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Inspection on 08/06/06 for St Phillip & St James Residential Home

Also see our care home review for St Phillip & St James Residential Home for more information

This inspection was carried out on 8th June 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff have successfully created an environment which is supportive to residents and importantly enables individuals to maintain their independence with the support and assistance of staff where needed. Residents spoke of a "friendly staff" "homely place to be" "you cant fault how we are looked after" "nothing is too much trouble" "it`s the best". There is a mix of residents with those who are relatively independent needing minimal assistance to those who are very dependant for personal care and supervision. There are a number of residents who have a level of confusion and disorientation this has created difficulties for staff and residents at times. There has been a real effort to enable those individuals to remain at the home and receive the care they need whilst recognising the views of some residents who find this behaviour difficult and at times distressing.

What has improved since the last inspection?

The home has addressed the requirements made at the last inspection firstly through the fitting of door locks to all resident`s accommodation improving the privacy and respecting the rights of residents, secondly through the decoration of areas of the home which were in need of improving to raise the quality of the environment of the home. The home has also addressed other areas relating to training and recruitment arrangements.

What the care home could do better:

This inspection found that the home continued to meet the standards required the only area which needs improvement is that of making sure that reviews of moving and handling and risk assessments are held and recorded correctly.

CARE HOMES FOR OLDER PEOPLE St Phillips & St James Residential Home 9-10 Priory Road Keynsham Bath & N E Somerset BS31 2BX Lead Inspector Jon Clarke Key Unannounced Inspection 8th June 2006 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 Phillips & St James Residential Home DS0000008161.V299700.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 Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Phillips & St James Residential Home Address 9-10 Priory Road Keynsham Bath & N E Somerset BS31 2BX 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 9863505 NONE Mrs Patricia Elizabeth Clarke Mrs Patricia Elizabeth Clarke Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 18 persons aged 65 years and over requiring personal care only. 6th December 2005 Date of last inspection Brief Description of the Service: St.Phillip & St.James provide accommodation for up to 18 older people in single rooms some with en-suite facilities. All of the rooms except two are over 10 square metres; all are fitted with a call bell system. The home is two houses, which have been converted to provide a pleasant and spacious environment with attractive and accessible rear gardens with decking and seating area. There are two communal lounges, a dining room and conservatory. The home is situated a short distance from the amenities of Keysham. The homes philosophy of care: To provide a warm and welcoming home environment for residents and their visitors. To allow residents the chance to express their individuality and respect privacy, residents are encouraged to bring personal possessions and rooms are fitted with a lockable door or lockable cupboard. To allow residents the chance to continue to live as a life as they wish within a support the supportive environment of the home. Care plans are agreed with each resident and regularly reviewed. To provide good quality food and well-balanced meals and allow for individual preferences. To encourage social participation and maintain skills and interests regular activities are provided. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day the manager was present during part of this inspection. The focus of this inspection was to look at the home’s performance and quality of care against the National Minimum Standards. A number of documents and records were examined to make a judgement and scoring of those standards. Included were care plans, medication arrangements and associated records, training and recruitment and health & safety. The inspector also discussed with residents their experience of living at St Phillip & St James and any comments they may have about the care they receive. Before the inspection 15 comment cards were sent to residents and relative asking for their views about the care arrangements. Seven residents and three relatives returned these cards with generally very positive comments. What the service does well: What has improved since the last inspection? The home has addressed the requirements made at the last inspection firstly through the fitting of door locks to all resident’s accommodation improving the privacy and respecting the rights of residents, secondly through the decoration of areas of the home which were in need of improving to raise the quality of St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 6 the environment of the home. The home has also addressed other areas relating to training and recruitment arrangements. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Phillips & St James Residential Home DS0000008161.V299700.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 Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home undertakes a pre-admission assessment so that they are able to make sure they are able and have the capacity to make the health and social care needs of the perspective resident. EVIDENCE: Records were looked at which included the homes assessment and also where the individual is known or has been assessed by a local authority a copy of their assessment is obtained. