CARE HOMES FOR OLDER PEOPLE
St Matthews Chequers Lane Redbourne Herts AL3 7QG Lead Inspector
Hazel Wynn Key Unannounced Inspection 10:00 6thJune 2006 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 Matthews DS0000050846.V295211.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 Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Matthews Address Chequers Lane Redbourne Herts AL3 7QG 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) 01582 792042 Colley Care Limited (Trading as B & M Care) Emma Louise Pead Care Home 52 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (25), Old age, not falling within any other of places category (27), Physical disability (5) St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may accommodate one (named) lady who is currently under 65 years of age. The home manager must inform the CSCI when the above (named) service user leaves the home, or reaches the age of 65, whichever come first. This variation applies only to this (named) lady and ceases to be in force when she leaves the home, or reaches the age of 65, whichever comes first. 1st December 2005 Date of last inspection Brief Description of the Service: St Matthews was opened in 2003. It caters for the needs of 52 older people 27 beds are dedicated to personal care on the ground floor, whilst the remaining 25 cater for residents with dementia on the first floor. The home has plenty of storage space and has assigned a room specifically for therapies and another for hairdressing. The laundry, kitchen and staff room are situated on the lower ground floor. Throughout the home there are facilities for visitors to prepare refreshments. The home has a vast enclosed garden and enables residents to utilize the grounds safely. Closed Circuit Television is in situ and is discreetly positioned over the main entrances to the home. The home is adjacent to a childrens nursery and therefore benefits from additional security measures. A number of rooms have a patio area outside and it is hoped in time that residents will personalize this area. The home employs a gardener to support this process taking place. The fee range at the time of this report was £600 - £660 per week. St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced inspection carried out by two regulation inspectors representing CSCI on 6th June 2006 using available evidence gathered, since the last key inspection, during this visit including observation, discussion with residents, care staff and the manager and examination of records maintained in the home. All of the key standards were assessed during this inspection and the overall outcome was positive. Requirements were made in respect of evidencing the regular supervision of all staff, and for individual falls risk assessments to be carried out that provide clear guidance for all care staff. More detailed guidance for staff were also required in respect of other aspects of the individual care plans All residents spoken expressed satisfaction with the home, and more especially the staff; however a frequently mentioned area was lack of provided activities. A recommendation was made to review the number of hours for the post of activities co-ordinator that has been previously advertised with poor response. Medication, recruitment, cares plans and health and safety records were inspected. Based on this inspection visit and information received since the last inspection visit, the overall quality of this service is adequate and improving. What the service does well: What has improved since the last inspection?
Since the last inspection care plans have been improved in respect of meeting nutritional needs and challenging behaviour. The care plans showed how assessed needs were being met. A protocol has been put in place for covert medication (this must be individualised should another resident require the same). Efforts have been made to achieve greater benefits in the dementia unit by way of furnishing the enclosed courtyard with patio furnishings so that
St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 6 residents can benefit the free and safe access opportunity. Portable airconditioning units and air-cooling fans were in use to keep the home cool. Infection control measures have been improved and only liquid soap and disposable towels were in use in the bathrooms and toilets for communal use. Restrictors were in place on all operable windows and there were no sharps such as razor blades or free access to corrosive products such as Steradent. Staffing has improved with most of the care staff now being permanently recruited members of the team. Staff have been provided with a one-day dementia-training course, which provides an insight into dementia care needs and staff stated that more in depth distance learning courses were being looked at. 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 Matthews DS0000050846.V295211.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 Matthews DS0000050846.V295211.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): Standard 3. Standard 6 does not apply to this home. Prospective residents do not move into the home until a full assessment of need has been carried out and assurances given that their needs will be met. The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A sample of files was examined as part of case tracking; those files seen contained a full assessment of need and care plans had been signed by either the resident or their representative, which evidenced their involvement. St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 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 - 10 Work has been done to improve care plans; however guidance to staff in managing tasks pertaining to care needed clarification. A falls risk assessment with clear guidance for staff was not available on the files examined. Up to date reviews could not be evidenced. Requirements were necessary. The quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: A lot of work had been done to meet the requirement, made at the previous inspection in respect of care plans. The improved care plans now needed additional work to ensure that there is clear guidance to staff in carrying out tasks required to meet needs. A discussion took place with the registered manager in respect of review dates for one of the care plans; the manager explained that the review had taken place but the review update of the care plan had been sent to a relative for signature. In order to evidence that a review has been held the registered manager was advised by the CSCI to keep a copy of the review. A requirement was made for all reviews to be kept up to date and evidenced.
