Inspection on 07/12/06 for St Peter`s Residence

This inspection was carried out on 7th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Residence 06/01/06

St Peter`s Residence 12/07/05

St Peter`s Residence 31/01/05

St Peter`s Residence 16/08/04

St Peter`s Residence 11/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE St Peter`s Residence 2a Meadow Road Stockwell London SW8 1QH Lead Inspector Mary Magee Unannounced Inspection 10:00 7 & 8th December 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 Peter`s Residence DS0000022757.V319710.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 Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Peter`s Residence Address 2a Meadow Road Stockwell London SW8 1QH 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) 0207-735-0788 lsplond@aol.com Little Sisters of the poor Sister Mary Brennan Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (0) of places St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2006 Brief Description of the Service: St. Peter’s Residence is a purpose-built residential care home for elderly people. It is located in it’s own grounds in South West London. The home is surrounded by pleasant well-maintained gardens. It is situated in a quiet residential area and within reasonable walking distance of local shops, bus routes, a tube station and a famous cricket ground. The ground floor of the home has a reception area, payphone, letter box, Chapel, parlour/guest rooms, arts & crafts room, shop, staff facilities, offices, main kitchen, main dining room, hairdressers, library, several lounges, tea/coffee bar, residents’ laundrette, linen stores and several toilets as well as a large entertainment hall. Living accommodation is located on the first and second floors. Each floor has two units of 15 and 13 residents respectively. Each unit has its own manager, staff group, lounges, dining room, kitchen, bathrooms and toilets. All resident bedrooms are for single use and have ensuite facilities. There is a shaft lift for all floors. The home is one of a number of homes owned and managed by the Little Sisters of the Poor, which is a religious order dedicated to the care of the elderly. The fees are £443 per week. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection. It was carried out over two days. The pharmacy inspector examined the medication procedures at the home. As part of the inspection process comments were invited in writing from service user, relatives and healthcare professionals. Written responses were received from nineteen service users, fifteen relatives. Written comments were received from Psychiatry, GP practice, and the optician and chiropodist. On the first day of the inspection a residents meeting was in progress, which the inspector attended. A number of records were examined that included the personnel files for service users and staff members. Interviews were held with four staff members and the registered manager. A tour of the building was conducted. All the communal areas were viewed as well as twelve bedrooms. As part of this unannounced inspection the quality of information given to people about the care home was looked at. Twelve people who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk What the service does well: Service users say that the home is a haven of peace and tranquillity where older people can relax and are secure in the knowledge that their best interests are at heart. Service users and families have confidence that the home is the right choice when needing residential care services. “Everything about this home is exceptional, the carers, the facilities, the quality of care and kindness” were included in the written comments received from one service user’s family. Another service user wrote in her response to the inspector. “ Since coming to live here I have improved in health as I am relaxed, I am loved and cared for and I feel special.” The home provides excellent accommodation and retained to high standards so that service users may experience comfort and pleasure in their older years. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 6 Mealtimes are important. They are made as pleasurable as possible for service users. Comments below received from service users described how individual tastes in food are met. The meals are nicely served on hot plates, anyone who does not like what is on the menu are served something else that they like”, “If one feels off or poorly the chef makes sure that one is tempted by serving something that is light and appetising”. The care is delivered in the way service users like and appreciate. “We have carers that are very good”, “ Our sisters are patient and very kind” were comments received both in writing and in person from service users. The staff team is composed of care staff that are dedicated and that are interested in the welfare of service users. Good practice is encouraged and promoted from management through to care staff. 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 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 Residence DS0000022757.V319710.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 Peter`s Residence DS0000022757.V319710.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Essential information is provided so that prospective service users are informed about the care services provided. Service users are only admitted when they have had their needs fully assessed and when the home is confident that they can meet their needs. Service users feel confident that they have made the right choice of home. EVIDENCE: As part of the CSCI wider study about information provided to people about care homes for older people (CSCI are calling this a “thematic probe”), the records relating to the admission process for three service users admitted in the last twelve months were examined. All three service users found that the home had been their choice and said that they had received a copy of the service user’s guide. Included in the guide are details of the home and the services offered, statement of terms and conditions and copies of the complaint’s procedure. For local authority funded service users copies of agreements between the home and the local authorities were available on individual files. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 9 Separate written contracts were provided to service users. Two service users had copies of the agreed written contracts stating rooms to be occupied, fees payable and terms and conditions payable. One self-funding service user did not have her copy of the contract, she told the inspector that her son who had power of attorney had taken the contract home to sign and had not yet returned it. She had moved to the home two weeks earlier. On checking with the registered manager evidence was contained in the office that the contract had been provided and that they were awaiting return of the signed agreement. All three service users spoke of their pleasure at moving to the home that they liked. One had experiences at the home from a previous respite care period. Another service user spoke of receiving care in her own home but because of her increasing frailty it did not meet her needs. She finds that she experiences a great quality of life living in a place of her choice. Other service users not involved in the CSCI “thematic probe” said that they had received contracts and signed them. However some spoke of having mislaid them over the years. It is recommended that a check is made with all service users and where contracts are mislaid that they are reissued with a copy of the original contract with the home. Information is supplied with the contract regarding the annual review of costs and a statement saying that increases may be necessary due to the increased cost of living. The manager explained that in February every year the costs are reviewed and that if an increase in fees is necessary service users and their families are notified in writing in good time of proposed increases. Local authorities are also informed by early March of proposed changes in the funding costs for service users. One service user gave his views on costing. He finds that he gets good value for money and realises that generally there are increasing costs to be borne if the home is to sustain the high standards currently maintained. Service users have their needs assessed in a variety of ways before they move to the home. For those referred via the local authority care management assessments are received by the home first. On receipt of this information a visit is made by a senior member of staff from the home to assess their needs and to make sure that the home has the capacity to meet the assessed needs. For some service users where capacity permits a visit is made to the home where they have their needs assessed. A service user wrote that she was hospitalised and needed residential care. With the help of her family she came to view the home. She said, “When I came here to visit I knew that it was the best place to be as I got older and frailer”. From information viewed on service users’ files it was evident that no service user moves into the home without first having their needs assessed and without being assured that their needs will be met when they move there. The home has experienced occasions when it has been identified that a few service users have greater needs than initially assessed on admission and sometimes have nursing needs. Staff has handled this sensitively when they St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 10 have found service users reluctant to acknowledge that they have nursing needs. The service has experienced a slow response to requests for urgent reviews to respond to these additional needs. The registered manager said that the home is considering applying for a variation to make provision for nursing on one of the units at the home. Three additional staff members employed in the past year are qualified nurses. Care management assessments are sought for service users referred by the local authority. These were present on the relevant care files viewed. The registered manager reported occasions when the information has not always been as accurate and comprehensive enough to ensure that the admission is appropriate. To make sure this is avoided the home has become more robust in the pre admission process to ensure that the assessments are thorough and that service users’ conditions are fully explored first before offering individuals a place at the home. For service users that are self-funding the home also completes a full needs assessment. In addition, a request is also made for a medical report from the GP to confirm medical needs. Care plans are drawn with service users and families or representatives based on care management assessment as well as on the home’s own needs assessment. The home successfully meets the needs of current service users. Nineteen completed written service user questionnaires were received. The majority stated that all the support and care they required was provided at the home. During the inspection the inspector attended a “residents” meeting. Twentynine service users were present. The meeting was relaxed with service users raising issues and making suggestions to management about how they would like the home run. They also discussed forthcoming activities planned for the festive season. Service users told the inspector that these meetings take place monthly. Over the two days of the inspection twelve service users were individually spoken with. The feedback received was that a loving and caring environment is promoted and fostered at the home. Although the home is run by a religious organisation service users from all denominations and cultural backgrounds are welcomed and accommodated. “As a service user I can participate in religious services if I wish although I am not a catholic,” was the comment of a service user. Service users from a variety of multicultural backgrounds live at the home. The composition of the staff team reflects this need. Menus also suggest that service users are offered a wide variety of foods that meet their diverse needs. “Nothing is too much trouble”, was the comment received from another service user. On enquiring further the service user spoke of the feeling of security received, she spoke of practices that demonstrate how good staff are at promoting a sense of feeling valued. She finds that the sisters are experts as St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 11 they dedicate their lives to caring for older people. Another service user spoke of the calibre of staff, he said “ this is not a job to the sisters it is a vocation”. Staff individually and collectively have the skills and experience and deliver a high standard of care to service users. A number of qualified nurses are on the staff team that support and guide care staff. Care plan and support needs are tailored and adapted according to individuals’ care needs. For service users requiring less support they are enabled and encouraged to retain and develop independence. A service user spoke of the difference the home had made to her quality of life, she said “I now have spacious accommodation and can get around independently in my wheelchair and can do so much more for myself”. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 12 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 10 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users find that the home makes excellent provision in caring and supporting older people. People feel valued and worthwhile and their views are listened to and acted upon. The home is managing medication well, ensuring that service users’ health conditions are being managed well. EVIDENCE: The arrangements in place for caring for six service users were examined. These were case tracked from the referral period through to the current delivery of care. Written care plans were in place for all six service users. These were based on needs assessments and set out the health and personal care needs for each individual. A separate social care needs assessment is completed to obtain a full picture of the individual service user and the kind of lifestyle experienced previously as well as how they would now like to live. Signatures of service users were in place on a number of these plans to acknowledge that their agreement. Two care plans did not have signatures. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 13 Records seen showed that needs assessments had been completed at the time of admission. Important information such as nutritional screening takes place on admission and regularly thereafter. Evaluations of care needs/plans take place for service users every month. Care plans are updated to reflect changes to individual needs. A more comprehensive internal review takes place every six months. This arrangement has the potential to result in monthly reviews that may not consider fully all the assessed needs. Therefore a recommendation is made regarding monthly evaluations. Risk assessments are in place for service users. These record the best course of action to take to minimise risks. All six files viewed had evidence of risk assessments, however for a service user recently admitted the risk assessment had not been completed. A care worker said that this was the practice in the first few weeks. In this way staff could assess the service user as they become familiar with the new surroundings. Staff said they find that there are often improvements found in service user’s mobility as the environment is more accessible. A recommendation is made in regard to risk assessments. When new risks are identified that highlight particular concerns referrals are made as appropriate to professionals. Examples were seen of consultations with speech and language therapists for service users with swallowing issues. For service users experiencing falls this information was recorded in daily progress notes and on evaluation sheets with appropriate intervention means where possible to minimise risks. Service users value and take the opportunity to exercise and take measured risks. Two service users spoke of how vital the support they receive is to remain healthy and safe. They find that on occasions people including relatives become over concerned when they continue to take risks. Both service users feel that staff are ever vigilant and keep an unobtrusive eye that enables them not to feel too restricted. They find that they have the opportunity to try to do things and not feel worthless. Records are maintained of all accidents, incidents and falls however trivial. A record is also kept of any subsequent injuries sustained such as bruising. As a result of frequent falls a number of service users had been referred to falls clinics for further guidance on the best way to support these individuals. Service users are encouraged to retain independence in as safe a way as possible. Service users that use powered wheelchairs independently had copies of risk assessments completed by staff, there were also copies of GP assessments to indicate that these individuals were competent at using the chairs independently. One service user who uses a wheelchair met the inspector on the corridor. She said she enjoys her lifestyle. When she was first admitted twelve months previous her quality of life was poor. She said, “my mind was active but because of my condition I felt totally housebound and dependent”. Since St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 14 getting a wheelchair she can use independently she is able to move freely in the home. Staff were seen supporting service users to the bathroom, those with equipment such as zimmer frames were encouraged to use these to support them when walking. Copies of accident reports indicate that service users sometimes like to access facilities without using the prescribed equipment or using the call bell for help. Service users spoken to all feel that the support is great but described how important it is to be allowed to do tasks themselves. All nineteen written questionnaires completed by service user spoken confirmed that all health care needs are met. One service user spoke of the satisfaction gained from weekly visits by the GP at a surgery in the home. Records are maintained of all the consultations that take place. Although at least five qualified nurses are employed on the staff team nursing tasks are carried out by the district nurse, as the care home is not registered to provide nursing care. One service user has a pressure sore that is dressed by the district nurse regularly. Appropriate pressure relieving equipment is provided to service users identified as having or being at risk of developing pressure sores. Continence is well managed with comments received from relatives that the home always smells fresh. Service users access chiropody and dental services in a number of ways. NHS facilities are available at the home, some service users are transported to external