CARE HOMES FOR OLDER PEOPLE
St Margarets St Margarets 10 Rothsay Road Bedford Bedfordshire MK40 3PW Lead Inspector
Dragan Cvejic Unannounced Inspection 29th June 2006 08:00 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 Margarets DS0000014960.V302556.R01.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 Margarets DS0000014960.V302556.R01.S.doc Version 5.2 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 Mary Theresa Cook 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.V302556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th September 2005 Brief Description of the Service: St Margaret’s is a privately owned care home that can accommodate 21 elderly people. The property itself is 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 has 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. The home mainly accommodated service users with dementia and frail elderly people. The fee was in the range of St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of the service. The evidence used to measure the outcomes for service users has been collected from a random inspection and a site visit as a part of the key inspection. During the site visit a case tracking methodology was used and three service users were case tracked. The manager, 2 staff and several service users provided their comments about the home. A visiting Community Psychiatric Nurse (CPN) also commented on the services and outcomes for service users. What the service does well: What has improved since the last inspection?
The home created a new admission assessment format and already used it for the admission of the newest service users. This format improved the assessment itself, as it asked for extra information. Care plans now addressed clearly how identified needs could be met. Since the last random inspection, the home arranged for a full reassessment of a service user whose needs had increased beyond their abilities to meet them. A multiSt Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 6 agency team that included the service user decided that the only option would be a transfer to a nursing home. The home was identified and the transition process was organised so that the service user understands the difference and gets reassured that her needs would be met in her newly chosen home. This home took further steps and organised training on diabetes for all their staff, to ensure that the safety and care of diabetics would be fully implemented. In relation to this condition, the home started recording what each individual had to eat if they chose a meal outside of the planned menu, to ensure appropriate health care monitoring process. The home’s response to an incident that instigated a random inspection, was remarkable in terms of both actions taken and timing of the improvements introduced. 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.V302556.R01.S.doc Version 5.2 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.V302556.R01.S.doc Version 5.2 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): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided clear information of the service and provisions and ensured that potential service users’ needs would be met if the referral was to be accepted. EVIDENCE: The home reviewed and updated the statement of purpose and the service users’ guide. The contract contained all the required elements, but the change of room during residence in the home was not recorded on it. A new format for initial assessment was devised and used once since a previous random inspection. This new format was more appropriate and contained sufficient detail to clearly determine the level of need for each individual. The home now reacted and demonstrated a prompt reaction when service user’s needs could no longer be met. They called in a multi-agency meeting and, including a service user, decided and arranged for a transfer to a more appropriate place for the particular individual.
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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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were very well assessed and their care was based on agreed care plans. EVIDENCE: The three inspected care plans were detailed, accurate and regularly reviewed. Health care needs were now recorded with detailed records covering areas where needs were changing. A scoring system was used for the assessment, but verbal descriptions of particular needs were provided with details in care plans. A risk of falls contained in one of the files contained five identified steps to minimise the hazard for that service user. Nutritional screening was improved. The home registered all food consumed outside the set menu for each individual. Weight monitoring was improved by acquiring a seating scale, but the significantly varying weights in a short time were not acted upon, nor were the reasons for it not checked and explained. Medication procedures were appropriate. Three case tracked service users’ records showed accurate and appropriate procedures. Medication prescribed on a “when required” basis was recorded on the back of the medication sheet.
St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 10 A nursing intervention happened during the site visit and demonstrated the promotion of privacy and dignity. A payphone was provided in the lift lobby, offering privacy. St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home were planned around the service users’ needs and wishes enabling them to enjoy daily life, as they wanted. EVIDENCE: The initial assessment was extended to record social interactions, religious beliefs, social skills, social preferences and existing social contacts. This helped the home in creating appropriate interventions recorded in care plans. The list of activities was displayed on a notice board. Lots of other information was there too, such as a library link, a list of independent OT specialists, a routinely planned church service and all in-house activities recorded for mornings and afternoons each day. A contingency plan for the expected heat wave was also displayed on the board. A service user reported to the staff and went out on her own, during the site visit. Another user went out for a walk by the riverbank with a staff member. There were no restrictions imposed on visitors, apart from one that was introduced on request of a service user. A service user stated that she gets her newspapers delivered, although she mentioned that she was paying for them. She also wanted to have some small change with her and the home should arrange for it with her relatives.
