CARE HOMES FOR OLDER PEOPLE
St Margarets 10 Rothsay Road Bedford Beds MK40 9PW Lead Inspector
Dragan Cvejic Unannounced 26 May 2005 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 Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Margarets Address 10 Rothsay Road Bedford MK40 3PW 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) 01234 345964 Calsan Ltd Mary Cox Care Home 21 Category(ies) of DE(E) - Dementia over 65 registration, with number LD(E) - Learning Disability over 65 of places PD(E) - Physical Disability over 65 OP - Older People St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10/08/04 Brief Description of the Service: St Margaret’s was a privately owned care home that could accommodate 21 older people. The property itself was an attractive detached Victorian building situated in a quiet residential area of Bedford just a few minutes walk from the banks of the River Ouse. The home had 17 single rooms and two doubles; two of the rooms had en-suite facilities. The home benefited from an installed lift and an extension to the kitchen area. This extension also provided a staff room and two more toilets, one of which was used as a staff toilet. The home was situated within easy walking distance of Bedford town centre and was well served by public transport. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one working day. The manager came in although it was her day off, showing commitment and devotion to the home. The methodologies used for this inspection were case tracking, reading documents, talking to management, staff and service users and checking the environment associated with service users chosen for case tracking. What the service does well: What has improved since the last inspection?
The home had improved the assessment and care plan forms that allowed them better recording of relevant details about service users. Service users meetings were introduced. The home planned activities on a monthly basis and displayed the list on a board. Skin care had improved and there were no service users with pressure sores. The home obtained a verbal agreement from relatives for two service users to share a bedroom, but the manager was aware that the written was necessary too. This was the only shared bedroom in the home.
St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 6 The bathing routine had changed to morning hours, as service users had asked for. The service users were attending hospital and medical appointments regularly now. The manager stated that, in cases when relatives were not able to escort service users, staff escort was arranged. The staff team was more stable and turnover of staff was minimised. The leadership and management of the home were better, with clearly defined responsibilities. The programme of 1 to 1 staff meetings was up to date and staff were supervised regularly now. A service user said that “ a new aerial had been put up and I can enjoy watching TV now”. What they could do better: 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 Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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 Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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) 1,3,4,5 The home provided sufficient and appropriate information that allowed service users to make an informed decision about their choice of home. The home assessed all new service users to ensure they could meet their needs upon admission. EVIDENCE: The home provided an information pack that contained a statement of purpose, service user’s guide and the home’s brochure where all necessary information was provided. Contracts of service users were not held in this home, but in the head-office, however files contained a copy of the agreement with social services. The home collected information about potential service users and carried out their own assessment. The home demonstrated capacity to meet the needs of existing service users. The manager stated that service users with needs that exceeded the home’s capacity to meet them, were not accepted. The home organised trial visits during which the initial assessment started and continued assessing service users during the first two weeks of their trial period.
St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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, 11 Service users were very well assessed and their care was based on agreed care plans. EVIDENCE: The home carried out very comprehensive assessments of service users’ needs. The manager was relying on the supplied information from social services, families and carers and carried out an assessment that covered all areas of service users’ life. The care plans were drawn up from this comprehensive assessment and all documents were reviewed regularly. A scoring assessment form was, in particular, a very good document and allowed easy, continuous monitoring and recording. A potted life history provided excellent descriptive information about service users. Evaluation sheets were effectively used to record any changes in needs. Medication storage, records and administration processes were appropriate. The home was particularly good in respecting users’ privacy and dignity, as the manager had introduced a completely new approach to service users. They were treated now as individuals and their personalities were respected.