clinics for appointments, the demand on the facilities can result in long waits. To compensate for this private services are arranged which service users purchase. Service users spoke of how well dignity, respect and privacy are promoted. Personal care they said is delivered in a dignified manner with attention given to making sure that user choice is respected. Male care staff generally care for male service users. “Staff always listen”, “there is always someone there within minutes when you call”, were typical comments received from two service users. Another service user spoke of periods when she has been unwell. She found that staff had made sure that she received additional attention at a time when she most needed it. Another service user spoke of the response from the sister in charge on the unit, she has experienced how quickly changes are noticed and of the response given when a service user experiences ill health. These reports of the good practices of individualised attention demonstrate the loving care provided at the home. Other service users spoke of feeling valued. People are treated with dignity and have their choices respected. This was the message received from the majority of service users interviewed. Written comments received also included the same response. The atmosphere of peace and tranquillity felt at the home is tangible. This was the experience of both inspectors. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 15 Lounges were in use with the choice of music and videos those favoured by service users. All were at comfortable volumes. In the dining room of one unit soft music played in the background which helped service users relax and enjoy their meals. Service users experience a sense of well-being psychologically and continue to get as much out of life regardless of disabilities. Service users have the benefit of meeting and talking with other people in the same age group from the sheltered housing unit. Appearances are important to service users and it was observed that detail such as a good laundry service are evident. Individuals’ clothes are cleaned and pressed to enable service users to continue to take pride in their appearance. A group of service users were complimented on their choice of dress. A service user replied that she liked to keep up her appearance including wearing jewellery as it made her feel good. A small number of service users have the capacity to and are enabled to do their own laundry chores that they said they thoroughly enjoy. The picture given by service users directly in discussions or via comment cards was of a lovely caring environment where older people feel valued and are listened to. The home is sensitive to service users’ wishes as they approach the end of life. A service user described her satisfaction with the approach of the home by stating the following, “I have found such peace and contentment and have told staff of my wish to spend my final days here”. At a resident’s meeting service users expressed their views on information sharing about the funeral arrangements for deceased service users. It was acknowledged that in the event of the death of a service user fellow service users wished to participate in attending religious observances to celebrate a service user’s life. When possible, service users are able to spend their final days in their own rooms within familiar surroundings. One of the sisters spoke of the practices as a service user approached the end of life and of the additional one to one support given by sisters from the convent if no relatives are available. Several service users are supported to keep and self-administer their medicines, which is good practise. Risk assessments are carried out monthly to ensure service users are happy and able to take their own medicines, and locked storage is provided in their rooms to ensure the safety of other service users and visitors. All medicines were in stock. Records or receipt, administration and returns of medicines are accurate, and ensure that all medicines are accounted for. In a few cases where service users do not wish to take their medicines, the GP has been contacted for advice. No medicines are being administered covertly (disguised in food or drink). St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 16 Although there were a small number of missing signatures, stock checks showed that medicines had been given but staff had forgotten to sign. Controlled drugs are recorded in a separate CD register, and all records/stock levels were accurate. The home keeps homely remedies (over the counter non-prescribed medicines for minor ailments). There is a list of items authorised by the GP and the home is in the process of setting up a book to record stock levels and usage. Most of the staff who administer medicines are nurses. Any other staff who administer medicines have had an appropriate level of training. Each of the 4 units has a separate clinical room, all medicines are being stored safely, at the correct temperature, and the rooms and trolleys were in very good order. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 17 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. Service users find that they are offered choice on how they like to lead their lives and enabled to lead fulfilling lifestyles. Mealtimes are enjoyable with service users receiving attractively presented nourishing meals. EVIDENCE: Service users like the style of life offered. They find that appropriate provision is made at the home to match their expectations and preferences. Daily routines of daily living and activities available are flexible and varied to suit individual user’s expectations, preferences and capacities. The interests of service users are recorded at time of admission and appropriate recreational activities are devised that suit preferences and capacities. A number of service users enjoy pursuing previous interests such as reading or watching religious stations on the television depending on previous occupations and lifestyles. A number of service users are retired clergy. They actively participate in regular daily worship in the chapel located within the home. Individuals’ wishes not to participate in planned activities or socialise are respected. A retired priest told the inspector that his choice of lifestyle is one of daily exercise and then