Inspection on 14/05/07 for St Quentin

This inspection was carried out on 14th May 2007.

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 Quentin 14/05/08

St Quentin 13/01/06

St Quentin 19/07/05

St Quentin 29/09/04

St Quentin 13/07/04

St Quentin 17/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE St Quentin Sandy Lane Newcastle Staffordshire ST5 0LZ Lead Inspector Jane Capron 14 th Unannounced Inspection and 16th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Quentin DS0000005004.V335179.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 Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Quentin Address Sandy Lane Newcastle Staffordshire ST5 0LZ 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) 01782 617056 01782 620255 st.q@virgin.net St Quentin Residential Services Limited Ms Christine Joan Rushton Care Service 20 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (20), Physical disability over 65 years of age (1) St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. (DE) over the age of 60 years - 5 beds Date of last inspection 13th January 2006 Brief Description of the Service: St Quentin is a care service, registered to provide personal care for up to 20 people in the above categories. The service is very gracious and maintains many old features, which are evident throughout the service. There are 18 single bedrooms, 7 with en suite and one double room, well appointed spacious lounges and very pleasant dining room. The service is located in a residential area on the outskirts of Newcastle and close to a range of shops and community services and situated on a public transport route. The service also has use of their own mini bus. The service was first established in 1988 and is owned and managed by the family business. There is a sister service next door, which provides nursing care 24 hours a day. The service is set back from the road with mature front gardens and ample car parking space. The service also accepts up to three people in the above categories for day care. The current fees are £376 a week for a shared room and up to £415 a week for a single ensuite room (May 2007). St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over a two-day period. The second day looked at the arrangements for managing medication and was undertaken by one of our pharmacy inspectors. The inspection included talking to residents, relatives, staff, the manager and the Director who was present for parts of the inspection. We also talked to health care staff that regularly visited the service and to staff from a local Authority. Prior to the inspection the service gave us information in a pre inspection questionnaire. We also got information from questionnaires we sent to people that lived there and relatives The inspection looked at the service’s assessments and admission procedures including the information provided to people that may be considering moving there. We also looked at whether the service was meeting people’s health and personal care needs and the involvement of people in the planning and managing of their care. We looked at how the people spent their time and whether they were able to make choices about their life and whether the service was promoting people’s privacy and dignity. We looked at the arrangements for administering medication. . We looked at the staffing levels, staff training and how staff were recruited. We looked at how the service responded to any concerns and how the service was protecting residents from abuse including looking at how the service recruited and trained staff. We looked at the environment including looking at the communal areas and a sample of the bedroom accommodation. We also looked at the procedures for fire safety. The inspection also looked at how the service monitored the service and took into account the views of the people that lived there. What the service does well: The service was well liked by the people we spoke to. They said that they were receiving a good service. Comments included: ‘Great home’, ‘Would recommend it’, St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 6 ‘Like a hotel’, and ‘like a servicefrom home’. The service always undertook an assessment prior to a person moving to the home. This ensured that only people whose needs they could meet came to live there. The service had developed good documents and guides that gave the information that people would need to know in order to decide if the service was right for them. People spoke highly about the staff seeing them as friendly and showing them respect and making sure that their privacy was respected. Staff we spoke to were caring and knew about the people that lived at the home. They were qualified and had received training to meet the peoples’ needs. People that lived at the service said about the staff. ‘I like them all’, ‘Staff kind’ ‘Staff very nice’ and ‘Staff very discreet’. The service provided the people that lived there with a range of activities including gentle physical exercise, craftwork, quizzes and music. People could also join the Q club that organised monthly events including trips out. A hairdresser visited every week. The service arranged a Church Of England service for those that wanted to attend and people could arrange to have their spiritual needs met by their own clergy. The people that lived there told us that they could make choices about their daily lives. They could choose where to spend their time – in one of the three sitting areas or in their bedroom, choose whether to join in with organised activities and make choices about the meals they ate. All the people we spoke to said that the service provided them with excellent meals. There was always a choice and something off the menu could be provided. Comments about the food included: ‘Food very good’, ‘Get a choice’ and ‘Can have wine at lunch’. We saw that when people needed help with eating this was provided in a sensitive manner. We also found that the service was monitoring people’s nutritional needs when necessary. The service provided good accommodation that was well furnished and decorated. What has improved since the last inspection? Since the last time we visited the service has undergone some improvements to the accommodation and whilst we were there one bedroom was being decorated and upgraded. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 7 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 Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service’s Statement of Purpose and service user guide were good providing people that were considering moving to the service and relatives with all the details of the service enabling them to make an informed decision about whether the service could meet their needs. The service’s admissions procedure was comprehensive ensuring that all the necessary information was gained to make an informed decision over whether the service could meet a person’s needs. EVIDENCE: Examination of files, discussions with people that live at the service and responses to the relatives survey confirmed that assessments were completed St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 10 before admission both by the service and the local authority in cases where local authorities were part funding. Assessments covered the person’s health and social care needs and included issues relating to family relationships and social issues. Assessments were also completed on the person’s nutritional needs and their mobility needs. Residents and relatives were involved in this process and this was completed either in the person’s own home or in hospital. One relative stated ‘every effort was made at assessment with positive results’. Relatives and the people who lived there reported that they were able to visit the service prior to making a decision to move there and always had a trial period before making their mind up whether to stay. On the day of the inspection the manager and deputy went to assess a prospective resident. Two residents stated that they had initially come for a short time and then decided that the service met their needs and decided to remain. One person that lived there said that the staff had made him feel really welcomed when he came in and this helped him to decide to stay. Copies of the Statement of Purpose and service user guide were seen. Comments from residents were included in this document as well as a copy of the contract. These documents were of a good standard and included all the necessary information to enable a prospective resident to know what services were offered. All residents and relatives were provided with a copy. None of these were in easily accessible formats or on audio but the service said that this could be provided if needed. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning practices included the people that lived at the service and were identifying with minor exceptions people’s health and personal care and social needs providing staff with the information needed to meet people’s needs. These could be in a more person centred format. The service was meeting the health and personal care needs of the people that lived there in a manner that promoted their privacy and showed them respect and there was evidence of effective liaison with health professionals. However aspects of the record keeping could be improved to more clearly evidence the actions taken by staff to respond to incidents. The service’s medication procedures and practices needed to ensure that people were having their medication administered and stored appropriately. EVIDENCE: St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 12 A sample of three people’s files was examined. The service had developed individual care plans covering health and personal care and social needs and relationships with friends and relatives. It was noted that not all plans had full information relating to people’s spiritual and oral needs although discussions with staff showed that these needs were being met. Plans were developed on the computer although there were paper copies available to staff. In order to make the plans more useable the service had created a short plan that identified a person’s main needs. People had signed to state that they had been involved in discussions about their care. Care plans were evaluated every month and updated as necessary. To improve the service plans could be made more user friendly to make them more accessible to residents in order that people could have more control over their lives and have more involvement in directing their service. Examination of care plans showed that the service had developed a number of individual risk assessments. These included such areas as moving and handling and managing a door lock. No risk assessments relating to bathing or the use of a wheelchair were seen. Several people were seen using wheelchairs without footrests and we were informed that this was because these people could not lift their legs. These people had signed a disclaimer but a full risk assessment should be in place. The care plans seen identified people’s health care needs. Nutritional, tissue viability and moving and handling assessments were in place. There was evidence that people were receiving pressure sore care and the service worked with the District Nursing service to ensure that the people received the necessary pressure sore care. Observation and discussions with the nursing service confirmed that the service provided pressure-relieving equipment when this was recommended. The District Nursing service also reported that they had a good professional relationship with the service and that there was effective liaison taking place to ensure that the people that lived at the service received the necessary health care. The District Nurses also reported that they always saw people in their bedroom privately. Discussions with staff confirmed that they were aware of people’s individual health and personal care needs and how they liked these to be completed. Discussions with a number of residents confirmed that their health and personal care needs were being met. One person said that ‘ If I am poorly they get the doctor’ and ‘The got the District Nurse to look at my poorly leg’. Another person commented ‘They have a chiropodist that here but I have arranged my own to come here’. The people that lived at the service were able to continue to have their GP, dentist and optician and chiropodist of their choice and several people stated that they had not changed these when they moved into the service. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 13 Records did show that residents were receiving dental care, having their eyes checked and seeing the GP. The service had several methods of recording the health care services people had received and this did not always tally and there were odd occasions when it was not always possible from the records to clearly identify the actions and outcomes of specific incidents. Relatives took a number of people to health care practitioners and the manager did inform us that in the vast majority of cases this worked effectively but there had been specific occasions when the liaison between the family and the service fell down. The service had received one complaint relating to health and personal care issues. This was ongoing but the service had put in a number of practices to try to reassure the family that their relative was receiving the necessary care. Staff were observed to have a relaxed manner with people and to treat them with respect and dignity. Staff sought their views over such issues as meals and how they wanted their care providing. Observation also showed that the staff respected people’s privacy when personal care tasks were being undertaken. People said that staff never entered their room without knocking. One person commented that she was never made to feel awkward when she was having a bath. The pharmacist inspector examined the effectiveness of the home’s handling of medication on the 16th May 2006 and some failings were identified during the visit. The policy and procedures for the safe handling of medicines within the service was found to be lacking in detail and did not provide the staff with a detailed account of how medicines should be handled. Some aspects of the medication records were poor. The service was not recording the receipt of any medication and therefore the service could not demonstrate that their administration records were accurate. The service was producing its own computer generated Medicine Administration Records (MAR) charts. The service did not have a system in place to check that these records were not accurately transcribed from the pharmacy labels, nor did they keep any evidence of the medicines being prescribed following the disposal of the medicines’ container. There were no gaps on the MAR charts but witnessing the charts being signed before administration had taken place and witnessing retrospective signing a few hours after the administration round had been completed brought into question the authenticity of the charts to confirm medication had been administered. An audit of some Amiloride 5mg tablets suggested that the records had been signed but the medication had not been given. The service had failed to seek written instructions for those medicines that had been prescribed with “as directed” directions. Administering with “as directed” St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 14 directions breaches the Medicines Act 1968 and may result in residents receiving the wrong dose which could affect their health and welfare. The service had not classified one of the resident who was administering his own inhalers, nebuliser solution and creams as a self-administrator. The service only related the term self-administrators to those who administered tablets/capsules themselves. As a consequence the service had not carried out a risk assessment to determine whether this resident was capable of managing his own medication and ii) whether any support was required by the service to support the resident to administer his medication. The service also had no evidence to show that they were monitoring to ensure that this resident administered his medication as prescribed. While discussing this resident with the manager it came to light that none of the staff had been instructed, by a healthcare professional, on how to use the nebuliser and therefore if there was a problem with it or if the resident became unable to use it, the service could not offer any assistance. The management of Controlled Drugs within the service was poor. The service did not appear to distinguish between Controlled drugs and non Controlled Drugs in their storage facilities. The service did not have a Controlled drugs cabinet instead the Controlled drugs were being stored either in the mobile trolley or the excess stock cabinet with the rest of the residents medication. The service had adapted an A4 hardback notebook to use as a Controlled Drugs register. On examination it was determined that the service was only recording the receipt of a new supply when the old stock had been completed and not when the new supply was received. With this recording practice and the fact that the pages in the Controlled Drugs record were not numbered meant that persons wishing to do so could easily achieve the misappropriation of Controlled Drugs. The service had also failed to identify that one of the prescribed medicines for a resident who had just moved in was in fact a Controlled Drug and as a consequence had failed to make a record of its receipt in the Controlled Drugs record. The residents medication was either stored in a mobile drugs trolley, in a wooden cupboard located in the dining room or in a couple of wooden cabinets, which were located in a designated medication room. The service was not using a Monitored Dosage System (MDS) instead all medication was administered via bottles or original manufacturers packs. It was found that the service was storing the medication so that each resident’s medication was kept together but separate from other residents’ medication. Examination of the residents’ medication identified out of date stock, the sharing of some residents’ medication with other residents, the decanting of medication from one pack to another and eye drops not being dated upon opening. Within the medication room the service had a small fridge, which was designated for storing medicine that required cold storage conditions. At the time of the inspection none of the residents had been prescribed any medication that required cold storage conditions. The service was reminded that when St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 15 medicines are stored in the fridge they must measure and record the maximum and minimum temperature on a daily basis to ensure that the temperature remains at between 2 and 8°C. At present the ambient thermometer being used was recording the temperature mainly at 0°C. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People that live at the service have the opportunity to take part in a range of activities, have their spiritual needs met and are provided with meals based on their choices. EVIDENCE: The service was addressing the social care needs of people that lived there. The service offered people choice over how they spent their time. They were able to choose where to sit either in their bedroom or in one of the lounges. The service offered several sitting areas and people could choose whether to sit in the main lounge, in the smaller quiet lounge or in the large entrance hall. Routines were relaxed with people having the choice of when to get up and go to bed and having choice over their meals. The service reported that if people wanted they could have drink-making equipment in their bedrooms. The service provided a range of social activities including craftwork; gentle physical exercise, quizzes, dominoes and card games as well as providing St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 17 some one to one time with some people. The service also had a range of library books and several people were observed reading during the inspection. The service had a hairdresser that visited weekly. The service also offered the Q club. This club meets every month and includes trips out. One person said that he regularly went out for a walk. The service also had a small shop selling some toiletries and cards and sweets. This was run by one of the people that lived at the service. The service provided people with the opportunity to take part in a Church of England service once a week. Also individual people had their spiritual needs met by visiting clergy. Discussions with people that lived there said that they could join in with any of the activities if they wanted to. During the inspection it became clear that visitors were very much welcomed into the service. Throughout the day visited called and discussions with several confirmed that they felt welcomed and involved with their relatives care. They said that they were kept informed by the staff. One relative that visited several times a week said that they always felt welcomed and could have a meal at the service if they wanted. All people spoken to said that the service provided excellent meals. There was a choice at all meals. There was always something hot at breakfast and several choices at lunch and tea. Comments from residents included ‘food’s good’, ‘always get a choice’ and ‘can have something else if don’t want something’. People could have their meals in their bedrooms or in the dining room. Wine was available at lunch. People that wanted it had a drink in bed before getting up. The service provided those that wanted it with supper. The service reported that people’s views were taken into account when the menus were developed. The service provided support t o people if they needed assistance to eat their meals. Special diets could b e accommodated. The service monitored the nutritional needs of people. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service had a suitable complaints procedure and relatives and people that lived at the there felt that the service would respond to issues they raised. The service’s safeguarding procedures and staff’s training was protecting the people that lived at the service but the service needed to always refer potential incidents in line with the agreed multi agency procedures. EVIDENCE: The service had a complaints procedure that was displayed in the hallway and the details were in the Service user guide. Discussions with several relatives and people that lived at the service showed that they were aware of the procedure. They felt that if they raised concerns the staff would deal with them. The service maintained a record of complaints. One complaint had been made and this was in the process of being dealt with. People that lived at the service were able to exercise their legal rights. They accessed health care services, dealt with their own finances if wished and able and were registered to vote in elections. One person stated that he had previously voted but at the recent local elections had decided not to. He said St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 19 that he could have a postal vote or someone would take him to the polling station. The service had a procedure for responding to potential safeguarding issues. Discussions with several staff showed that they were trained and were aware of signs and symptoms of abuse and they were able to identify how they would deal with any potential incidents. Case tracking showed that the service had received information about a potential safeguarding issue but they had not referred this to the local authority as the co-ordinating agency due to the belief that it could not have occurred. The service had taken alternative action to respond to the information. The service does need to ensure that all potential incidents however unlikely they appear are referred to the local authority. Staff reported that there had been a couple of incidents of aggression. They were aware that such actions could be a way of communicating views and needs. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 20 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): 19,20,21,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provided the people that lived there with good quality accommodation that was furnished and decorated in a pleasant and domestic manner. There was scope for improvements through the introduction of bedrooms locks to increase people’s privacy and minor environmental changes to aid the orientation of people with dementia care needs. EVIDENCE: The service provided a high standard of accommodation. There was an environmental improvement plan in place. The service was well decorated and well maintained. Furnishings were domestic in style. Externally at the front of St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 21 the property there were large gardens with a secure pond. There was a patio that provided seating. Internally people had a choice of communal rooms including a large lounge with TV, a smaller quieter lounge and the large entrance hall. All areas provided a range of seating. The service had a separate dining room. The service had a range of bedrooms that varied in size. Seven bedrooms had ensuite facilities. One bedroom had an adjoining door so would be suitable for a couple and another was a shared room. This room had an archway in the middle thereby providing privacy to the occupants. Bedrooms were well -decorated and provided adequate storage and furniture. Only one bedroom was lockable. The manager advised that none of the current people wanted a lock on their door and that everyone had been asked and had signed to confirm that this was the