Inspection on 17/09/08 for St Kilda Community Support Centre

This inspection was carried out on 17th September 2008.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE St Kilda Community Support Centre 15 Drew Street Brixham Devon TQ5 9JU Lead Inspector Rachel Proctor Unannounced Inspection 17th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Kilda Community Support Centre DS0000071973.V372357.R02.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 Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Kilda Community Support Centre Address 15 Drew Street Brixham Devon TQ5 9JU 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) 01803 853158 01803 859898 The Sandwell Community Caring Trust Mrs Susan Helen Cohen Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users to be accommodated is 36. Date of last inspection New registration Brief Description of the Service: St Kilda is a residential home that provides 24-hour care for up to 36 service users that are in the category of old age, not falling within any other category. The home offers respite, intermediate and long term care. Other services are also provided from the same building but this report concerns the residential service, which is kept quite separate and has its own dedicated staff team. The home has all single bedrooms that are found over three floors. In addition to this a seven-bed intermediate care unit is sited in a wing of the home quite separate from the long-term area. Each floor has its own communal lounge and separate dining area. A vertical lift is available and appropriate bathing and toileting aids for persons that have mobility issues, good access is provided throughout the home. Attractive gardens are found on two sides of the home, which are equipped with tables and seating areas. A hard standing off road car park is available at the home but this has many demands made on it and parking can be very difficult. The home is located in Brixham within walking distance of the community amenities including local shops. The weekly cost of care at the home on 17.09.08 was standardised at £434.60. The statement of purpose was provided on each floor where people live and was available from the office of the home. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the key unannounced inspection, which took place over two days starting on the 17th September 2008. We followed the care of two people living in the home. One from the long stay unit and one from the intermediate care unit. This included seeing the rooms people occupied, speaking to them where possible and reviewing their plans of care. A tour of the home was completed with the manager. All the communal areas were visited and some peoples rooms were entered. During the tour of the home two people were spoken to in the privacy of their own rooms. Documentation relating to the health and safety management of the home was viewed with the registered manager. Other records relating to the care of individuals living in the home were also seen. The records relating to the recruitment and employment of staff working in the home were viewed for three staff. The records the manager held for training staff had completed were discussed and reviewed with the training coordinator. Supervision and appraisal were discussed with the manager and the template used to record supervision and appraisal were viewed. We reviewed the information received from the new providers since their registration. We received survey forms for three people living in the home, three relatives of people living in the home, two staff members and one heath professional, prior to the inspection. Some of the comments made in the survey forms and comments people made during the inspection have been included in this report. What the service does well: St Kilda’s has a core staff team that are experienced and committed to providing a high standard of care for the people who live there. They have access to training that improves their knowledge and skills to care for people. It was clear from observations undertaken that care was delivered in a sensitive way and people were treated with respect. The intermediate care unit provides an excellent service for people admitted for re-enablement. People have access to the multi disciplinary team to assess and promote their abilities. Care being provided was goal orientated and agreed with the person receiving care. One of the health professional who St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 6 responded to a survey stated. I feel proud of the intermediate care service we deliver as a team. We have good outcomes, our clients and their families give us good feedback. Meals times are a pleasant experience for people living at St Kilda’s. These are varied and well balanced with choice always available. All the people spoken to said that they thought the meals were of good quality and they said they always had enough to eat. What has improved since the last inspection? What they could do better: Two Requirements and four Recommendations have been made as a result of this inspection. The Requirements for the health and personal care have affected the overall rating of the home. Assessments for people on the long stay unit did not have a care plan that addresses their assessed needs clearly. Information in the assessments for the long stay unit did not all include the persons GP and their preferred name. This means that people may not have all their needs met by the staff caring for them and staff being unaware of the way the person liked to be addressed. Care plans on the long stay unit had not been reviewed monthly or when the persons need change. This means that staff did not have access to an up to date plan of care that reflected the persons current care needs. The manager had not ensured that all the care needs of the people in the long stay unit were clearly reflected in their plan of care. This means people were at risk of not receiving the care they needed. Although activities were being provided for people and staff were able to report what activities people had taken part in these had not been recorded. This means that staff did not have a record about the activities the people they were caring for had taken part in and enjoyed. Unless people are cared for by staff who know them well they may not get the opportunity to take part in activities they enjoy. Not all the people living at St Kilda’s and their representatives were aware of how to raise concerns and who to speak to. Two people spoken to said they did not know how to complain but did not have any concerns about their care. Two of the people who responded to the surveys also said they did not know how to complain. This may mean that the way the complains information was being provided was not suitable for these people to enable them to understand. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 7 The redecoration and refurbishment of the environment has continued. However some rooms and communal areas on the top floor and lower ground floor had not been redecorated. One comment received in a survey form said, The care is there but the building could do with an interior facelift in some areas 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 Kilda Community Support Centre DS0000071973.V372357.R02.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 Kilda Community Support Centre DS0000071973.V372357.R02.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): 1,3,6, Quality in this outcome area is good. People have sufficient information to make an informed choice about whether the home can meet their needs. The new assessment documentation for the long stay and respite unit adopted by the manager should ensure that people have their care needs fully assessed. The home has a dedicated intermediate care unit where people are helped to achieve their full potential supported by care, nursing and therapy staff. People’s care and rehabilitation needs are identified and realistic goals are set with them. People can have confidence that their changing health and personal care needs will be met. The care planning for the intermediate care unit was very clear. It gave clear instructions to staff how they should meet the persons care needs and promote their re-enablement. People using the intermediate care unit have the opportunity to achieve their full potential supported by staff who understand their care needs. This judgement has been made using available evidence including a visit to this service. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose and service users guide was available in each of the lounge areas. A copy was also available in the office of the home. These gave people information about the home and its services. A copy of the complaints procedure was also contained in the statement of purpose. The manager advised that when people have a social services assessment these are included with the care planning information. Two people who had had a social service assessment had these available. However not all the information regarding care need had been recorded in the home’s plan of care to inform staff how this need should be met. Discussion with the manager revealed that one person whose care was followed had panic attacks when they ate the food if it was difficult chew. The persons care plans said they needed a liquidised food. This had not been included in the persons assessment of care needs. The person was observed eating puréed meat and normal vegetables during the inspection. The staff spoken to knew the persons care needs and how they needed their food presented. The assessment and care plan for this person did not clearly state this care need. The plan of care for staff to follow was unclear. One person receiving intermediate care had their care followed. Their assessment clearly stated their assessed need and what the goals of the rehabilitation were. The person had signed their assessment and care plan. When this person was spoken to they said staff had discussed what they hope to achieve during their stay in the rehabilitation unit. The goals they indicated they wanted to achieve were recorded in the care plan. The person said that staff regularly review their progress and looked at what theyve achieved. The staff member spoken to working in intermediate care unit advised that the multidisciplinary team assesses and manages people’s care. The multidisciplinary team included district nurses, physiotherapists, occupational therapists and the care staff working on the unit. The person receiving care spoken to confirmed that they received assessments and treatment from the physiotherapist. They also advise that the occupational therapist had assessed them using the kitchen. One health professional commented in a survey form, I feel proud of the intermediate care service we deliver as a team. We have good outcomes and our clients their families give as good feedback. The assessment processes adopted in the residential unit are different from those being used in the intermediate care unit. St Kilda Community Support Centre DS0000071973.V372357.R02.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): 7,8,9,10. Quality in this outcome area is adequate. The care plans on the long stay and respite units had not been reviewed monthly or when the person’s health and personal care needs changed. This means that people are reliant on staff remembering the people who’s health and personal needs had changed and how they should be met. Not all the information captured by assessment and in discussion with the manager had been included in the person’s plan of care for the long stay and respite unit. This means that staff did not have a record of all the persons care needs and how these should be met within their plan of care. This practice puts people at risk of not receiving the care they need. The medication practices are satisfactory. People living at St Kildas are treated with respect and dignity by the staff team who care for them. This judgement has been made using available evidence including a visit to this service. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 12 EVIDENCE: Two people had their care followed as part of this inspection. One person in the intermediate care unit and one person in the long stay and respite unit. The person in the long stay and respite units had an assessment completed and a plan of care. However the way the information about their care was being stored made it difficult to follow. The information on what happens each day was being kept on the by staff where the person lived. The care plans were being stored in a locked cupboard next to the office of the home. Information relating to contracts were stored in a different filing cabinet. One person in long stay whose care was followed had not had their care reviewed since June 2008. Two other peoples plans of care reviewed the last time they will be viewed as June 2008. The manager advised that when a person sees a health professional or their GP it was recorded in their daily statement and not captured elsewhere in the care plan. It was difficult to see when the person whose care was followed in the long stay unit had last seen their GP or other health professionals. The manager advised that she was in the process of introducing the new providers