St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 10 A full falls risk assessment was not available on the files seen that would provide staff with clear guidance to staff; a requirement was made. Policies and procedures are in place in respect of medication. There were no gaps in the Medication Administration Record. Medication had been dated on opening. Two bottles of medication were no longer in use (one bottle in the refrigerator and one in the drugs trolley). We discussed with the manager that these be removed and labelled for disposal to ensure they were not overlooked. The CSCI observed staff supporting residents in a respectful, dignified and gentle manner and residents spoken with further confirmed that staff are very caring and respectful. St Matthews DS0000050846.V295211.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 - 15 Activities is an issue at the home, despite staff efforts to provide entertainment and engagement. Religious needs are met according to preference. Contact with family and friends is supported and residents who are able keep contact with the local community. Staff encourage residents to maintain choice and control over their lives and this could improve with a better social and recreational provision. A wholesome and appealing diet in pleasant surroundings is provided. Due to the insufficient provision of activities, which impedes on the social and recreational needs being satisfactorily met, the quality in this outcome group is poor; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Some of the residents spoken with stated that there were insufficient activities; one lady said that she was in too much pain to enjoy activities but had discussed the lack with others who felt bored. As part of feedback with the manager, the lack of sufficient activities was discussed. The manager stated that it has proved difficult to recruit an activities co-ordinator and a recommendation was made for the hours being offered to be increased in order to make the post more attractive. Additionally a recommendation was made for more materials to be made available for pleasurable occupation. Visiting ministers from local churches meet the religious needs of residents. Residents were observed to be given choice and control in various situations throughout
St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 12 the day; however the lack of sufficient activities has a big impact on choice and control and it is hoped that the CSCI’s recommendations to attract a recruit to the post of activities co-ordinator will be considered. The manager stated that visiting ministers provide for the religious needs of residents. Visitors were observed to be welcomed throughout the inspection and those spoken with provided good feedback but would like to see more in the way of activities. The residents said that the food served has improved greatly and the meal served looked attractive and was enjoyed by the residents, several of who complimented the meal. The menu seen provided variety and choice of wholesome food and a cooked breakfast is available. The dining areas looked fresh, attractive and were brightly lit and those who required support were observed to be assisted in a discreet and appropriate manner. St Matthews DS0000050846.V295211.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 and 18 Complaints are listened to, taken seriously and acted upon. Residents are protected from abuse. Quality in this outcome area is good; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: There had been four complaints since the last inspection and these had been well handled and in accordance with the home’s policy and procedure; some relatives had written to thank the registered manager for the manner in which she had managed their complaint. The manager stated that residents’ charges are invoiced and no personal cash is held by the home for residents and there are policies and procedures in place for residents and staff in respect of valuables and gifts. The manager stated that during elections residents can either use the postal vote or some go to the polling station supported by relatives. Newly recruited staff had not yet attended adult protection training course but the policies and procedures had been discussed with them. The registered manager stated that she had requested replacement copies of the adult protection poster and folder as these had gone missing. St Matthews DS0000050846.V295211.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 and 26 There are some areas of maintenance that require attention. The home is clean pleasant and hygienic. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: Some of the windows in various areas of the home are screwed down and cannot be opened; the windows on stairwells are all screwed down and there is no ventilation in the stairwells. Some of the windows that were screwed down had broken or missing furniture, which needs replacing and all windows, should be operable with restrictors fitted. Where risks are identified in respect of windows, a risk assessment should be drawn up and kept reviewed. Since the last inspection, action had been taken to improve temperature control in the home and cooling fans and portable air conditioning units were in use in communal areas. The home was fresh and clean throughout.
