CARE HOMES FOR OLDER PEOPLE
St Lawrence Churchill Drive Crediton Devon EX17 2EF Lead Inspector
James Rose Unannounced Inspection 1st November 2005 09:30 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 Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 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 Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Lawrence Address Churchill Drive Crediton Devon EX17 2EF 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) 01363 773173 01363 774121 Devon County Council Ms Karen Louise Fereday-Jaskowski Care Home 29 Category(ies) of Dementia (29), Old age, not falling within any registration, with number other category (29), Physical disability over 65 of places years of age (29) St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The manager must obtain the Registered Manager’s Award by December 2005 12th May 2005 Date of last inspection Brief Description of the Service: St Lawrence is a local authority care home situated in Churchill Drive in Crediton providing a range of services for older people. It has 29 rooms spread over three floors, including an intermediate care and short stay unit on the ground floor. Access from outside is level, and there is a connecting lift to all floors. The home itself is easy to locate, being fairly near to the town centre. The home has limited parking. This home also provides a fifteen-place day service for local older people on weekdays. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on 1st November 2005 over 5.5 hours. Samples of Care records were examined, five residents were consulted, three visitors were asked for their views and the district nursing team was contacted for their opinion. Observations were made of the way care was delivered and a complete tour of the building was undertaken during the inspection process. As the current manager is absent the inspection was undertaken with the assistance of the acting manager. What the service does well: What has improved since the last inspection?
It is acknowledged that the care team has maintained the good quality of the face-to-face care and many examples were observed during the inspection at the home despite the prolonged absence of the registered manager. An acting manager has now been appointed who had just taken up the post on the day of this inspection. Part of the garden has been remodelled and the entrance drive and the car park of the home have been resurfaced.
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 6 What they could do better:
Six requirements were raised at the last inspection that was undertaken on the 12th May 2005, it is disappointing that none of them has been satisfied and all their timescales have passed. The administration of medication undertaken by the home continues to demonstrate deficits to the homes own policy and procedure; this is very serious as it has the potential to put residents at risk. Personnel records continue to have deficits and are unable to demonstrate that carers have been appropriately recruited. Some reports have been received by the Commission of events covered by the regulations but there were some that were missing, this is also an outstanding requirement. A requirement had also been raised concerning the sluice facilities provided on the top floor of the home and the laundry area both require additional facilities for washing to assist with infection control procedures. A requirement was also raised in the last report for a complete statement of purpose and a service users guide to be produced that satisfies the legislation. All the above requirements have been repeated in this report and the timescales for completion has been agreed with the acting manager of the home, should there be any difficulty in meeting the timescales the manager should contact the Commission to negotiate extra time. Recommendations were also raised in the last report but little progress has been achieved. A requirement has been raised at this inspection calling for the development of the social element of the assessment and care planning undertaken to ensure that all residents’ needs are met by the service provided. Care plans must be signed by the residents concerned or their representative if more appropriate. Where service users are admitted only for intermediate care they must be appropriately assessed before they move into the home and dedicated accommodation provided to assist in intensive rehabilitation to enable them to return home. All chemicals subject to safety legislation must be appropriately stored to ensure that the residents are not at risk in the home.