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a good standard of care planning so that staff have the necessary information to meet care needs. Residents health care needs are met through the provision of community based services. The homes medication policy and practice help to ensure the protection of resident’s health. Residents are treated with respect and rights to privacy are upheld by the home promoting a supportive and caring environment with committed and competent staff. EVIDENCE: A number of care plans were looked at and showed a good level of information and detail about individual care needs. Care Plans provide a social profile, medication information, daily living ability and support needed. Where individuals are self-medicating a risk assessment is completed however these were not always reviewed and recorded on the risk assessment document to evidence that the individual remain able to have responsibility for their medication. Moving and handling assessments are done to give safe working guidance to staff these were not always fully completed on all the areas where St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 10 moving and handling was possibly required. Reviews are not clearly evidenced on the assessment document and in one instance there was no indication that there had been a review since 5/08/04. It is not sufficient to record a general review of care plans in the daily record which is current practice there needs to be a review recorded on the care plan. It was noted however that residents are involved in the review process, which is positive. The arrangements for the storage and administer of medication were looked at and showed that there is good practice in this area. Staff receive the required training so that they can safely administer medication and have the necessary skills and knowledge. Administering records showed an accurate and through record of medication given to residents. Arrangements for meeting health needs of residents are good with regular visits to the home by chiropodist and optician. The inspector spoke to the chiropodist at the time of this inspection she was very positive about the care given to residents and particularly the practice of contacting her if they had any concerns about resident’s mobility. She also commented that she had also noted that the staff approached residents in a respectful way. Where necessary residents receive dental treatment. In the event residents need medical treatment on a daily or weekly basis this is provided by the community nurse service. The home has good links with local authority social service and mental health team whose support is requested where residents require more specialist support particularly where there is an element of confusion or disorientation. In discussing one resident the member of staff was very clear about how to manage an individual who can be restless and confused. Importantly the home is very clear about only using medication to relieve symptoms and not to create a situation where the individual is unnecessarily medicated. Residents spoke positively of the attitude of staff feeling that they were always treated “as I would want” “with respect”. A resident also stated that she did feel there were “unnecessary restrictions it very relaxed atmosphere” another “I feel I can do as I wish”. The fitting of locks to residents accommodation and providing of keys if residents wish has also improved the privacy of residents and given the choice of locking their rooms if they wish. As far as possible there is flexibility in the routines of the home such as going to bed. It was also observed at this inspection that staff approached residents in a supportive way and recognised the right of residents to say no this was in relation to an individual who was asked if she wanted to see the chiropodist who was visiting the home at the time of this inspection. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents of the home are given good opportunities to meet their social, religious and recreational needs and able to maintain contact with family/friends and the local community. The practices of the home help in making sure that residents are able to exercise choice in their daily lives. The dietary needs of residents are met with a balanced and varied menu which meets resident’s tastes and choices. EVIDENCE: Generally residents spoke positively of the leisure activities provided in the home. There is a member of staff who visits twice a week and undertakes crafts and importantly does individual activity with those residents who are not as able to participate in group activity. A number of residents spoke of how much they had enjoyed the exercise class that had been arranged. One resident said there was “enough” activities and another “always seem enough if you want it”. It is part of a number of resident’s routines to go for daily walks, shopping or having coffee in Keysham which is a short distance away. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 12 The home has strong links with a local church and there are monthly services in the home. Visitors are encouraged and there are no restrictions on when relatives and friends can visit. Wherever possible residents are encouraged to manage their own financial affairs offering assistance if this is needed. The manager doesn’t have control or manage any resident’s affairs this being undertaken by the individual or their representative. Items and services such as chiropody are purchased and this is taken from resident’s monies held by the home or directly by the individual. Residents are positively encouraged to choose how they spend their day and there is a “relaxed and friendly atmosphere” in the home. One resident said when asked about the routines of the home and her daily routines “as near as being in your own home as you can get”. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has created an environment where individuals are able to express their views and make a complaint and know that action will be taken if this is necessary. The home through its policies and procedures and necessary training makes sure that as far as possible residents are protected from abuse. EVIDENCE: The home has a complaints procedure of which residents when asked were aware of and how they could make their views or any dissatisfaction known “I would always speak to Pat and she would do something” was a typical comment made by residents. “I wouldn’t hesitate to say if I was unhappy about something” “never had reason to complain” were examples of other comments made by residents. No complaints have been made since the last inspection. The home has a vulnerable adults policy which sets out the practice in the event allegations of abuse are made. Staff have completed BANES Vulnerable Adults training. When asked residents said they felt safe in the home that staff always treated them appropriately. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is clean and hygienic and offers a homely and well-maintained environment. EVIDENCE: Following the previous inspection when requirements were made regarding improving the environment re-decoration of parts of the home has taken place. St.Phillip & St.James provides a homely environment with pleasant and comfortable lounge areas, dining room. In addition there is a conservatory and level access to the well-maintained garden with decking and seating provided. One comment received from a resident was that “the pleasure of having use of a pretty garden is much appreciated”. There are good arrangements for maintaining a hygienic and clean environment and at the time of this inspection the home was clean and free from offensive odours. A number of residents said that the home “is always St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 15 nice and clean” and generally commented positively on the cleanliness of the home. Comment cards received from 7 residents all stated that the home is “always” fresh and clean. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The staffing arrangements in the home ensure that there are sufficient staff on duty to meet the care needs of residents. The recruitment practice ensures that the welfare of residents is protected and staff are trained and competent. EVIDENCE: Staffing rotas for the month of May were looked at and showed that despite some sickness staffing was maintained at the necessary level. There are 2 staff on duty am, 3 pm with waking night staff. The majority of staff are NVQ 2 or 3 trained, the deputy manager has NVQ 4 Registered Managers Award. Training records showed that all staff have received mandatory areas of training such as Moving & Handling, Fire training and where required First Aid, Food Hygiene. Some staff have also recently completed Dementia Awareness training. Other training has also been provided including Care of the Dying and Bereaved. Recruitment records showed good practice in this area applicants providing full employment history. Criminal record checks and POVA are obtained for all staff as well as two references. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The manager of the home has the competence and ability to run the care home in an efficient way with a good understanding of the needs of residents and staff. The management and staff of the home make every effort to make sure the home is run in the best interests of residents and opportunities are provided for residents to comment on the quality of the service they receive. The practices of the home with regard to health & safety are good and protect residents and staff as far possible. EVIDENCE: St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 18 The manager Mrs P.Clarke has extensive experience of caring for older people and has been the manager and owner of St.Phillip & St.James for a number of years. She has a supportive and sensitive approach to the residents and places great importance in trying to make sure that the needs of residents are seen as paramount and providing care, which meets the needs of all residents in every way. She has completed training in all of the mandatory areas as required. Residents are very much encouraged to express their views and regular Residents Meetings are held. These provide an opportunity for residents to comment on the care they receive and make suggestion. In looking at the minutes of recent meetings (generally monthly) residents have made comments on the food provided in the home and also about activities and outings, which are to be arranged. Action has been taken to make changes as suggested by residents. Questionnaires have also been issued to residents and relatives asking for their views. The inspector was unable to see the responses but a summary is to be provided to the CSCI. Heath & safety records were seen and showed that the required checks of fire systems are made. There are yearly fire system and equipment servicing and also servicing of other equipment such as hoists. Accident records were seen and these were completed correctly. St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 20 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 OP7 Regulation 15 (2) Requirement Reviews of Moving & Handling and Risk Assessment to carried out on a regular basis and evidenced on the assessment that the review has taken place. Moving & Handling assessments to be fully completed to provide information on safe handling on all areas of personal care. Timescale for action 08/06/06 2 OP7 15 (1) 08/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Phillips & St James Residential Home DS0000008161.V299700.R01.S.doc Version 5.2 Page 22 - 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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