St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 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 There were adequate staff on duty with a balance of skilled staff and staff in the process of induction and training. (See Standards 7 - 11 in respect of guidance to staff in relation to tasks). Recruitment of staff is robust. There is a training programme in place and training provision is evidenced. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: On the day of inspection there were adequate staff on duty; recent recruitment drives have been successful and some of the staff on duty were working through their induction programme. The duty rota showed that there were 7 senior staff and 1 bank senior, 11 care staff, 3 night senior care staff and 4 night carers covering 24 hours in addition to the registered manager and deputy assistant. The training records were up to date and recorded the type of training given. All staff are required by the home to attend mandatory training courses. Some of the newer staff had only just commenced employment a few days prior to the inspection and so had not yet been on courses but were being supported through an induction. (See standards 7 – 11, where guidance to staff is discussed and requirement is made in respect of the falls risk assessment). Some staff had attended a one-day course in meeting dementia needs, it is highly recommended that a more in depth course be provided for staff working in the dementia unit. St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 16 Recruitment files of care staff who have commenced employment since the last inspection were examined by the CSCI during this inspection and procedures were evidenced to be robust. Staff were observed to be confident and competent in managing their duties and supporting residents throughout the inspection. St Matthews DS0000050846.V295211.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, 33, 35, 36 and 38 The service is run by a person fit to be in charge, is of good character and has the ability to discharge her duties fully. The service is run in the best interests of the residents. The financial interests of the residents are safeguarded. There were gaps in formal supervision records. The health, safety and welfare of residents and staff needs to be better evidenced through good quality falls risk assessments that provide clear guidance to staff. The reviews of health, personal and social care needs of residents must be evidenced as current. The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. EVIDENCE: The registered manager is well experienced in the management of a care home and was recently registered as the manager of St Matthews by the CSCI. The CSCI carries out robust checks when registering a manager. The registered manager has worked hard to satisfy previous requirements and has introduced new care plans; the new care plans need some additional work but this does
St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 18 not detract from the hard work that has gone in to improving the care plan system. Quality assurance systems are in place and the views of the residents and their relatives are sought in an endeavour to run the home in the best interests of the residents. The home recently surveyed 16 residents and a copy of the report was made available during the inspection. The registered manager stated that the residents are invoiced for charges and the home does not manage any monies on behalf of residents. Policies and procedures were in place in respect of gifts to staff and safeguarding residents valuables. One member of staff had only one formal supervision recorded since commencement of employment in January 2006. Three other members of the care team had not been in employment long enough to have their first formal supervision and were currently working through induction. Evidence must be provided that all staff receives formal supervision at least 6 times a year in addition to an annual appraisal; a requirement is made in this respect. Four care staff recruited since the last inspection had been robustly recruited and there files were examined during this inspection. A requirement is made earlier in this report for falls risk assessments to be carried out and to provide clear guidance to all staff. A requirement has also been made earlier in this report for care plan reviews to be evidenced. St Matthews DS0000050846.V295211.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 1 St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1)(b) Requirement Care plans must have a comprehensive falls risk assessment that provides clear guidance to care staff. As the manager has worked hard to improve care plans an Enforcement Notice will not be served on this occasion. Further expansion is still required relating to individual service users needs, especially in respect of guidance to staff. ALTHOUGH THIS REQUIREMENT HAS BEEN MET IN MANY AREAS IT REMAINS UNMET IN FULL. The review dates of care plans must be evidenced to show that on going monitoring of needs is current. Service users must be provided with stimulation and recreational activities both in and outside of the home, which suits their needs, preference and capacity. Windows that require repair should not be screwed shut. Under the programme of repair
DS0000050846.V295211.R01.S.doc Timescale for action 16/07/06 2. OP8 15(2)(b) 30/07/06 3 OP12 16(2)(m) & (n) 30/08/06 4 OP19 23 30/08/06 St Matthews Version 5.2 Page 21 5 6. OP36 OP38 18(2) 13(4)(a), (b)&(c) these must be deemed operable with reliable restrictors. Risk assessments should be in place and kept reviewed. Several windows throughout the home have remained screwed down. Some of the windows have been repaired and are now operable since a requirement was made in the last report. The provision of formal supervision (at least 6 times per year) must be evidenced. The health, safety and welfare of residents and staff must be assured by ensuring OP7 and OP8 above are met. The meeting of OP12 above has been given additional time. 15/08/06 30/07/06 St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 22 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 OP9 Good Practice Recommendations As soon as medication is no longer needed remove from the trolley or fridge and label for disposal. If necessary store in a dedicated secure area whilst awaiting disposal (if disposal cannot be immediate). This will ensure its disposal is not overlooked. Consider reviewing the package available for the activities co-ordinator post that has been advertised (i.e. more hours, level of pay for qualified/trained person). This may make the post more attractive and ensure someone accepts the post. The post has been vacant for a considerable period to the detriment of the residents. It is highly recommended that a more in-depth dementiatraining course is pursued (staff did state that this was being looked into). This will greatly benefit residents who have dementia care needs and increase the quality of the service. 2. OP12 3 OP30 St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 St Matthews DS0000050846.V295211.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
