CARE HOMES FOR OLDER PEOPLE
St Martins House St Martins Crescent Camborne Cornwall TR14 7HJ Lead Inspector
Lynda Kirtland Unannounced 25 April 2005 09.30 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 Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service St Martins House Address St Martins Crescent Camborne Cornwall TR14 7HJ 01209 713512 01209 711444 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) Cornwall Care Limited Mrs Susan Margaret Crouse Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20, Old age, not falling within any other category (8), Physical Disability (12) St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to Service users to include up to Service users to include up to Service users to include up to (MD(E)) Total number of service users 8 adults of old age (OP) 12 adults with a physical disability (PD) 20 adults aged over 65 with a dementia (DE(E)) 20 adults aged over 65 with a mental illness not to exceed a maximum of 40 Date of last inspection 3 December 2004 Brief Description of the Service: St Martins House is one of eighteen homes owned by Cornwall Care Ltd. It is registered to accommodate forty older people in need of personal care and who are over retirement age. The majority of St Martins house is on a single floor, which is accessible to all service users. St Martins House provides three core services: residential home, rehabilitation unit and day care provision. The residential home provides long term care to service users who are in need of personal care and are over retirement age. Admissions are planned and emergency admissions are avoided whenever possible. The rehabilitation unit; referrals are made by health professionals to St Martins House for service users who due to a physical health need are needing a period of rehabilitation before they return to their own homes in the community. St Martins House provides twelve places in this unit. The length of stay is around six weeks. The ideal is for admissions to be planned but this cannot always be achieved. Day care is available at St Martins House for 1-3 service users a day.The full range of community health care professionals visit the home on an as need basis or routinely. St Martins house is near to local facilities and has good transport links to the local town. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited St Martins House on the 25 April 2005 and spent the day at the home. This was an unannounced visit. On the day of inspection 38 service users were resident in St Martins House. The inspector met with 18 service users and 6 representatives and a number of staff to gain their views on the services that St Martins House provides. As the registered manager was on leave the inspector also met with the rehabilitation coordinator and the duty manager to assist in and provide feedback on the inspection process. The inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well:
Service users from the residential home and rehabilitation Unit stated that St Martins House provides good quality care and accommodation. Those attending day care also enjoyed their day visits to the home. They made various comments about staff such as; they are ‘kind’ and ‘caring’. Service users and their representatives commented that the admission to the home was approached in a ‘calm and sensitive’ manner. Service users and their representatives commented that they felt they were involved in the development of their individual care plan and that staff meet their care needs. Continued training is being provided to improve the quality of service users care planning process further. This inspection highlighted that St Martins House provides a good standard of care that addresses physical, social, educational and leisure needs. Service users and their representatives and staff felt that the St Martins House management team are supportive and that they are prepared to listen to new ideas on how to continuously improve the service that St Martins House provides. St Martins House ensures that the home is maintained to a good standard at all times. This inspection was positive and the inspector would comment that Cornwall Care Ltd is an organisation that wants to achieve a high standard of care to all its service users and provide appropriate training and support to its staff group. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 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 Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 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) 3,5,6 Prior to admission, service users and their representatives participate in a pre admission assessment with members from the management team to identify individual care needs. A trail period of stay within the home is planned before long-term placement is agreed. Emergency admissions are avoided wherever possible. The rehabilitation Unit provides a separate service to service users who are admitted for intermediate care. EVIDENCE: St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 9 From discussion with service users and their representatives, plus inspection of three service users files (from the residential home) it was evident that they are consulted in St Martins House pre admission assessment. Care needs identified by the referring professional assessments were incorporated in the assessment process and transferred to care plans This assessment is detailed and identifies the service users individual physical, emotional, social, educational and leisure needs and how the home would aim to address them. A months trail period is offered to all new service users after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. Service users and their representatives commented that the preadmission and ‘moving in period’ are carried out sensitively by staff and could not see how this process could be improved. They also stated that this was undertaken with their participation and that their care needs were identified accurately. Intermediate care is provided in the rehabilitation unit. This is a separate unit, and has a multi disciplinary staff tem who, along with the service users draws up an individual care plan, which will meet the service users health and social needs. This inspection did not look at service users files from the rehabilitation unit. However in discussion with service users who are currently residing in the rehabilitation unit all stated that they felt the introduction and ‘settling in’ period was carried out in a positive way and minimised the anxiety of moving into a care home. All felt they were aware of their daily work programme but some said they would like to know the plans for when they will go home. This was discussed with staff from the rehabilitation unit who acknowledged that plans are made in some cases on a daily bases as it is dependent on improvements in the individuals physical health and arranging support systems within the community to allow a planned discharge home. The rehabilitation coordinator commented that consulting service users about their discharge home is on going. