Inspection on 23/08/07 for St Peter`s

This inspection was carried out on 23rd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Peter`s 02/08/06

St Peter`s 31/08/05

St Peter`s 23/01/05

St Peter`s 03/08/04

St Peter`s 10/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Peter`s Bishopthorpe Road Westbury on Trym Bristol BS10 5AB Lead Inspector Sandra Garrett Key Unannounced Inspection 23rd & 24th August 2007 09:30 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 Peter`s DS0000035285.V346432.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 Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Peter`s Address Bishopthorpe Road Westbury on Trym Bristol BS10 5AB 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) 0117 3532227 0117 9031032 brssljk@bristol-city.gov.uk Bristol City Council Lorraine Knight Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2006 Brief Description of the Service: St Peters is run by Bristol City Council Adult Community Care and registered with the Commission for Social Care Inspection (the Commission). The home is in the residential area of Westbury-On-Trym, known as Manor Farm, that is close to Southmead Hospital. St Peters offers personal care for older people over the age of 65. It houses thirty residents with two short stay/respite care places. The home is across the road from a small rank of shops and there is a pub close to the end of the road. It has a large garden at the back of the home and a small car park with lawned area at the front. The home is accessible to disabled people and is laid out over two floors with lift access. The full fee for living at the home is currently £460 per week. People funded through the Local Authority have a financial assessment done in accordance with Fair Access to Care Services procedures. Local Authority fees payable are worked out according to individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk. Copies of the last inspection report weren’t seen displayed in the home at this visit. The certificate of registration was displayed and was correct. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was our first visit to the home since August 2006. We spent two days talking to people and getting their views for our survey. Ten people made comments on a range of topics that are included throughout this report. A second inspector spent time observing life in the lounge to see how peoples wellbeing is promoted – particularly if they have dementia. We looked at a range of records that included care plans and assessments, complaints, activities, staff files and health and safety. What the service does well: What has improved since the last inspection? St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 6 No requirements were made at the last visit. Refurbishment and redecoration of communal areas has improved safety and better meets peoples needs. What they could do better: Three good practice recommendations were made at the last visit but not enough information was available to show if these had been fully adopted. Information about reviewing activities wasn’t seen. Activities were seen happening although not everyone was included and from observation of life in the lounge comments about being bored were heard. Information from both our survey and the home’s own quality assurance survey report (just published) should be used to make sure activities are regular and meet everyone’s needs, not just a few. It wasn’t clear if a recommendation about finding ways of making sure that care staff work as a team had been adopted. At this visit lots of agency staff were working in the home although a number of new staff had been taken on recently and further recruitment is planned. However comments from people living at the home showed that there are still difficulties because of lack of staff time to spend with them and the continued use of agency staff, that they feel aren’t well trained. A recommendation about care staff being offered continuing training in working with mental health needs and dementia care was partly adopted. The home works with the In-Reach team that offers support to care homes in respect of peoples mental health needs. This support continues and sessions about how to understand and manage needs are held in the home. However from training records seen at this visit none of the five new staff had undertaken recognised training in dementia care. A new requirement is therefore made so that people are properly cared for by staff that understand their needs. Other requirements made at this visit included: The home’s Statement of Purpose must be reviewed and amended to make clear the range of needs that can be met. It should also include information about how specialist needs of people from other groups in society will be met if they come to live at the home. Very few specific risk assessments were seen for individual people. Issues that need clear risk assessments included swallowing difficulties, self-medication, falls or use of a catheter. The assessments must be put in place to make sure people are protected from risk of harm happening to them. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 7 Medication management must be improved. A range of issues was picked up that showed poor practice in administering medicines. This puts people at risk and must stop. Issues included lack of proper administration procedure and lack of security. Further the Adult Community Care policy on homely remedies must be re-considered so that people are able to have single doses of nonprescribed medicine if they need them. The manager must make sure that all staff have done training in safeguarding adults from abuse. There was no evidence to show if nine staff had done the training. The manager said she thought that they had done it but it hadn’t been recorded. Records must clearly show what training each staff member has done and be kept up to date so that it’s clear people are protected from risk of harm or abuse. A good practice recommendation was made for the home to consider getting weighing scales that meet peoples needs. Currently people have to be able to stand on bathroom scales and not everyone is able to do so. Sit-on scales would make sure everyone’s weight could be regularly checked and recorded. Menus aren’t displayed in the dining room as they used to be and the daily choice at lunchtime wasn’t put up on the board designed for this purpose. Therefore people aren’t able to see what’s on offer during the week. Weekly menus should be reinstated and put where people can easily see them. This will make sure that they have opportunities to know what they want to eat at any time. From the home’s own quality assurance survey report comments were seen about bedrooms that need redecoration. A plan for assessing bedrooms that need re-decorating should be drawn up. This will make sure that everyone has a pleasant and homely room decorated to their choice. 