St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 18 relaxing in peaceful surroundings, this includes using the lovely garden when weather permits. He finds that the home is a haven for this. Eight service users experience dementia. Staff have attended a reminiscence centre to enable them gain a better understanding of how best to make provision for this. A recommendation is made for more development in this area. Members of staff were seen spending time with service users that remain in their bedrooms for long periods. To overcome isolation staff engage regularly with them and not just at specific times. From speaking with care staff it was evident that they are familiar with individual preferences and previous lifestyles and use this knowledge to provide stimulating conversations. A service user recently admitted expressed her pleasure with the facilities and activities available. She said “ It looks like I am having the time of my life in my later years”. She had attended an event outside the home the previous night and was planning to attend another event that night. The home benefits from having it’s own transport that enables service users to attend many external functions. Another service user spoke of the forthcoming festive season, she said “this is the best place to be for Christmas, the home is decorated to the last and a full programme is always in place for this period”. Many service users like the fact that they can avail of the opportunities and the support to enable them visit supermarkets and large shopping centres. Many service users said that this was part of regular routines before they moved to residential care and are glad that they continue with these routines. They feel that it enables them to retain personal interests and offers them the choice of purchasing what they like. There is also a shop within the home for service users to purchase toiletries and confectionary. A number of hobbies are pursued, these range from clay modelling to glass painting, flower arranging and knitting circles. The sewing room is currently under refurbishment but service users have numerous other facilities available for their use. In terms of the social care needs assessments for a small number of service users the information recorded were incomplete. Staff in charge said that they had difficulty in gaining this information if a service user was unable to supply it due to memory loss. They had relied on relatives where possible to assist in this area but for some it had not been received. A recommendation is made in relation to making provision for developing appropriate stimulation for service users that meet and respond to their social care needs. A number of volunteers assist with activities at the home. A large entertainment hall with a stage is available. This is used to hold regular activities ranging from musical bingo to shows. The home has established good links with secondary schools. Service users are invited to large school functions such as musicals and shows. A service user spoke of presentations made to the most senior citizens the previous evening at one of the schools. Over lunch a St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 19 number of service users complimented the special effort made by young people to look after senior citizens from the home. Three visitors to the home were spoken to. All spoke of how welcome they feel when visiting. Guest rooms are sometimes available for accommodating service users’ relatives. One service user was pleased that her son could stay overnight and be present at the Christmas period. Relatives spoken to find that management and staff are approachable and sincere. The quality of meals provided is excellent. The inspector was invited to share lunch with service users over the two days. On both days a three-course meal that was nourishing and wholesome was served. The inspector and service users at the table found that meals served over both days were delicious and attractively presented. The inspector observed that mealtimes are special at the home. There is one large dining room on the ground floor. Each table accommodates a maximum of four people. Individual dining rooms are provided too on each unit. All the dining rooms are attractively decorated, dining rooms are prepared well in advance, they have suitable cutlery, serviettes, condiments and drinks. Service users enjoy coming together, relaxing and chatting over meals. Meals are served promptly and at the correct temperatures. Soothing music is played in some of the dining rooms that make the environment more pleasing. Mealtimes are not interrupted by other chores such as the administration of medication. Service users expressed their satisfaction and find that the food is consistently of a high standard. Menus are planned and prepared according to individual tastes and dietary needs. One service user said “The food here is better than a first class restaurant”. Indeed, this was evident over both days of the inspection. One of the many compliments paid by service users regarding meals demonstrated how well individual’s particular needs are met. A service user told the inspector of feeling off colour and having very little appetite, she did not feel like going to the dining room. She found that a member of staff had coaxed her by suggesting a light dish to maintain her strength, she was delighted to find that the chef had cooked especially for her some smoked haddock which she really enjoyed. Service users reported that they have real choices in the food served, if a person changes their mind and is not keen on the planned meal then alternatives are always served. Recognising that tastes differ and balancing meals with individual likes can be difficult when catering for fifty-six people. The home successfully manages to do this. The nineteen comment cards suggested that service users are very satisfied with meals. Service users also get the opportunity to express their views and choices at residents meetings. The inspector observed at the meeting that service users made known preferences for various seasonings and accompaniments. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a caring sensitive service where the views of service users are welcomed and where any concerns are acknowledged and responded to satisfactorily. Service users live in a safe environment where they are safeguarded from abuse by the skilled and knowledgeable staff team. EVIDENCE: All service users receive a copy of the complaints procedure with the service user’s guide on admission. All twelve-service users spoken with are confident in how the home responds to issues raised. These were also the views from nineteen service users that responded in writing. One service user spoke of an issue raised with the manager. He found that every channel had been explored to resolve the issue and feels assured that home always responds satisfactorily to service users’ views. Service users spoke of the various routes to raise issues, the first point of call is speaking to the unit sister. “Usually I speak to the sister if I have something to ask, the response is always good” was the view of a service user. Regularly monthly meetings are held with service users. One was in progress on the first day of this unannounced inspection. Evidence of how the home responds to views expressed and ideas on how services should be run was evident at the residents’ meeting. Service users freely expressed how they would like events communicated as well as consideration to individual preferences. The views expressed by two relatives visiting on the day were that the service welcomes peoples views and suggestions and do all in their power to put St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 21 things right when issues of concern are raised. Three relatives wrote to the inspector to pass on their experiences. They expressed 100 satisfaction with the services. A number of service users wrote on the comment cards the following view “I have never had a reason to complain, there is nothing here to complain about”. In the past twelve months two complaints were received directly at the home. Records viewed indicated that these had been resolved satisfactorily. Two complaints were received at CSCI about the service. CSCI had not found evidence of a failure to meet the national minimum standards or The Care Homes Regulations 2001. The staff team have received training on safeguarding people from abuse or neglect. Appropriate action is taken by way of notifications of any injuries or incidents as well as referral to appropriate healthcare professionals. There is always a qualified nurse available during the day as part of the staff team to make professional judgements. At night staffing levels have been increased. There are three competent carers on duty with a qualified nurse available on waking night duty. Care staff are experienced and informed and call on the qualified nurse when they have serious concerns about a service user’s condition. A recommendation is made regarding the current guidelines in place on when care staff should contact the waking night sister. If a service user should experience a fall their condition is promptly assessed. During the day this is done by a qualified nurse, at night care staff seek the assistance of the sister on call if the assessment suggests this is necessary. Following a fall the service user is closely monitored and observed for a period of time thereafter. Records are maintained of these observations and of any indications for medical intervention. Appropriate admissions take place as necessary to accident and emergency departments for service users. On interviewing four members of staff it was evident that they are knowledgeable on the correct procedures to adopt to safeguard service users from neglect or abuse. In the event of a service user deteriorating staff recognise and acknowledge individual’s feelings. A number of service users spoke of periods when they have experienced poor health that could have resulted in hospital admissions. However they spoke of the tenderness and care rendered at the home that enabled them recover in the home. The inspector found that service users experience a service that is safe and sensitive and that has their best interests at heart. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 22 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 20 22 24 25 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are proud are proud of their home. It is comfortable, clean, safe and well maintained. A significant investment is made in terms of finance and also staff commitment that enables it to be retained to this high standard. EVIDENCE: The home is beautifully presented and provides a spacious environment for service users to exercise and entertain. The organisation makes a significant investment in order to retain it to such a high standard. The reception area of the home is attractive, inviting and peaceful, with side rooms that are used for meetings/interviews/visits. There is also a Royal Mail post box for service users’ convenience. On the ground floor is a chapel for worship, an entertainments hall, coffee bar, sewing room and shop, quiet lounges and a large dining room. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 23 The layout of the premises is good. Service user accommodation is arranged over four units located on the first and second floors. Each of the four units has a separate lounge and dining room. A lift is provided to access all the floors. A gallery is available directly onto the chapel on the upper floors so that wheelchair users may participate in church services. The entire home is attractively decorated and contains good quality furnishings and fittings. A programme of maintenance is in place with any items requiring attention responded to promptly. Retiling was taking place in some bathrooms where tiles had become loose. Externally, landscapers were working in the garden, removing shrubs that had become too large and replacing them with smaller more colourful shrubs. Service users feel proud of the home and many expressed satisfaction at the way it meets their needs so comfortably. One service user spoke of her contentment, she said, “ I want to spend the rest of my days at my lovely home here”. The home is well designed with each bedroom benefiting from a good supply of natural light. Temperatures were comfortable throughout the building. All areas of the home seen were clean hygienic and fresh smelling. The home employs a number of housekeeping staff that have responsibility for maintaining the high standard of hygiene, these include two laundry assistants, a seamstress