16 & 17 The home has a complaints system in place but to date this has not been tested. EVIDENCE: The home has not received any complaints. A copy of the complaints policy is included in their Statement of Purpose. A local MP was visiting the home on the day of the inspection and service users spoken to said they could participate in the election if they so wish. St Judes Residential Home Version 1.10 Page 13 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 standard(s) No standards were assessed at this inspection. EVIDENCE: The home has basic food hygiene training booked for May 2005. Infection control procedures have been implemented by providing protective clothing for staff to wear when necessary. St Judes Residential Home Version 1.10 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their whole quality of lives. The home has invested in a training programme to ensure the staff are meeting the needs of the service users. EVIDENCE: The homes duty rota is set and any changes are documented in the homes diary. On the day of the inspection the needs of the service users were being met. The home has one staff member with NVQ 2 training and one qualified nurse (who is not practicing). One member of staff is undertaking the NVQ 3 training. The home has group of core staff that have worked at the home for a number of years providing continuity of care. No staff have been appointed after the implementation of the POVA list, however the Registered Provider is aware of the amendments to the Care Homes Regulations. The home needs to obtain a Criminal Records Bureau and POVA check for the volunteer. St Judes Residential Home Version 1.10 Page 15 As the home has not had any new staff, the induction programme was not inspected. The home has booked a training programme for staff that includes food & hygiene, medication, moving and handling and fire. The home also plans to arrange infection control and first aid training for staff. A number of staff have completed a basic care course. St Judes Residential Home Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 & 36 The management of this home is satisfactory overall, however the home needs to develop their quality assurance systems to ensure they continue to run the home in the best interests of the service users. EVIDENCE: The Registered Manager undertook a City and Guilds in foundation management for care in 1992 and the local college are in the process of investigating whether it is an equivalent to the NVQ 4. The Registered Provider has undertaken the NVQ 4 training. The Registered Manager is receiving the same training as the other staff. The home looks after one-service users monies. Receipts and records are maintained. The Registered Provider is an agent for 4 service users but has completed the DSS process to be able to undertake this role. St Judes Residential Home Version 1.10 Page 17 Records were examined of staff supervisions sessions; the home is looking to undertake this every 6 weeks. Evidence was seen of servicing of the boiler, electrical certificate and Portable Appliance Testing. The home needs to continue to devise their quality assurance procedure to ensure the interests of the service users are being met. St Judes Residential Home Version 1.10 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 2 x x x 3 3 x x St Judes Residential Home Version 1.10 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 1(d) Requirement The Registered Person must confirm in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of their health and welfare The Registered Person must undertake individual risk assessments where appropriate. Timescale of the 30/6/04 and 15/1/05 were not met. Care plans must be updated to reflect the current care given to service users. Timescale of the 30/6/04 and 15/1/05 were not met. Medication Adminstration Record (MAR) charts must be reviewed to ensure they are complete and accurate, including date of birth, GP, section for allergies, reason for non-adminstration and any homely remedies. Timescale of the 30/6/04 and 30/12/04 were not met. The Medication Adminstration Records to be signed by the designated person producing them each month with a signed
Version 1.10 Timescale for action 30/6/05 2. 7 15 1/7/05 3. 7 14(2) & 15 1/8/05 4. 9 13(2) & 17(1) 1/7/05 5. 9 13(2) & 17(1) 1/7/05 St Judes Residential Home Page 20 6. 9 13(2) 7. 9 15 8. 9 13(2) 9. 15 17(2) & Schedule 4(13) 19 & Schedule 2 24 10. 29 11. 33 check by a second person; this also applies when any handwritten entries are made. Timescale of the 30/6/04 and 30/12/04 were not met. The Registered Person must provide a lockable facility to transport medication safely around the home during the adminstration process and include the Medication Adminstration Record in this process. The Registered Person must complete an assessment of all service users who wish to self medicate and review this at regular intervals. The Registered Person must store medication in the fridge in sealed containers to reduce the risk of cross infection. And creams and insulin must be stored in separate sealed containers. The Registered Person must maintain records of any special diets catered for. Timescale of the 30/6/04 and 30/12/04 were not met. The Registered Person must apply for a Criminal Records Bureau and POVA check for the volunteer. The Registered Person must continue to develop its quality assurance system. The Registered Person must make a copy of the outcome of the service user questionnaire available to service users. Timescale of the 31/8/04 and 30/1/05 were not met. 1/8/05 1/7/05 1/6/05 1/7/05 1/9/05 1/8/05 St Judes Residential Home Version 1.10 Page 21 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. 2. 3. 4. 5. Refer to Standard 3 7 8 9 38 Good Practice Recommendations The home should complete a pre admission assessment on all proposed service users to ensure the needs of the service user can be met by the home. The home should review all assessments for all service users to see if their care needs have changed. The home should document each service users weight in their care plans. The home should devise a specimen intials and signature list for staff that adminster medication. The home should maintain records of fire training and fire drills. St Judes Residential Home Version 1.10 Page 22 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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