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 7 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 Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 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 Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 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): 3 and 6 Assessments of need were undertaken of potential residents; health issues were comprehensively addressed; social needs require further development. Dedicated intermediate care accommodation is not currently available at the home and the assessment process is not always appropriate. EVIDENCE: Four assessments were examined at the time of the inspection, these demonstrated that health needs were well covered and healthcare professionals were consulted where appropriate. Social needs lacked detail and did not accurately reflect the interests of the persons in any depth. A requirement has been raised in this report for the development of social needs assessment to ensure all a persons needs are covered. Five residents were asked if they felt all their needs were met and they all stated that they were. However, their views were focused on health issues and they were unaware of what social elements could be provided at the home. Currently the home provides the facility of intermediate care for up to three persons. This care can be provided in accommodation that is not dedicated to
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 10 intermediate use, this approach does not meet the legislation and a requirement has been raised to ensure that this position is rectified. From conversations undertaken with staff at the inspection it was clear that persons admitted for intermediate care have not always been appropriately assessed; this area is also subject to a requirement to ensure that this service is delivered in the correct manner to ensure residents receive the service they require. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Care planning at the home covers health and personal needs but lacks detail of social need. Residents are able to self medicate at the home if they have the capacity. The recording of the administration of medication undertaken by the home has substantial deficits. Residents were treated with respect and their privacy was maintained. EVIDENCE: Four care plans were examined during the inspection process, health needs were appropriately covered but the social needs element of the plan lacked detail and in some plans was not recorded at all. It would clearly be difficult for carers to provide an appropriate service if these needs were not known. A requirement has been raised to ensure the necessary development is achieved. The care plans are drawn up with each service user and agreed with them or their representative, however, not all the plans have been signed to demonstrate agreement, this must be undertaken as an integral part of the process. The district nursing service was consulted by telephone as part of the inspection process and they advised that they did not have any concerns about
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 12 the quality of the service provided at St Laurence and felt that they were always consulted appropriately about residents’ health issues. Residents are able to self medicate at the home subject to a risk assessment approach to ensure they have the capacity. Agreement for the home to administer medication for a resident is recorded in some care plans but is missing in others this position should be rectified as soon as possible. The recordings of the administration of medication were examined during the inspection and substantial deficits were apparent that have the potential to put residents at risk. Gaps were seen in the issue record, the checking and booking in of medication when received was not complete and medication had not been returned when unused. Several preparations in cream form were left out in residents’ rooms leaving open the question of contamination. A requirement has been raised in this report to ensure that the medication policy and procedure that the home has available is followed by all staff that have access to medication. All the service users consulted during the inspection advised that they felt they were treated with respect and that their privacy was seen as important and was given a priority by their carers. Examples were observed on the day of the inspection of staff knocking on doors and giving residents time and space to make their own decisions. Care was seen to be given to ensure residents privacy when they were assisted with their toileting. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 13 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 lifestyle at St Laurence satisfied the expectations of the residents and they were able to maintain contact with family and friends. Assistance is given to service users to help them control and exercise choice about matters than affected them. A wholesome balanced diet is provided in appropriate surroundings. EVIDENCE: Five residents were consulted during the inspection; they all advised that they liked the life at St Laurence. They said that they were well treated by their carers and nothing was too much trouble from them. One resident remarked “This suits me if I can’t be at home and the food is very good” another remarked “I’m comfortable here and well looked after and if I need help I can get it and my family can come and see me anytime”. The home has an unrestricted visiting policy and the three visitors interviewed on the day of the inspection confirmed that they felt the service provided by the home was of a high standard and that they could visit when they liked, no concerns were expressed. From observations made during the inspection it was clear that residents were assisted to exercise choice and were encouraged to express their views about
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 14 matters that affected them, residents advised that they felt in control and were confident that their wishes were given priority by carers. The five residents consulted were quick to say that the food provided at the home was to their liking and that choice was always available to them. Residents were able to decide where they would like to take their meals and the dining rooms in the home were well appointed, light and airy. Meals were served up from heated trolleys at each dining room. The meals provided on the day of the inspection were clearly much appreciated by the residents. Visitors that wished were able to share a meal with their relative for a nominal fee. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 15 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 Visitors and residents were confident that if they raised an issue it would be dealt with appropriately. Service users were protected from abuse. EVIDENCE: Three visitors and five residents were consulted during the inspection process they were all confident that if they raised an issue with the home it would be taken seriously and resolved quickly to their satisfaction. No complaints were made during the inspection. The home has a clear complaints procedure readily available to all to ensure that any cause of concern can be raised and resolved. The home has available an adult protection policy and procedure and carers are trained in its use. A record of this training is maintained as part of the personnel files in the home. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 16 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 and 26 Residents live in a home that is generally safe and well maintained. The home is clean and good standards of hygiene were evident throughout. EVIDENCE: A complete tour of the home was undertaken during the inspection, residents’ bedrooms were well decorated and demonstrated ample evidence of personalisation. The lounges were comfortable and the dining rooms light and airy. Bathrooms and toilets were well presented and had suitable aids available for residents that had mobility issues. A vertical lift is available to all floors that is regularly serviced. Some modifications have been undertaken to the sluice on the top floor, it appears that a washing facility was removed but not replaced. This had been achieved in the other sluices in the home. Added facilities are also needed in the laundry area and these are all outlined in a requirement raised in the last report. The home was clean and high standards of hygiene were evident throughout.