and a full time gardener. The spacious corridors make it a pleasure for service users to exercise comfortably, either by walking or using their wheelchairs independently. Attention has been paid to décor throughout. Attractive curtains, pictures and flower arrangements are seen on corridors and in all communal lounges. Twelve bedrooms were viewed. They were comfortable and attractive. Service users had personalised them with items of furniture and personal possessions such as photos and pictures. Bedrooms have en suite facilities. The home has a number of specialist baths on both floors so that service users with restricted mobility can bathe comfortably. The home has a rehabilitation room with a range of physiotherapy equipment available. A physiotherapist is available twice a week. This service could be used more effectively if a nursing unit is established at the home. The standard of hygiene throughout the home is excellent. Service users and relatives appreciate this. A large number of service users wrote on comment cards they sent to the inspector the following, “ we are grateful to all the domestic staff for the way they maintain the home to such high standards”. Relatives also spoke of the consistent standard maintained at the home and how it is presented; they said “ we have never found an unpleasant smell in this home at any time”. A service user commented to the inspector on the standard of hygiene, she said, “ You will never find a speck of dust in this home “. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. 27 28 29 30 This judgement has been made using available evidence including a visit to this service. Service users are supported and protected by a trained and qualified staff team that understand and are committed to meeting their needs safely and competently. EVIDENCE: Service users involved in the consultation expressed satisfaction with the calibre of staff employed. They find that staff are good listeners and have the right approach. The inspector also found staff to be knowledgeable and keen to look after service users in the desired way. The needs including dependencies of current service users were analysed alongside staffing rotas and staff skills. Appropriate numbers of suitably trained staff are on duty at all periods to care for and support service users. An additional staff member has been engaged for night duties when it was identified that this was necessary. The registered manager spoke of future plans to engage an additional staff member for night duties. This will take the numbers to four available at night to cover both floors. A waking night nurse is always on call for nighttime. The home has appropriate numbers of staff available to cover emergencies in the case of the absence of regular staff and continues to recruit to vacant posts. Agency staff are not necessary or employed to cover vacancies. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 25 It is custom and practice at the home for one of the sisters from the convent to sit with a service user if they are approaching the end of life and where there are no relatives available. The home has recruited an additional three nurses to compliment the team of care staff. Service users find that staff are approachable and kind and respond promptly to the service users’ needs. A service user spoke of how the service is run. She said, “ if I need help and I use the nurse call bell I am attended to quickly”. Additional housekeeping staff are employed to prepare and serve food, also domestic staff are engaged to retain the home to the high standard of hygiene. The home has recruited a number of new staff. Records for six of these staff were examined. Pre employment checks had taken place, appropriate references were supplied, confirmation that CRB enhanced disclosures had been sought for these staff members was recorded. For one member of staff the staff file showed a discrepancy with a part of the information supplied in previous employment history. This was brought to the attention of the registered manager. The inspector was informed of the subsequent and appropriate action taken to address this area. The CRB enhanced disclosures had been examined for all other staff at a previous site visit in 2005. An audit had taken place recently of all staff files as part of a Regulation 26 visit. The audit concluded that there was no gaps found in the files for all the care staff employed. Of the four staff interviewed all confirmed that the home makes good provision for training the staff team. Staff training is organised by the training coordinator. Among the staff team are two manual handling trainers, also two NVQ assessors. The assessment of staff competencies takes place on the floor where working practices are observed. Should a member of staff be identified as not adopting best practice then this member of staff is dealt with by offering retraining or under the disciplinary procedures of the home. Staff receive induction training and foundation training in the first six months, workbooks are completed and signed off to demonstrate their competencies. 50 of care staff have achieved NVQ Level 2 in care or equivalent. Mandatory training has been provided to staff in the past twelve months. This includes manual handling, food and hygiene, fire training. There were few details of additional or specialist training relevant to the service user group other than the dementia and reminiscence sessions at an external venue. The central training file has not been attended to and needs to be updated to reflect training needs of individual staff members and of the planned training needed to meet these needs. A recommendation is made regarding training and development. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 26 From discussions with twelve of the service users feedback received was that staff were kind and knew how to look after people. The majority of service users singled out the unit sisters for particular praise. They find that the Sisters lead the staff team by their good example and dedication. Two service users gave their views on why the services are so good. Both said, “ To the Sisters this is not a job but a life time dedication and commitment that they have made to looking after older people”. Care staff find that the sisters are supportive and guide them on the right way to care for older people. A number of volunteers attend the home regularly. They complement the staff team by assisting with and organising various activities. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is good. 31 33 35 36 38 This judgement has been made using available evidence including a visit to this service. Service users live in a safe well-maintained environment. The health and safety of service users and staff are promoted. Management and staff work tirelessly in providing a home that is run in the best interests of service users. EVIDENCE: The inspector found evidence that this is a well run home. Service users feel that the registered manager gives clear direction to staff and service users. All the feedback received from service users and relatives confirmed great confidence in the management of the home. Members of staff feel valued and respect the high standards cascaded by the manager. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 28 It was observed that the management approach was open. The views of service users were welcomed and recorded. An assurance was given that the views and suggestions would be considered and acted upon. The home demonstrates that the home is run in the best interests of service users. Comments received from staff over the two-day inspection all suggested that service users are placed at the heart of the service. Staff comments included the following remarks, “ we like to make sure that the home is always looking it’s best as the environment is so important to the Psychological needs of service users” “The festive period is important to older people so a full entertainment’s programme is in place for this period”. The home has developed a quality assurance system. This includes the views of service users. A recent survey was completed in writing involving service users. Meetings with service users are also used as part of the QA system. Regular reviews take place of service users’ needs that link to changing care needs and the arrangements to meet these needs. The home should consider including the views of relatives and stakeholders in the community including the GP and other professionals involved. Fifty-three service users have their benefits directly paid into their own bank account. Forty-three of those manage their own financial affairs and withdraw cash from their accounts, as they need it. Seven service users are subject to power of attorney. For two service users the registered manager acts as appointee. Records are maintained of all financial transactions in separate files held at the office. Savings are invested for service users that do not handle their own financial affairs in separate bank accounts. Unit meetings are held monthly. Staff said that they received Individual one to one supervision sessions. Some of these take place on the floors with senior qualified staff or team leader observing directly practices. This is not always recorded and not all of the units keep the supervision records up to date to evidence this. A recommendation is made regarding supervision. Records relating to the maintenance and servicing of the premises and equipment supplied were seen. Essential equipment is serviced and maintained. Fire prevention and fire fighting is regularly tested and is safely maintained. Regular fire drills take place. All staff receive annual fire prevention training. The home has a health and safety committee. According to the registered manager a health and safety inspection was undertaken in August 2006 by the organisation’s health and safety officer. Recommendations made have been implemented. Records are maintained of all accidents and incidents and appropriate notifications made. St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 x 3 x 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 3 X 3 St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations The registered person should ensure that service users that have mislaid statement of terms and conditions and contracts are reissued with copies of original documentation. The registered person should consider including a fee to cover the physiotherapy services offered at the home so that this can be developed further. The registered person should ensure that service users are fully involved where possible and that written agreements are sought on the agreed care plans. The registered person should ensure that the emphasis is placed on undertaking monthly reviews that consider all the holistic needs of service users. It is therefore unnecessary to duplicate this work by performing six monthly reviews. The registered person should ensure that risk assessments DS0000022757.V319710.R01.S.doc Version 5.2 Page 31 2 OP2 3 4 OP7 OP7 5. OP8 St Peter`s Residence are constantly kept updated with as much emphasis on promoting physical activity as possible. Information on how to manage the risks should be clearly recorded and communicated to staff from date of admission. 6. OP8 OP12 The registered person should consider developing further facilities for people experiencing dementia. In the absence of informed social care needs assessments these need to be developed so that plans can be made for appropriate and suitable stimulation for each service user. The registered person should consider the current guidelines in place for night staff and how these could be further developed to include clearer indications on when to contact the night sister on call. The registered person should ensure that the staff training and development programme is kept up to date. Appropriate provision should be made within the service for identifying and addressing staff training needs. The registered manager should consider including as part of the quality assurance system the views of relatives and stakeholders in the community including the GP and other professionals involved. The registered person should ensure that one to one supervision is regularly provided and at least six times a year. Records to be made of all supervision sessions. 7 OP18 8 OP30 9 OP33 10 OP36 St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. Extracts may not be used or reproduced without the express permission of CSCI St Peter`s Residence DS0000022757.V319710.R01.S.doc Version 5.2 Page 33 - 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. 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