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to service users. Staff training is a priority to Cornwall Care Ltd and the staff commented that the training they receive assist them in their daily work. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 10 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) 7,8,10 Service users and their representatives are consulted in the implementation and subsequent reviews of their individual care plans. Care plans ensure that physical, emotional, social, educational and leisure pursuits are assessed and action to address the care needs are detailed for all staff to meet in a consistent manner. Service users are treated with dignity and privacy at all times. EVIDENCE: St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 11 From discussion with service users, their representatives, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of service users files, and in discussions it is evident that St Martins House encourage service users and their representatives to express their views in the formation of their care plans. The care plans are detailed documents, which clearly identify service users skills and where assistance is needed. From this the care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. Staff confirmed that they are more involved in the care planning and reviewing stages of the individuals care plan. The duty manager stated that corporate training is occurring in the development of care planning process, which will be cascaded to all staff. Risk assessments were evident on the majority of files. The duty manager agreed to ensure that up to date risk assessments are present on service users files at all times to ensure that they available to staff. From inspection of service users files and accident books, it was noted that health needs are identified and appropriate actions taken to address them. Service users and their representatives commented that health needs are met by the staff at the home and by external professionals to a high standard. Records of all health professional visits are recorded in detail. All service users spoken with stated that staffs ‘at all times’ display a high standard of respect in their daily interactions. Service users stated that staffs ensure that their privacy and dignity is maintained and could not see how this area of care could be improved. In addition the inspector observed staff communicating with service users in a professional manner at all times, alongside a sense of humour when appropriate. Cornwall Care Ltd has relevant policies on this area of care, which are incorporated, in staff’s induction process as well as through NVQ training. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 12 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) 12,13, 14 St martins House ensure that service users social, educational and leisure needs are identified and aim to provide a variety of activities in the home. Service users visitors are encouraged to visit their relative. Cornwall care limited are reviewing the provisions of meals in all the homes, to ensure a high standard of dietary provisions are maintained. EVIDENCE: St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 13 From discussions with service users and their representatives they commented that there is ‘enough to do’ during the day at St Martins House. Service users recalled a variety of activities that are provided such as arts, films, weekly trips out, Tai Chi, celebrations, hand massage, nail painting, keep fit and church services. St Martins House has a vehicle that can take up to 4 service users out on weekly trips, some service users commented that they preferred the mini bus as it felt that the trips were more frequent as it could take more service users at a time. In addition some commented that they would like better access to a larger garden. The duty manger stated that the registered manager is aware of these comments and that she is actively considering how to address them. The inspector observed some activities occurring during the inspection and saw information on display advertising future events. St Martins House policies and documentation demonstrate that they aim to encourage service users to pursue their hobbies and interests. Individual interests are recorded in service user care plans and their ‘life story book’. Service users have opportunities to access advocates and some choose to have relatives act on their behalf. Relatives and service users stated that the home is welcoming to them. Service users gave differing opinions to the inspector in respect of the variety and quality of food provided. It was evident from discussions with service users and their representatives and staff that there is a choice of main meal and that alternative meals will be provided. The duty manager was aware of this mixed response and that Cornwall Care Ltd is addressing the area of food corporately. Cornwall Care ltd has provided training to all homes managers and chefs to implement the ‘Food Project’. This focuses on the nutritional and social aspects of food. It’s aim is to provide a service users focused meal provision encouraging meal times to be social occasions whilst allowing service users the opportunity to maintain their own independence and skills i.e. encouraging self serving of food, menu cards to be introduced and to improve the presentation of meals. As this is due to be implemented this will be inspected in further detail at the next inspection. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 14 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) EVIDENCE: This section was not inspected. The inspector would comment that from discussions with service users and their representatives that all stated they had ‘no grumbles’, and ‘no concerns’ about the service that St Martins House provides. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 15 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) 19,20,21,22,23,24,25,26 St Martins House provide a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. EVIDENCE: The majority of St Martins house is on a single floor, which is accessible to all service users. There is one small portion of the building that is used for office space. The home is built on a cross principal with four wings radiating out from a central communal area. Each wing is a self-contained unit with bedrooms, dining, lounge, toilets and bathroom facilities. The central communal area leads out to a garden. Bedrooms are for single occupancy and are decorated and furnished to reflect the individual’s personality. From a tour of the home it was evident that St Martins House continuously update and invest in the homes décor and furnishings. St Martins House have a continuous redecoration and maintenance programme to ensure that all parts of the home are presented and maintained to a good standard.