St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 10 There was a verbal agreement from families for 2 service users that shared a room, but the home needed to obtain a written and signed agreement for this arrangement. The staff stated that dying and death were not discussed with certain service users as this would have upset them. Some others had their wishes recorded. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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) 12,14,15 The home provided a good daily programme where service users were able to contribute to and design their own programme. EVIDENCE: The service users had monthly meetings where daily life was discussed, together with other issues in relation to the running of the home. A list of activities was on the board and demonstrated variety. A copy was also placed in each bedroom. An OT was in the home on the day of the inspection providing stimulating activity for service users. The staff presented their plans for a garden party. Meal times were relaxed, but some service users commented that they would prefer to wait in a lounge until it was their turn to be served a meal rather than waiting in the dining room. Menus were discussed and created on a monthly basis. Service users confirmed that they had a choice and that alternatives were available when requested. The cook stated that these alternatives would be recorded in the future. Food on the menu was nutritious and varied. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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) 16,17,18 The home had an effective complaint procedure and the manager was committed to listen to, and take seriously, any potential complaint or concern. Service users’ civil rights were partly promoted. EVIDENCE: The home had not had any complaints since the last inspection. The manager stated that she would take any complaint seriously. Some service users confirmed that they knew how to complain if they wanted to. A complaint procedure was displayed in the main hall in the home. The manager stated that no service users took part and voted in the recent elections. No one used an advocacy service, but information about Age concern was displayed in the home. There were no referrals to the POVA register from the home and no allegations of abuse. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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) 19,20,21,22,24, The home offered a comfortable and pleasant environment, with facilities that helped service users maintain their independence and preserve their personality. EVIDENCE: The home’s location and layout were appropriate for service users. A stair lift was used in addition to the passenger lift to connect all three floors of the home. A paved garden was accessible and used by service users. Communal areas were used by the majority of service users, as their abilities allowed them relatively independent trafficking through the home and they tended to gather in the main, comfortable lounge. A carpet in the dining room showed signs of wear and tear and should be considered for replacement. Maintenance was arranged, organised and minor tasks carried out by one of the owners who was regularly present in the home. The owners supported all staff when they were present. A service user stated: “the owner always dusts the area around TV when he is in.” Bedrooms were very individualised with the service users’ private possessions, be it a piece of furniture, ornaments or pictures. The manager was trying to
St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 14 find a solution for the odour that occasionally affected two bedrooms. Apart from this, the home was bright, clean and very pleasant. Grab rails, raised toilet seats, private phones, walk- in shower facility and the other necessary equipment was there to help service users retain their independence. Screening was provided in a shared bedroom. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 15 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) 27-30 The service users and the home benefited from a stable, strong, compact and committed staff team that ensured appropriate comfort was offered to all in a pleasant atmosphere. EVIDENCE: Skilled, competent and motivated staff were employed in the home ensuring that service users’ needs were met. A co-operative and supportive atmosphere created conditions in which the continuity of care was effectively delivered to the users. The manager covered shifts when a service user had appointments by deploying extra staff in addition to planned rota. Mandatory training was regularly organised and attended by staff and kept their training up to date. The NVQ programme was recently introduced as a regular training offered to staff and there were 6 staff on the training at the time of the inspection. Although there were no 50 of the NVQ trained staff, the high motivation and the home’s attitude to this training was serious to reassure their commitment. Recruitment processes were appropriate and staff files contained the required documents. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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) 31-38 The home was well managed and run. Service users benefited from the open style of management and protected by the appropriate administration system. EVIDENCE: The manager was experienced and very skilled in care and constantly worked on self-development regarding the managerial aspect of her role. She was waiting for the marking of her NVQ3 and was already enrolled on NVQ4. She did not submit her application for registration and was encouraged to do so during the inspection. Her style of management created an open, creative and co-operative atmosphere. Service users and staff felt more empowered in this atmosphere. The home have introduced a very appropriate quality assurance reviewing system. The review carried out collated important information on services and provisions and allowed effective analysis to be carried out. The owners were very much involved in this process and their skills and expertise helped the home use the outcome in a very effective way.
St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 17 The home had a new financial policy regarding service users money that enhanced protection of their finances. Staff were regularly and properly supervised. The manager was the main supervisor in the home and there was a plan to delegate supervision through cascaded staffing structure. Records kept in the home were up to date and were available to service users if they wanted to see them. Safe working practices were in place. There was one thing that manager was aware that needed reviewing, the footrests from wheelchairs were occasionally left unattached in the corners of the corridors. Accidents and incidents were now appropriately recorded, reviewed and used to minimise further risk. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 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. 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 3 x 4 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2
COMPLAINTS AND PROTECTION 2 3 3 3 x 3 x x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 4 3 3 3 3 3 St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 19 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 15 19 28 31 Good Practice Recommendations The meals served to service users as alternative to the meals from the menu should be recorded together with the name of a service user who asked for them. The manager should consider replacing worn carpet in the dining room. More staff should be encouraged to enroll and complete the NVQ programme in order that 50 of staff gain the NVQ qualifications. The manager should send her application for registration to the regulation authority, the CSCI. St Margarets I51 s14960 St Margarets v232808 260505 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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