care planning template. Although no one on the long stay unit on the first day of the inspection had one fully completed. On the second day of the inspection the person who had their care followed on the long stay unit had the new plan of care completed. This was easier to follow and had all the care planning information in one place. This included risk assessments, the personal preferences of the person and the care they needed to meet their needs. Information regarding who the persons registered GP and next of kin were easy to find a new care planning documentation. The manager advised that she would be updating the remaining peoples care plans with the new information as soon as possible. A total of 14 people were living in the home at the time of the inspection, this included long stay and intermediate care beds. The care plan for the person whose care was followed in the intermediate care unit had a full assessment of their needs completed with a clear plan of care developed. Risk assessments were an integral part of this care planning process. These included manual handling, risk of falls, nutritional risk and pressure sore development. The multidisciplinary team had regularly assessed the person. Each member of the multidisciplinary team had a section within the persons care plan to record treatment and therapy given to the person. The senior carer had completed a daily evaluation record for this person on since their admission. Self-medication risk assessment information had been completed. The goals for rehabilitation had been agreed with the person. When this person was spoken to they said they were pleased with the progress and were realistic about the goals they had set. One other person receiving St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 13 care in the intermediate care unit was spoken to during the inspection. They said they were pleased with their progress and staff were working with them to help them regain their mobility. One health survey form a health professional indicated. Clients are asked to formulate their own goals regarding their future. Generally the aim of the services to help clients return to their own home. The review meeting takes place two times during the stay to ensure the team has understood clients choice and is tackling the issues most important of them. The three relatives who responded to the survey all indicated that the care home meets the needs of their relative. The medication records for two people were viewed during the inspection. One from the intermediate care unit and one from the long stay unit. Each had a record of the daily medication, which had been given recorded and signed by the staff member giving it. Medication storage was safe. The manager advised that she was in the process of introducing a lockable storage trolley for medication on each of the floors where long stay people were living. These were in place during the inspection but were not being used. The medication for the long stay unit was being stored in a locked treatment room within a locked trolley. The controlled medication being stored for one person was checked against the records is correct. A record was being kept of medication return to the pharmacy. This had been signed by the staff completing the record and the pharmacist on receipt. One person commenting on the intermediate care unit in a survey form said, “A pharmacist discusses medication administration with each client. The plan is made regarding the level of support and level of supervision needed. When the client needs to become independent with medication administration strategies are put in place to achieve this Staff observed caring for people during the inspection were respectful and supportive towards the people they were caring for. Staff were explaining what they were doing before they did it keeping the person informed of any care tasks. Staff were involving people in discussion and treating them respectfully. One survey form returned indicated, “Sometimes staff are unaware of the clients need for privacy and conversations are being concluded about clients in an area where they can be overheard by others e.g. the dining room or lounge or in the corridor rather than behind closed doors. This was not seen during the two days of the inspection. Four people spoken to living at the home said staff were always friendly and helpful towards them. One person commenting, I really like living here, they look after me really well. Other comments form the survey forms included, great support from all, very caring, nothing is too much trouble. St Kilda Community Support Centre DS0000071973.V372357.R02.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): 12,13,14,15. Quality in this outcome area is good. Activities are provided for people who live at St Kildas, however these may not always meet peoples expectations. People are suitably encouraged to exercise choice and control over their daily lives by the staff team who care for them. Mealtimes are a pleasant experience for people who live at St Kildas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that the home has links with the local community college. Recently people had attended a pottery session at the college. One persons room entered had a pottery plate they had made. Staff spoken to on the unit advised that there had been trips into Brixham and visits to other local attractions in the area facilitated by the staff. The manager also advised that external activities providers are also organise for people living at St Kildas. A day centre operates from St Kildas and occasionally people living in the home take part in the activities organised by the day centre. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 15 The care plans included what the person like to do and what their interests were. These were clearly recorded in the new style plan of care, which had been introduced by the new providers. Where this had been recorded in the old-style care plans it was difficult to see when this had been reviewed and if the person still had the same interests. People spoken to said they could choose to take part in the activities if they wished. During the inspection two people on the long stay unit had gone out into Brixham. An activity book was being kept on the third-floor unit. However no entries had been made in this since July 2008. The staff confirm that people have regular activities provided for them as well as one-to-one support from staff in the afternoons if they need this. The new care plans to be introduced had a template to record the activities the person had taken part in on a weekly basis. This had not been recorded in the old-style care plans. People appeared to be able to get up and go to bed at the time that suited them. Not everyone was up and dressed at the start of the inspection. This was their choice. Staff was seen to encourage people to take part in activities or just sit and chat. One person spoken to said they preferred to sit and chat and rather than take part in activities. Although they knew these were offered. An up-to-date list of activities to be provided was not displayed in the unit visited during the inspection. The staff on duty said they tell people on a dayto-day or week by week basis whats on offer for them. The home has an open visiting policy and visitors were coming and going throughout the time of the inspection. People were seeing visitors in the privacy of their own room or in one of the communal areas available to them. The manager advised that restrictions on visiting were not imposed unless it affected the persons health or they had requested not to see anyone. One relative commented in a survey form, the clients needs are always uppermost, also concern is given for the family and the general feeling at St Kildas is that of a large family. As relatives we know that care and support is always there for us as well as the client.” The care planning system on the intermediate care unit clearly shows people are able to exercise personal autonomy and choice over their daily lives. Each persons room entered during the inspection had been personalised with items of that persons choice. This included ornaments, pictures and photographs. The manager advised that as the home was redecorated people are being encouraged to choose the colour schemes for their room. Each of the three floors in the long stay and intermediate care unit has a separate dining room and lounge area. The lunchtime meal was observed in the top floor of the long stay unit, which was catering for eight people. The lunchtime meal observed during the inspection was unhurried. People were eating their meals at their own pace. Staff were offering assistance to people that needed it in a supportive non-intrusive way. Staff were telling St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 16 people what was on offer for lunch and giving them a choice. The staff on duty advised that during the morning people are reminded whats for lunch that day and asked what they would like. They confirmed that if they didnt like what was on offer an alternative would be provided. One person spoken to confirmed this. There was a choice of vegetables at the lunchtime meal and three people in the dining room had chosen not to have one particular vegetable. The staff were ensuring that the meals they had contain the items they like to eat. The manager advised that the menus are changed seasonally and this was done in consultation with the people living at the home to ensure the meals provided meet their needs. Two of the three people who responded to the survey said they usually liked the meals and one said they always liked the meals. Specialist diets were being catered for, these included a diabetic diet and a soft diet. The staff advised that one person found it difficult to chew meat. This person was provided with puree meat and normal vegetables, which they were able to eat without any problems. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 17 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): 16,18. Quality in this outcome area is good. Although people spoken to during the inspection said they knew how to raise concerns and they knew who to speak to, not everyone who responded to a survey questionnaire was aware of how to make a complaint. This may mean some people dont know who to speak to if they have any concerns. Staff have received training for protection of vulnerable adults. The staff team are aware of how to recognise and respond to any incidents that cause concern, and people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Not everyone who responded in the survey forms said they knew how to make a complaint or who to speak to if they had a concern. The complaints procedure was easily available in each of the units. These were contained with the statement of purpose in a folder kept in the communal areas on each floor where people were living. People spoken to during the inspection said they knew who to speak to if they had any concerns and were confident that any concerns they had would be addressed. The manager advised that she keeps a record of any complaints and concerns received and the action taken to address them. The preinspection information Annual Quality Assessment Audit (AQAA) indicated that no complaints had been received since the registration in April 2008. The Commission has not received any complaints about St Kilda since the registration as a new service. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 18 The manager confirmed that staff have protection of vulnerable adult training. Three of the staff spoken to confirmed that they had had this training. The training coordinator advised that they would be keeping a record of all the courses staff had completed. The training matrix was available for inspection. However the dates the staff had last completed protection of vulnerable adult training had not been included. A senior manager within the organisation advised that information on staff training prior to the change of ownership was being kept centrally at present. They confirmed that the information contained in the staff files would be used to update the training database as soon as possible. The home has policies and procedures in place and available for staff in relation to protecting people from abuse. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 19 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): 19,26, Quality in this outcome area is good. The management team at St Kilda has shown commitment to improving the environment for people living there. This means people who live in St Kilda can have confidence they will have a reasonably well-maintained environment to live in. St Kildas was being kept clean, hygienic and free from offensive odours throughout and systems were in place to control the spread of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was completed with the manager. All the communal areas were seen and disabled access bathrooms. Some peoples rooms on each floor were entered. The long stay and respite unit was arranged as on three separate floors each containing nine or ten bedrooms for people to use. The intermediate care unit contains seven bedrooms for people to use. In addition to the seven bedrooms on the intermediate care unit, a therapy room and an St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 20 assessment kitchen was available for health professionals to assess peoples ability and progress. The manager advised that the middle floor, which contained 10 bedrooms, had just been redecorated and refurbished. Three of these rooms were entered during the inspection. New furniture and furnishings had been provided in the rooms. The manager advised that the top floor was due to be redecorated and refurbished. Some paint was chipped from doorframes and the décor in some rooms looked tired on this floor. The manager confirmed that the refurbishment and redecoration would continue until all the rooms had been refreshed. One comments received from a relative indicated that. The care is there but the building could do with an interior facelift in some areas. The three people spoken to during the inspection said they were satisfied with the room they were occupying. A maintenance man was working during the inspection carrying out repairs and renewals and redecorating individual rooms that had become vacant. Accommodation was provided in single rooms without en suite facilities. Bathrooms and toilets were available close to individual peoples rooms and the communal areas. Some of the bathrooms and toilets entered on the top floor did not have toilet roll holders. Some toilet rolls were placed on top of radiators others are on the floor. On the second day of the inspection the manager confirmed that the maintenance man had fitted toilet rolls holders in all the toilets identified. The home was fresh and clean in all the areas entered during the inspection. Cleaners were working cleaning communal areas and individual peoples rooms. The three people living at St Kilda’s who responded to the survey indicated that, the home was always fresh and clean. The people spoken to during the inspection confirmed that their rooms are kept fresh and clean by the staff. The manager advised that older carpets where staining had occurred would be replaced on a rotational basis until all had been replaced. The manager has introduced a policy for infection control, which was available for staff. Disposable gloves and aprons were readily available for staff throughout the inspection. Staff were seen using these when providing personal care for people. A yellow bag system was in place for the disposal of clinical waste. A sluicing area was available for staff use on each floor where people were living. A disinfecting sluice had not been provided; a hopper style sink was available in each sluicing area for disposal of waste. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 21 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, 30, Quality in this outcome area is good. The home has adequate numbers of experienced staff available to ensure that peoples’ needs are appropriately met. The home has a robust recruitment system to protect people from unsuitable staff. The staff team who work at St Kilda’s receive relevant training and are competent to fulfil their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided a duty rota, which showed how many staff were on duty each shift and in what capacity they were employed. The manager advised that the system for staffing the home was being changed. She advised that seniors were to be appointed for each area one for each floor and the intermediate care service. She confirmed that seniors would be responsible for the people living in that area. The manager had developed the new rota system and provided a copy for inspection. Two of the staff spoken to during the inspection said they were interested in applying for the senior positions. They said this would enable them to extend their experience and improve their management skills. During the inspection three staff were working on the top floor, where eight people were being cared for. The manager advised the staffing she envisaged St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 22 would provide one senior and a carer in each area with another member of staff available to assist where they were needed. All the staff spoken to during the inspection said they had sufficient staff on duty to meet the needs of the people they were caring for. In addition to the care staff the home employs domestic staff, a cook, kitchen assistants, maintenance staff and a training coordinator who also maintains staff personnel files. The AQAA (Annual Quality Assurance Assessment) information indicates that the homes management team are committed to ensuring staff achieve an NVQ (National Vocational Qualification) level 2 or above in care. This information indicated that twenty-three of the thirty-six permanent care staff employed had achieved an NVQ level 2 or above. Three of the staff spoken to during the inspection said they had recently completed their NVQ level 3. Two other staff advised that should they be successful in obtaining one of the senior positions they would be able to complete a management award. This shows that the management are committed to training the people who work for them. Three staff files reviewed during the inspection, one from a new member of staff and two existing staff members. Each contained evidence that robust recruitment had been followed when appointing the staff. The new staff member’s personal folder contained an application form, two references, proof of identity, evidence that they had a police check completed and a record of previous training. The person responsible for maintaining personnel records advised that staff dont start work at the home until all the pre-employment checks are returned including a police check. The new staff member’s start date was after the date the police check had been returned. Each of the three staff member files viewed had the statement of their terms and conditions in their staff file. The manager advised that all staff would have a training and development plan as part of their annual appraisal, which would be reviewed at supervision when necessary. Two of the existing staff files seen contained training and development plan for that person. A record that supervision had taken place had also been recorded. The manager advised that a new induction programme would be introduced when new members of staff started work at St Kildas. A copy of this induction programme was provided for inspection. The manager advised that although she had not had chance to use the new induction programme she felt it gave the clear record of what the new staff member covered during their induction. The manager also confirmed that staff who join the home who have not achieved an NVQ in care would be unable to complete this. A senior manager within the organisation confirmed that it was the companys policy to ensure that staff were well trained for the jobs they were being asked to do. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 23 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): 31,33,35,38. Quality in this outcome area is good. St Kildas manager was committed to ensuring that the home was being run in the best interests of the people who live there. The health and safety management of the home should ensure that peoples health and safety is protected and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has recently completed the Commissions fit person process. She has several years experience working in care. Since the change of ownership the management systems with in the home have changed. The manager advised that a new structure, which had senior carers responsible for each floor where people were living, was due to be introduced. The senior carer would be responsible for up to ten people in their area. A copy of the St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 24 proposed rota was provided for inspection. The staff spoken to had been kept informed of the changes to be introduced and most were looking forward to them. There was a mixed response from the staff surveys returned with some very positive comments and some negative comments. The office staff are keen to hear any ideas care officers have them will listen. My manager is always on hand to listen to us, with work issues and even personal issues which is very reassuring. It would be very good if we had more staff meetings and discussions, this would help clear some problems sooner rather than later, later usually means a bigger problem to sort out. I enjoy my job and its a nice place to work on the clients are happy which is very important. More frequent training courses would be an advantage and be very helpful for care officers. All the staff spoken to during the inspection said their access to training had improved since the change of ownership. These staff also said they had access to training that helped them to do their jobs. The manager provided information about the quality assurance being introduced by the new owners. She advised that a quality audit would be completed when the new service had been in place for 12 months April 2009. The information provided in the AQAA showed that the policies and procedures had been reviewed in August 2008. The manager advised that she was in the process of up dating the policy folder for staff and new policies introduced would be added to this. The money held for one person was checked against the records held as correct. The manager advised that each person has a separate folder with the money they have given to staff for safekeeping. Copies of receipts of expenditure were also being kept. The manager confirmed that the home does not manage any of the current peoples financial affairs. She stated that family or advocate manages this on behalf of the people living at the home who are unable to do this themselves. There was a clear record of supervision for staff that have received this. The manager advised that the new staffing system with senior carers would delegate some of the supervision of junior carers to them once they had received training. Staff spoken to said they felt supported to do their work and the manager was approachable. The manager has provided a written statement of policy, organisation and arrangements for maintaining safe working practices at St Kildas. This was available in the office of the home. The manager has ensured that staff receive mandatory training for manual handling and fire safety. The training St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 25 coordinator was also keeping a record of the date staff completed first aid, food hygiene and infection control. Chemicals being used in the home were stored securely. The manager confirmed that COSHH (Control of Substances Hazardous to Health) information was readily available for staff. The AQAA provided information about the electrical systems and gas servicing checks completed. The manager confirmed that the maintenance man completes water temperature checks. The windows in the home above ground floor checked on the day of the inspection had window restrictors fitted. The manager advised that windows above the ground floor level all had to restrict is fitted to them. The manager confirmed that risk assessments had been completed for working practices in the home. The fire risk assessment was available during the inspection. Records of accidents were being kept with individual’s care planning information. Two of these were seen during the inspection. St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 26 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 X 3 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 X 3 X 3 3 X 3 St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14(2) Requirement The Registered person shall ensure that the assessment of the service user’s needs is(a) Kept under review; and (b) Revised at any time when it is necessary to do so having regard to any changes of circumstance. Assessments for people on the long stay and respite unit must be followed up with a care plan that addresses their assessed needs. Care plans must be reviewed monthly or when the persons needs change The Registered person shall (b) Keep the service users plan under review The manager must ensure that all the care needs of the people in the long stay and respite unit are clearly reflected in their plan of care. Staff must have a clear plan of care to follow for people in the St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 28 Timescale for action 19/11/08 2 OP8 15(2) (b) 19/11/08 long stay and respite unit. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The assessments on the long stay and respite unit should reflect the care needs of the individual clearly. Information in the assessments for the long stay and respite unit should include the persons GP and their preferred name. The manager should ensure that the activities provided for people are recorded. The manager must ensure that all the people living at St Kilda’s and their representatives are aware how to raise concerns and who to speak to. The redecoration and refurbishment of the environment should continue. 2 3 4 OP12 OP16 OP19 St Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Kilda Community Support Centre DS0000071973.V372357.R02.S.doc Version 5.2 Page 30 - 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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