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. The summary of this inspection report can be made available in other formats on request. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 8 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 Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Out of date information doesn’t keep people fully informed. Further, people from minority groups may not feel welcome at the home without positive information available about this. Satisfactory admission arrangements makes sure peoples needs can be met. EVIDENCE: From the survey that we did during the two days of the visit, eight people said that they had received enough information about the home before they moved in so that they could decide if it was right for them. Two people said ‘no’ to this however. Comments included: ‘I just moved in’, ‘I visited first’, ‘I received some good information about here, my daughter and son-in-law looked around at seven places and this was by far the best’, St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 10 ‘I’d been in several times on respite so I knew what it was like and I was quite happy to come here’ and: ‘The officer brought me here for a day and I liked it so then I waited for a vacancy to come up’. The home’s Statement of Purpose was out of date and included details that are no longer correct. The responsible individual (the person named by the provider to make sure legal responsibilities under the Care Homes regulations are met) had issued recent guidance to all local authority care homes. This guidance states that: the Statement of Purpose had been revised and: ‘does allow us to provide care to people that have a level of dementia that is manageable providing the primary and presenting needs are concerned with their physical care and not their dementia’. The Statement seen in the home didn’t reflect this and wasn’t clear about admission of people with dementia. Further, neither the Statement of Purpose nor the service users guide (copies of which were seen in peoples rooms) included any information about meeting specialist needs of people from diverse groups such as black or minority ethnic, sexual diversity, gender, disability or religion. (The Statement of Purpose is one that is the same for each Council home. Therefore each home’s Statement of Purpose should contain the same information). From our survey five people said they had received a contract although five said they hadn’t. However, four people said they couldn’t remember - some because they were ill and some because it was a long time ago. Signed contracts were seen in peoples files. Copies of financial assessments that included the amount of fee to be paid by a person were also kept in the files. Copies of Adult Community Care assessments were seen that gave information on care needs at the time the person came into the home. Assessments that were done by social workers were detailed and gave background histories as well as information about the personal and health care needs the person needed help with. This information is used by the home and later transferred into care plans. From the Annual Quality Assurance Assessment (AQAA) that the Commission requires homes to fill in once a year, the manager had written that equalities and diversity information (about specialist needs such as culture, religion, disability, sexuality or gender) is done by social workers when assessing people. This information was seen on the assessments looked at (although not all equalities issues are mentioned). One person had a specific religious need that was picked up on the assessment but nothing had been done about it. The person when spoken with said s/he would ‘really like’ to see a minister from that religious group. Contact was immediately made with the local group and a visit requested on her/his behalf. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are looked after well in respect of health and personal care needs. However, lack of proper risk assessments don’t keep people safe and protected. Administration of medicines fails to keep people living at the home fully protected from risk of harm. EVIDENCE: From our survey eight people said they ‘always’ receive the care and support they need, whilst one said ‘usually’. Comments about this included: ‘Yes quite well’, ‘very well’, ‘You’re better looked after here than you are by your own family’, ‘Excellent, 100 and I won’t let anyone say any different. If they did then they’re not used to good living’ and: ‘They’re ever so kind’. However, comments were mixed about the question: ‘Do the staff listen and act on what you say?’ ‘Haven’t always got the time’ St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 12 ‘We’re getting a lot of agency staff and I don’t always think that some of them have been trained enough’, ‘Sometimes’, and: ‘The staff are very good’ (two comments). To the question in our survey: Do you receive the medical support you need? Everyone said ‘always’. Comments included: ‘I’ve got my own doctor at Horfield Clinic’, ‘My medication keeps me calm’, ‘If I want the doctor I ask for him’ and: ‘They get the doctor out whenever I need him’. A healthcare professional regularly involved with the home filled in a survey form for this inspection. She commented: ‘I am extremely impressed with the care people receive at the home. The carers know the people very well and have built good relationships. They work very hard to meet peoples needs and to ensure a happy, comfortable environment. They involve me in decisionmaking and communicate very well – they’re