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 17 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 Residents’ needs were met by the care team in the home and were safe at all times. The recruitment process undertaken for new carers does not demonstrate that it adheres to the policy and procedure of the authority. An appropriate training programme is running to ensure carers are competent to do their jobs. EVIDENCE: All the residents consulted advised that their needs were well met by the staff team and they did not have to wait when they used the call bell system. The new acting manager is going to undertake a complete review of the staff team as a priority to ensure that all residents’ needs are met. Three personnel files were examined during the inspection and deficits were apparent of the information held on each carer. This is the subject of a requirement in the last report and this is repeated here with an agreed timescale for completion undertaken with the acting manager. The home does have a comprehensive training programme in place to ensure that carers are appropriately trained to be competent in their posts. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 18 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 and 38 The new acting manager of the home is well qualified to meet the responsibilities of the post. The home is run in the best interest of the residents and their finances are safeguarded. Health and safety issues are given a priority but there was one serious deficit. EVIDENCE: The new acting manager of the home has achieved the registered managers award, NVQ 3 and 4 and is a qualified assessor, she has many years experience and is well able to discharge the responsibilities of the post. The home is run in the interest of the residents, this was confirmed in conversations undertaken with visitors, residents and the district nursing service. It was also clear from observations made during the inspection that residents’ needs and wishes took priority over the daily routines of the home. The home does assist some of the residents with their pocket monies, this is clearly accounted for and receipts are held for any purchases made on behalf
St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 19 of a resident. Where a service user has a degree of confusion two staff signatures record all transactions. St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 21 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 4,5,6,Sch d 1&4 Requirement Timescale for action 31/01/06 2. OP9 13(2) 3 OP3 14 4. OP29 Schedule 2 Produce an up to date, accurate statement of purpose, and service users guide containing all the required information. (Previous timescale of 30/09/05 not met) The registered provider must 07/11/05 ensure that all staff adhere to the policy and procedure for the correct administration of all medication in the home. (Previous timescale of 30/06/05 not met) The registered provider must 30/11/05 ensure that new residents are admitted only after the completion of a full assessment of their needs. Staff records must contain all the 31/01/06 information and documents required in Schedule 2. (Previous timescale of 31/08/05 not met) St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 22 5. OP38 37(1)(2) 6. OP38 13(3) 7. OP6 12 8. OP38 12 9. OP7 15 The registered person shall give notice to the Commission without delay of any event in the care home, which adversely affects the well-being or safety of any service user. Any notification made in accordance with this regulation, which is given orally, shall be confirmed in writing. (Previous timescale of 31/08/05 not met. The registered person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (One sluice room on the upper floor has no hand-washing facilities, which must be rectified, and on the ground floor, the laundry room only has one sink, which doubles for staff washing their hands, washing clothes and washing commodes, which must be addressed.)(Previous timescale of 31/08/05 not met) The registered provider must ensure that where service users are admitted only for intermediate care, dedicated accommodation is provided, together with specialised facilities, equipment and staff to deliver short term intensive rehabilitation and enable service users to return home. The registered provider must ensure that the COSHH regulations are adhered to within the home. The registered provider must ensure that all service user plans are signed by the service user or their representative to demonstrate their agreement. 07/11/05 31/01/06 30/11/05 07/11/05 30/11/05 St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 23 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 OP4 Good Practice Recommendations A training course should be provided to care staff and activities staff, which could provide an understanding of the different stages of dementia type illnesses and provide insight for care staff into the experience of this client group. Care plans should be reviewed on a monthly basis and be signed by the residents or their representatives. Residents should be offered the opportunity to be involved in reviews. A regular record should be maintained of residents nutrition, including weight gain or loss. It is recommended that for all hand written entries on the Medication Administration Record chart that the person signs and dates the entry, and this is then checked and signed by a second person. Consideration should be given to relocating the rooms for people with a dementia type illness to a more central position within the home. The home should have an enclosed garden, which is safe and accessible to all residents. Staff levels should continue to be monitored and records kept if the levels impact on service users and there are instances of unmet need. For example, if staffing levels impact on activities and allocation of a key worker. The results of the homes quality assurance survey should be published and be made available to current and prospective residents, their representatives and other interested parties, and the CSCI. 2. OP7 3. 4. OP8 OP9 5. 6. 7. OP19 OP20 OP27 8. OP33 St Lawrence DS0000033100.V257943.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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