CARE HOMES FOR OLDER PEOPLE
St Margarets St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW Lead Inspector
Dragan Cvejic Unannounced Inspection 26th September 2005 07:30 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 Margarets DS0000014960.V254158.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 Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Margarets Address St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW 01234 345964 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) Calsan Limited Mrs Beryl Baxter Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Learning registration, with number disability over 65 years of age (21), Old age, not of places falling within any other category (21), Physical disability over 65 years of age (21) St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26/05/05 Brief Description of the Service: St Margaret’s was a privately owned care home that can accommodate 21 elderly 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 benefits from an installed lift and an extension to the kitchen area, this extension also provides a staff room and two additional 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 DS0000014960.V254158.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during 3.5 hours. Only the key standards were inspected and the report should be read together with the report from 26/05/05 when most standards were covered during the inspection. On this occasion, the case tracking methodology was used, by which 3 service users were followed through their daily life, notes and files. Five service users, 3 staff, a manager and a deputy, a hairdresser and a visiting district nurse contributed to the inspection with their comments. The inspection demonstrated that the home continued to provide good care and that all staff worked hard on improving the records, working practices and on protection of the service users. What the service does well: What has improved since the last inspection?
A service user, who is a smoker, commented that, after she asked the inspector on the last inspection, she was given a choice to keep her lighter with her as long as she wanted. Her care plan noted that, as she wished, she could decide when to hand in her lighter to staff to minimise the risk of fire. The home had just obtained a sitting scale that allowed staff to monitor the weight of users’ who were not able to weight bear. Staff gained a wider knowledge on rights and choices by attending the NVQ training course. All staff were on this course, as well as all having completed the updates on medication and infection control.
St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 6 A new deputy was learning through the work management tasks and thoroughly enjoyed her promotion. There were two staff members at management level and service users now felt that the home had clear and achievable targets and objectives. The home obtained a “Blue Cross” quality assurance system, in addition to the one that they had already developed and used. 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 DS0000014960.V254158.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 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 the following standard(s): 2,3,4 The home arranged for effective pre-admission assessment to be carried out in order to ensure that service users knew that their needs would be met upon admission. EVIDENCE: The home carried out an admission assessment and scored the abilities of prospective service users. They also used the information from social services and hospitals to determine that they could meet the needs of service users. Two new service users confirmed that they were assessed prior to admission. Service users were given a contract to sign within 48 hours of admission. This document was kept in another individual file, together with a property list and financial arrangement details and this contained all required details. The users’ files contained records of external professional visits in relation to service user’s health care needs. Appropriate charts were introduced to ensure effective monitoring of the assessed needs. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 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 the following standard(s): 7,8,10 The care plans were effectively devised and used as working documents in meeting service users’ needs. EVIDENCE: The initial assessment was used to create a care plan and a key worker was now the person who devised the care plan together with the service users. The care plans were regularly reviewed and updated. The home dealt effectively with pressure sores. A care plan stated that a special cushion was used to minimise potential development of pressure sores for a service user. A district nurse commented that the home was effective in prevention and treatment of pressure sores. A service user wore three cardigans, when asked why he did this, he stated that it was his wish: “I felt cold and they gave me my cardigans, now I am fine”. A visiting district nurse stated that communication with the home was good and effective. She added: “This is a good home”. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 10 St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 Service users could continue to enjoy their activities, maintain social contacts and their independence were promoted as far as their conditions allowed. EVIDENCE: The initial assessment provided information on service users’ preferred activities and the home tried to provide some matching activities to allow them to continue to engage in the same. Service users’ autonomy and choice were promoted. A service user who wished to keep her cigarette lighter with her for a longer period of time was allowed to and the home changed her care plan and risk assessment to accommodate this. Another user commented that she could not knit anymore, due to her health conditions, but she now enjoyed playing bingo as a replacement. A service user’s visitor, who wanted to make decisions for the user, regarding who would be able to visit them, was overruled, the manager respected the service user’s wish and would not ban visits from other friends. Another service user, who had difficulty remembering telephone numbers of her relatives, was regularly given help from staff by giving the number to the service user. This enabled her to make independent phone calls and the staff also exchanged money for her, so that she could use the payphone whenever she wanted.
St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 12 A service user, quite able and active, commented that she would like to see more entertainment organised. The manager explained that the home organised fundraising events to increase the fund for this purpose. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 13 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 Service users, staff and visitors could complain if they wished, following the complaint procedure displayed in the main hall. The procedure described how the home would have dealt with the potential complain. EVIDENCE: The complaint procedure explained the procedure in a timely manner, but did not provide the telephone numbers against addresses where the complaint could be made. The manager demonstrated that service users interests were respected when the complaint in relation to who visited a particular service user was made. The user’s voice and wishes were respected in the outcome of this complaint made by a visitor. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 14 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): None These standards were not inspected during this inspection. EVIDENCE: The home was clean and bright in the areas visited during the inspection, but the standards were not inspected. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 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 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, 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: Service users spoken to stated that staff were kind, responsive and friendly. The rota demonstrated that sufficient staff were employed per shift. The home benefited from the promotion of a senior staff member to a deputy manager. She started taking on delegated responsibilities and contributed to the management of the home. All staff without qualification were now on NVQ training courses and the home was on the way to exceeding this standard. All senior staff completed a medication course and extended infection control training. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 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 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): 31,32,33, 35,36 The manager was skilled and effectively managed the home. She needed to complete her registration. Service users enjoyed an open and inclusive atmosphere and respect for their individuality. EVIDENCE: The manager was experienced and used her skills to successfully run the home. She was approaching the end of her NVQ 4 training. She was providing a management induction for a new deputy and kept herself involved in regular training. Her application for registration was in progress. The service users and staff commented that the atmosphere in the home was open, inclusive and friendly. Quality assurance review is now done by using the “Blue Cross” system. This provided information on the quality of service and provisions and created the opportunity to plan and address areas identified by service users for further improvement. The same system indicated which policies needed update. It also included reviews from staff and resulted in much higher staff involvement in
St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 17 running the home. With two effective quality assurance procedures for exploring the status and development of service’s provisions, the home exceeded the requirements from the standards. The home held personal allowances money for one service user and a few others had some small amounts with them. The records of transactions were held, but the signature of a service user whose money was held by the home was not obtained due to his incapacity to sign. It was suggested that an independent representative signs the transaction in the presence of the service user. Staff confirmed that they were regularly and appropriately supervised. The manager was supervised by the owner. The number of accidents/incidents was significantly reduced due to a stable staff team and the management; this ensured better protection of the service users. St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 4 X 2 3 X x St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 19 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 OP16 Regulation 22 Requirement The complaint procedure must contain telephone numbers of the recipients of the potential complaints. The manager must complete her registration process. Timescale for action 31/10/05 2 OP31 31 30/11/05 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 OP12 Good Practice Recommendations The entertaining activities organised in the home should not depend on funding raised by fundraising, but should be funded from the fee, as stated in the statement of purpose. The home could explore alternatives regarding entertaining activities to meet the wishes of very able service users. The home should arrange for service users who are unable to control their finances to have an independent representative. 2 OP35 St Margarets DS0000014960.V254158.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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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