only too happy to implement any care I request’. Three care plans were looked at closely. One of these was unable to be found at the visit and the manager later found it miss-filed and sent it on to us. Care plans showed the range of needs picked up from the Adult Community Care assessment, were written in a person-centred way and were clear about specialist health needs. One person had difficulties with swallowing and actions to support her/him with this were clearly recorded. However the only risk assessments seen were for moving and handling. These show how independent people are with standing, sitting and walking and identifies the help they need either mechanically e.g. from a hoist or from staff. The assessments also include information about behaviours or understanding but don’t include individual areas of risk. No specialist risk assessments were seen for a range of issues that included self-medication. One person takes at least eleven different medicines that are kept in her/his room, together with prescribed creams etc. The care plan simply stated: ‘to ensure (the person) has sufficient supplies’. The person said s/he felt confident about administering the medication. Other areas that needed to be assessed for risk included: choking, use of a catheter and a history of falls. Risk assessments must be put in place where there are risks to the person that have already been picked up from assessments and care plans, or new ones that have come about since entering the home. Medication practice was observed at the start of the visit. Some medicines were being taken around on a tray in pots that were not marked with the person’s name. The assistant manager giving out the medication was confident about who it was to be given to, but use of the tray didn’t make sure the medicines would be secure if she was called to do something else. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 13 Further, some people couldn’t be given the medicines at the time she took it round so they had to be left for later. The assistant manager also admitted she had signed for the medication before giving it whether someone took it or not. This is not good practice. On checking the medication cupboards all controlled medication that must be kept locked away and recorded separately was in good order and amounts checked, correct. Medication Administration Sheets were properly signed with no gaps. For people self-medicating the majority of them had signed when they had been given a new supply. The home doesn’t keep a supply of non-prescription medicines or ‘homely remedies’. The night care staff cupboard was seen to have at least seventeen different boxes of paracetamol that were each named for individual people. We saw in the staff communication book that one of the GP’s visiting the home had commented on this as a ‘wasteful policy’. No non-prescribed paracetamol is available for someone with mild pain such as a headache if they need it. When asked, the assistant manager said the GP would be contacted to write a prescription. This would have to be done at any time of the day or night, would take time and may not be actioned quickly - if at all. Therefore it might not meet the person’s need at the time. The medication policy drawn up by the team that supports homes has a section on homely remedies but this had been crossed out. The assistant manager was unable to say why this had been done. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 14 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. 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 home continues to give some people opportunities to have various formal and informal activities that happen regularly. However not everyone’s needs are met that could lead to boredom for some. Good contact with the local community helps people feel less isolated. People living at the home have lots of choice and are able to live their lives in a relaxed way with few restrictions. Meals at the home are well managed and provide daily variation, good nutrition and social contact for people. However failure to display menus means that people aren’t able to see what is on offer at mealtimes. EVIDENCE: From our survey nine people said ‘always’ to the question: are there activities arranged by the home that you can take part in? Comments were largely positive, although mixed and included: St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 15 ‘There is if I want to go. I go now and again but I’m quite happy by myself with my memories’, ‘They do a lot here and I really enjoy having my hair shampooed and set’ ‘They’ve just started up again. There was a period when there was none at all’, ‘There’s a lot more now than there was. It seemed to stop for a while and now there’s loads again’, ‘There is but I’m not very keen. I can’t hear very well’, ‘There are plenty of activities. There’s always something going on’, ‘There is and I go to whatever I can but I can’t sit for too long’, ‘I’m not one for that sort of thing. I like my reading and to be on my own but I know they do quizzes and bingo and the like’ and: ‘There are loads of activities available if you want to do them’. Activities were happening on both days of this visit. A number of people joined in although others stayed in the lounge. During the inspection, the second inspector used a specialist observation tool that helps to show how some people experience care. It also allows for observation of the relationships between each other and with staff. Two hours were spent watching the care being given to a small group of people in the main lounge on the first day of the visit. From the observation it was noted that one person spent most of the time asleep. Others read books or magazines or listened to music on the stereo. One person didn’t know bingo was going on in the dining room. Another commented: ‘it’s ridiculous that we’re all just sat here doing nothing’. People commented on how bored they were and it was also seen that staff spent little time with them. One person knocked on a table and said ‘let’s wake everyone up!’