St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 12 Mealtimes were relaxed and without hurry. The menu showed a nutritional and varied diet. The home had sought advice from a diabetic nurse about food for diabetics since the last random inspection. Fresh fruit was provided in a fruit basket in the dining room between meal times. The food stock was appropriate and well monitored by kitchen staff. St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 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): 16.18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and others associated with the service stated that they were very satisfied with the service provision, felt very safe and well supported by the home that has their protection and safety as a priority. EVIDENCE: The home had not received any complaints since the last inspection. Two service users and one staff member confirmed that they were clear of how to and confident to complain if they wished. After the slip in the care process that initiated a random inspection, the home corrected their procedures to ensure full protection of service users. The home would need to expand its financial protection of service users in relation to relatives handling users’ financial affairs and controlling users’ personal allowances. This should be at users’ disposal if they wanted to, as one service user expressed a wish during the site visit. St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 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): 19,20,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offered a comfortable, well maintained and clean environment where service users felt safe and enjoyed freedom of access to all areas of the home. 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 lounge. The carpet in the second lounge was recently replaced. There was a new arrangement to refurbish all bedrooms before offering them to the new service users. Service users spoken to confirmed that they had all they needed in their bedrooms and found the home comfortable. The home was clean and bright. Infection control was in place.
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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): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Skilled and committed staff provided very good level of care to service users. The service clearly defined the roles and responsibilities of staff through accurate job descriptions and specifications. EVIDENCE: Four service users and two staff members stated that there were enough staff per shift to meet the users’ needs. A displayed rota showed that on a particular day an extra staff member was engaged to ensure that all planned activities took place. Staff roles were clearly marked on the rota. All staff acquired the NVQ qualification either at level 2 or 3. The home exceeded this standard. Recruitment was carried out appropriately. Full staff team ensured consistency of care for service users. The manager and the owners were in process of renewing staff CRB disclosures for staff that were employed for more than 3 years. Staff training was now appropriate. All staff attended training on diabetes, as this shortfall was identified during the random inspection. Service users benefited from a well trained staff team. Staff stated that they could spend time with individual service users, just talking to them. A visiting CPN stated that staff knew service users, their needs, problems and the best actions to meet their needs. St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 17 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): 31,32,33,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and had in place the procedures that promoted and safeguarded service users wellbeing. EVIDENCE: The home was run and managed by en experienced and skilled manager. The relaxed daily routine and friendly atmosphere created a positive and safe environment that service users enjoyed. Staff were trained and supported. The manager and the owner managed to identify, organise and arrange delivery of the diabetic training all in two weeks time, showing commitment to the safety of service users. The home’s quality assurance programme was running on an on-going basis. Two service users were case tracked every six months and this, proportionate quality review was used actively to improve services and provisions. This
St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 18 innovative approach to quality assurance was excellent and showed that the home exceeded this standard. Supervision records and staff statements about supervision showed regular and planned sessions were provided at least once in two months. The home did not deal with service users’ finances, but encouraged families and, in one case arranged for a solicitor to manage users’ money. Records were up-dated following a random inspection within only one month. With all mandatory training up to date and recently reviewed infection control procedures, the home offered a safe environment for service users. St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 19 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 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 3 3 St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 20 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. 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 Refer to Standard OP2 OP8 OP14 OP18 Good Practice Recommendations The home should record on the contract when service users change a room during their residence in the service. When there is a significant fluctuation in service users’ weight, the home should explore and identify the reasons for this and take an appropriate action. Service users should be empowered to hold their personal allowances when they wish so, even in cases where their families manage their finances, and the home should negotiate with families on how to respond to this wish. St Margarets DS0000014960.V302556.R01.S.doc Version 5.2 Page 21 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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