St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 16 Service users and their representatives all commented that they are satisfied with the homes presentation and quality of furnishings. All rooms inspected were clean and decorated to a good standard, were personalised and service users had the option to lock their rooms if they wish. St Martins House have suitable laundry facilities. Service users commented that the laundry service is ‘good’ and did not raise any issues in this area. There are suitable bathing and toileting facilities in the home. Aids and adaptations were evident to assist with mobility and transfers. There were sufficient sluicing facilities in the home. Service users and their representatives were positive in their comments in how the home maintained cleanliness. From the inspectors observation this was confirmed. Previous requirement in respect of the environmental standards have been complied with. The previous recommendations remain in progress. On this inspection the inspector has identified requirements to: ensure that all doors marked ‘fire door keep locked shut’ are kept locked shut: and that a broken window is replaced. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 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 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, St Martins House aim to employ suitable trained staffs in sufficient numbers at all times. EVIDENCE: On the day of inspection four care staff and duty manager were present in the residential home (ratio 1:8). In the afternoons/ evenings the care staff to service users ratio alters to 1:10 plus manager cover. In the rehabilitation unit the rehabilitation coordinator, 2 carers plus a float, physiotherapist and Occupational therapist were on duty. (Staff ratio1:4). In the evening this alters to 1:12. Kitchen, laundress, domestic, handyperson and administration staff cover both areas of the home. At night there is sufficient cover. Service users and their representatives commented that ‘staff are busy’ and felt that a increase in staffing levels would be beneficial i.e. some commented that response to call bells could on some occasions take some time to answer, The inspector noted from staff meeting minutes and discussion with the duty manager and rehabilitation coordinator that there have been some consultations with staff regarding staffing levels. The managers note that the tea time period in particular can be difficult to gain sufficient cover, which results in a 1:10 staff ratio. Kitchen staff informed the inspector that there has been difficulty covering the kitchen department due to sickness. The inspector recommends that the staffing levels be reviewed. In addition the inspector recommends that a member of staff undertake the intermediate food course. Service users and their representatives made positive comments about staff skill and attitude in meeting their individual care needs. The inspector observed staffs that were competent in their work.
St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 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 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) 32,37, 38 The management approach creates an open, positive and inclusive atmosphere. All records are maintained to a satisfactory standard St Martins House ensure that the home is maintained to a safe standard for those who live or visit the home. EVIDENCE: St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 19 During the inspection service users and their representatives told the inspector that if they had any issues or ideas as to how to improve the service that St Martins provides they felt able to approach staff to share these ideas. Service users told the inspector that there are residents meetings (minutes not inspected) and that these occur approximately three monthly. From inspection of staff meeting minutes these evidenced that staff meet with the management team approximately 3 monthly. Staff commented to the inspector that they felt that these meetings were informative and a venue for discussion. Staffs spoke positively about the management support within the home. Records held by the home are stored in a confidential manner and in line with the Data protection Act. From inspection of St Martins House various documentation and maintenance certificates, this confirmed that inspections from the fire authority, environmental health had been completed. Equipment in the home had service records and Cornwall Care have comprehensive policies in the remit of health and safety, Legionella and COSHH. Staffs have attended relevant training in the areas of fire, health and safety, manual handling and infection control. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x 3 3 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 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 3 x x x x 3 3 St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 21 no 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. 2. Standard OP19 OP27 Regulation 23(4) 18(1)(a) Timescale for action All fire doors marked keep locked 30.04.05 shut must be adheered too. Staffing levels must be reviewed 30.08.05 to ensure sufficent and qualifed staff are employed at the home at all times. Requirement 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 Op19 OP27 Good Practice Recommendations the window in the rehabilitation corridor should be fixed. A member of kitchen staff should complete the Intermediate food hygiene course. St Martins House D52-D04 S8910 St Martins House V217457 250405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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