. When staff did have contact with people the majority of their interactions were good. From all the above comments and observation it’s clear that activities aren’t geared to meeting everyone’s needs for social contact or stimulation. Everyone must be able to have some activity that’s meaningful and physically accessible depending on their abilities and wishes. The manager said that older people from a local community group visit the home twice weekly and hold coffee mornings or bingo sessions. The group had made the first contact and had recently run a fete for them, giving all the proceeds to the home. The manager said the relationship with the group was working well. Locally there is a small rank of shops across the road from the home and a pub at the end of the road. However not everyone is able to go out independently to visit them. People living at the home have choices e.g. when they want to get up, at mealtimes, where to sit, whether to stay in their rooms, etc. From the observation of life in the lounge people were offered the choice of television or to listen to music and chose music. People were seen sitting in the entrance hall, moving purposefully about the home and coming in and out of the office. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 16 Members of the management team and staff responded to their questions and requests positively and in a caring manner. From the survey eight people said they ‘always’ like the meals at the home, one said ‘usually’ and one said ‘sometimes’. Comments were almost all very positive about food and included: ‘The food is lovely’, ‘They are very good and they know my likes and dislikes. I can always have something different if I want’, ‘It’s excellent’, ‘You always get a choice and the menu is out first thing so you can look at it and make sure it’s something you like’, ‘The food is first class’, ‘The meals are terrific’ and: ‘it’s quite good actually’. However one person said ‘it’s alright - eatable’ and one person said: ‘ I’m a fussy eater and they are very good at alternatives’. The lunchtime meal was observed and people were offered a choice of cheese flan or chicken stir-fry and vegetables. There is a board in the dining room where the daily menu is written up although it was blank on the first day. Weekly menu cards used to be displayed on cardholders on each table but the assistant manager couldn’t say what had happened to them. We asked for copies of the four-week menus that are now only kept in the kitchen. People therefore aren’t able to see what is on offer at mealtimes for each day of the week. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 17 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. 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. People living at the home have the necessary information and feel confident about being able to raise concerns or complain about their care if they need to. The way abuse issues are handled keeps people protected from risk of harm or abuse happening to them. However improvements in staff training in the subject is needed to keep people safe. EVIDENCE: We asked two questions in our survey about complaints: ‘do you know who to speak to if you’re not happy?’ and: ‘do you know how to make a complaint?’ Eight people said they ‘always’ knew who to speak to although one said ‘usually’. However all ten people said they knew how to make a complaint. They commented about speaking to care staff, their key worker or the officer on duty at the time. Comments about making complaints included: ‘I would make one if I needed to’, ‘I know the leaflet is in my file’, ‘I’ve done so in the past’, ‘I’d be happy to make a complaint if I needed to’ and: ‘ I have the leaflet in my file’. These comments show that people living at the home are confident about who to speak to if they’re not happy, that they feel able to make complaints and that they have the information they need to do so. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 18 The complaints log was looked at. No new complaints had been received since the last inspection. A new complaints leaflet issued by Adult Community Care was seen. However this doesn’t include information about how to contact the Commission. This will be taken up separately with the registered provider. A sheet was seen that showed training each staff member had done in essential areas of work. From this eleven staff (including two of the management team) had no safeguarding adults training recorded. When individual staff files were looked at no information about any such training was seen either. However the manager said she felt sure staff had done the training but not recorded it. All staff must have training in the subject to make sure people are protected from risk of abuse happening to them. All safeguarding adults training must be recorded so that its clear training is up to date. New staff just taken on had all done safeguarding adults training shortly after they had started working at the home. This is good practice. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and looked after, physically accessible and meets their needs. EVIDENCE: From our survey nine people said that the home is ‘always’ fresh and clean. A comment about the environment was made: ‘It’s always lovely and clean here’. A person spoken with at the visit also said: ‘it’s lovely here’. The person had a spacious room that had been made homely by personal possessions and photographs and many other rooms, although decorated differently, were also homely and personalised. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 20 A lot of work had been done since the last inspection including: work to improve the flooring in corridors and dining room, re-carpeting of the ground floor corridor and redecoration of public areas including the corridors. People had been asked their opinions on colour schemes and carpeting. Toilet and bathroom doors had been painted a different colour to make sure people could find them easily. This is good practice, especially for people with dementia. New furniture had also been purchased that looked modern although the manager said some people had commented about the lack of headrests. The manager had been successful in getting a grant of £5,000 from the Department of Health to buy new ‘profile’ beds that are height adjustable and enable people to sit up, get in and out and be cared for more easily. From the home’s own quality assurance survey report the environment scored 88 satisfaction from people living there and their relatives. Positive comments particularly about peoples own rooms were seen and they said that they felt safe and secure, especially at night. Relatives and professional people visiting the home had commented on bedrooms i.e. ‘ the common areas have been re-carpeted and re-decorated – the bedrooms could do with similar treatment’ and: ‘bedroom décor a bit tired’. These comments had been included as action points for improvement. However, from the Annual Quality Assurance Assessment (AQAA) sent in before our visit, plans for improvement to the home over the next twelve months don’t include re-decoration of bedrooms. This should be considered so that people have a fresh and homely personal space decorated to their choice. The home is accessible to disabled people. There are assisted bathrooms, one with a specialised ‘parker’ bath and two shower rooms. All toilets have grab rails and raised toilet seats. Toilets and bathrooms are within easy reach of peoples bedrooms. All corridors have grab rails either side and a loop system to boost peoples hearing aids is in place in the lounge. There are private, well-kept gardens to the front and back of the home and the back garden is accessible to wheelchair users. People take the opportunity to spend time in the garden in fine weather and were seen enjoying the sunshine at this visit. The home was exceptionally clean and smelled fresh at this visit. Domestic staff were seen cleaning all areas. Laundry facilities are situated at the far end of the building away from food preparation areas and the dining room. From the home’s communication book an item of one person’s clothing had gone missing and hadn’t been found. The manager said the person had been told this and a replacement item would be bought out of the home’s budget. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Low numbers of permanent staff and reliance on agency staff affects the quality of life for people living in the home. Staff progress with National Vocational Qualification in Care training makes sure people are looked after well. Adequate recruitment processes make sure people living at the home are protected from risk. Lack of essential training for new staff in mental health, dealing with behaviours that challenge and dementia awareness, doesn’t make sure people are looked after properly and their needs met. EVIDENCE: From our survey the question ‘are the staff available when you need them?’ drew mixed responses. Comments included: ‘We’ve been quite short staffed especially at weekends. I only ask when it’s urgent’, ‘I know that they’re around’, ‘The staff are 100 ’, St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 22 ‘There is always someone about, ‘There isn’t enough staff’, ‘Sometimes I might have to wait five minutes but they come as quick as they can. They’re quite short staffed’, ‘They’ve been a little bit short staffed over the last couple of weeks’ and: ‘I never have to wait long for anything’. The home’s own survey report scored 90 and comments were positive particularly about staff attitudes, competence and the welcome relatives felt they get when they visit. Professional people that visit the home also commented positively on staff: ‘the staff are all highly committed, caring people’. However comments from relatives or other professionals visiting the home about attitudes and training were seen in the action points for improvement: ‘Staff has been cut down recently’, ‘Some agency staff don’t appear to be properly trained or to understand peoples needs, ‘Some friction between permanent and agency staff’, ‘Having more patience with older people’, and: ‘Some problems with night staff being reluctant to cover aspects of peoples’ care that are readily managed by day staff’. Further a healthcare professional had filled in a survey for us that confirmed these comments: ‘I think agency staff are sometimes used, making hard work for permanent staff’. On the first day of this visit all care staff on duty were from an agency. However one of these has worked at the home for a long time and is well liked by people living there. There are sixteen permanent care staff working at the home to care for up to thirty residents with different levels of need. Four of those are permanent and twelve are part time. Five new staff or staff that had been working temporarily at the home had now been taken on permanently. Two vacancies are left for care staff – one of which is to do activities. The assistant manager said that staffing was more manageable now that people needing higher levels of care had left the home. She went on to say that the atmosphere was better now that more permanent staff had been taken on. From observation when going around the home it was clear that permanent staff have good relationships with people living there whilst agency staff are more focussed on doing the tasks and didn’t interact as much. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 23 From the AQAA received before the visit, the manager had given information about progress with National Vocational Qualification in Care training. The assessment stated: ‘All of the domestic staff have attained Level 1. The majority of our care staff apart from the recent recruitment have undertaken Level 2. All new staff will be required to do so as soon as possible’. At the visit the manager said that three care staff are currently doing Level 2. The deputy manager is doing NVQ Level 4 and the person assessing her was visiting the home whilst we were there. The deputy said she was enjoying the training and felt it helped her in her work. Recruitment and personnel information was seen for staff recently taken on. Some of the staff had been working for some time as temporary staff but had now been made permanent. Proof of identity and clear photographs were seen in files together with copies of other information including application forms, references and Criminal Records Bureau disclosures. Staff induction files were also seen for the staff recently taken on. Induction files seen were detailed and comprehensive including information on peoples rights and quality assurance as well as other main subjects covered. The induction took place for each person on 10 and 11 July ’07 and each part of the file was signed and dated as information was given. Training in essential subjects followed the two days. Sessions included: Effective recording skills, Person centred care Harassment Safeguarding Adults and Moving and Handling. However training in mental health needs of older people or dementia hadn’t been organised. This is essential as several people living at the home have needs relating to their mental health or dementia and staff must be aware of how to treat them and meet their needs. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Both people living at the home and the staff team continue to benefit from an experienced manager who encourages an open style of communication. Suitable ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Peoples finances are well managed that makes sure they are protected from financial abuse. Peoples health and safety is promoted by clear policies and procedures that keep them safe. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager Ms Lorraine Knight, has been at the home for over two years and has many years experience of managing local authority care homes in Bristol. She has NVQ Level 4 and the Registered Managers Award. Ms Knight said she continues to do essential training plus management training. In the last year she has done moving and handling, managing people, managing fire safety and a four-day First Aid course. Ms Knight and her assistant managers were welcoming and open to the inspection process and a relaxed atmosphere was noted between both people living at the home and staff. People have access to the management team and were seen visiting the office whenever they liked. An independent firm appointed by the City Council had done the home’s most recent quality assurance survey. A copy of the report had been sent to the Commission just before this visit. Comments from the report are included above. The report was positive and showed over 80 satisfaction with life in the home in each of the six categories. Further, the report included action points for the home to consider from comments made in each category. However it wasn’t clear how people living at the home are helped to be able to read the report or how the action points will be dealt with. A random check of peoples cash that is looked after for them was done. Five peoples cash balances were checked and all were correct. Receipts for items bought for them were attached to their individual sheets and evidence of regular balance checks done by management staff, were seen. New guidance had been issued to all local authority homes by the team that supports them. A copy was seen at the home. The new procedure is to be followed when staff are asked to buy goods with peoples own money. The procedure clearly outlined the actions to be done that will make sure peoples money is kept safe and to reduce risk of financial mis-management. This is good practice. A check of health and safety records showed that regular checks are carried out on equipment, fire safety and water temperatures. Evidence of regular fire safety training for staff and for new staff including those from an agency was seen. Fire drills are done regularly and were seen written up with outcomes and action points of each drill. A fire safety risk assessment was in place that is checked regularly. St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 26 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 2 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 6(a) Timescale for action The Statement of Purpose must 31/12/07 be reviewed and amended to make sure it is up to date and gives clear information about the types of needs the home can meet and the circumstances in which people are admitted. This will make sure that people considering a move to the home will get the information they need. Requirement 2. OP7 13(4)(b)(c) Risk assessments must be put 30/09/07 in place for specific issues where clear risks are identified e.g. falls, choking and for people that self-medicate. This will make sure that people are kept safe from risk of harm. 13(2) Administration of medicines 31/10/07 must be done safely and securely at all times following local and national guidance. Medication administration sheets must be signed for after giving of medicines not before. 3. OP9 St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 28 The policy on homely remedies must be reviewed so that peoples individual needs for non-prescription medicine is met quickly and easily whilst keeping them safe. This will make sure people are protected from harm when needing medication. 4. OP12 16(2)(m) A review of all activities must be 01/11/07 done to make sure that every person has the opportunity to take part in social events that are meaningful to them. Staff that haven’t had training 31/10/07 in safeguarding adults must attend a course as soon as possible. When training is completed this must be recorded and all records kept up to date. Training in mental health needs 01/11/07 and dementia must be done for newly recruited staff within a short timescale. This will make sure people are cared for by staff that understand their needs. 5. OP18 13(6) 6. OP30 18(1)(c)(i) St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The Statement of Purpose should be amended to show how people from different groups in society e.g. black or minority ethnic, sexual diversity, gender and different religions can be cared for and their needs met. This will make sure people from other groups in society will know that they are welcome at the home and that it can meet their needs. Weighing scales that each person can use should be bought. This will make sure that everyone’s weight can be checked and recorded for health care purposes. Menus should be clearly displayed around the home so that people can see and remind themselves of what is on offer throughout each week. A plan for re-decorating peoples bedrooms should be drawn up. This will make sure that everyone has a pleasant and homely room decorated to their choice. 2. OP8 3. OP15 4. OP24 St Peter`s DS0000035285.V346432.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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