case. This view was confirmed by one person who said they did not want a lock. However the provision of locks would provide people with the choice to lock their rooms and would provide a higher level of privacy. People were able to bring in pieces of furniture and bedrooms seen were personalised with a range of pictures, photos and ornaments. The service had adequate numbers of bathing and toilet facilities. Since the last inspection the heating radiators had been covered to prevent them being a hazard to the people that lived at the home. The service for people with dementia care needs may be improved through the introduction of some environmental changes for example pictorial signage on communal rooms and methods of identifying bedrooms in line with current good dementia care practices. The service was clean and hygienic and staff were observed using protective clothing when completing personal care tasks. People that lived at the service and relatives spoken to said that the service was always clean. Comments included ‘always clean and tidy’ ‘never any smells’ and ‘it is very clean’. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were trained and provided in sufficient numbers to meet the needs of the people that lived at the home. The service’s recruitment and selection procedures and practices were protecting the people that lived at the service. EVIDENCE: The service provided suitable staffing levels that could meet the needs of the people that lived there. An examination of the roster showed that during the morning three care assistants were on duty. During the afternoon two staff were on duty. Overnight there were two care staff on duty. The service also provided adequate catering and domestic staff. The service did not use agency staff having a small group of bank staff it could call upon to cover for permanent staff. The service had a good level of staff qualified to at least NVQ level 2. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 23 A sample of staff files was examined. The service had an effective system for the selection and recruitment of staff that was safeguarding people. Records showed that all cases staff were only appointed once the necessary checks had been completed. Staff were subject to a POVA and a police check and two references were always sought. Staff identities were confirmed and all staff completed a health survey to check they were fit enough to undertake the work. Examination of records and discussions with some staff confirmed that the service had training programmes in place. Staff had received induction training and undertook training in Health and Safety issues, and adult protection. Most staff had received training in medication and dementia care and those that had not completed these were scheduled to attend the next course. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service was generally well led providing some good outcomes for the people that lived there. People’s views were sought and the service was safeguarding their finances however there were Health and Safety issues that needed to be addressed to provide the people with a completely safe environment. EVIDENCE: The Care Manager has worked at the service for many years starting as Care Assistant and working up to become the manager. Although not qualified to St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 25 NVQ level four she has NVQ level 3 and extensive experience of working with older people. The service did not manage any person’s personal allowance but looked after small amounts of money on their behalf. Sampling showed that suitable records were being kept with receipts supporting expenditure. The service had systems in place for monitoring the service by surveying the people that lived there. These surveys addressed a number of areas including the care provided, the accommodation, food and medication. There was scope for this to be developed to include the views of others such as health and social care professionals and relatives and to have systems to undertake audits of care practices. The service had Health and Safety procedures in place and was undertaking checks of equipment. The service was checking fire equipment including weekly checks on the fire alarm and doors. The emergency lighting had not been tested for nearly a year. The manager reported that this was due to a mix up and would be immediately rectified. The service had an evacuation plan in place but this did not identify the level of support each person living at the service would need to evacuate the building. The home had been unaware of the changes in fire requirements. Staff had been trained in Health and Safety practices. St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF SERVICE Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 3 3 X X 3 3 3 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 2 X 3 X X 2 St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Services Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. OP7 15 The care plans to include the 14/07/07 information for staff to know how to effectively respond to any incidents of aggression. 2. OP7 13(4) The care plans to include 14/06/07 assessments of risk in respect for example of bathing and using wheelchairs to ensure that people are not placed at risk 3. OP9 13(2) The medication policies and 14/06/07 procedures for the service must be reviewed and amended so that they specifically portray details of how medicines are to be handled within the home. 4. OP9 13(2) The records of the receipt, 14/06/07 administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. 5. OP38 23(4)(c) A full evacuation plan that takes 28/06/07 (iii) account of the needs of the people that live at the service must be put in place to increase their protection 6. OP38 23(4)(c) Checks must be carried out on 21/05/07 the emergency lighting to ensure that all fire precautions are in place to provide people with a St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 28 safer environment. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP1 OP7 Good Practice Recommendations To provide the service user guide in different formats To develop care plans in more person centred format and ensure that they cover all areas of needs including oral and spiritual needs. That the individual records clearly show how health issues have been addressed. It is recommended that a Controlled Drug cabinet be obtained so that Controlled Drugs can be safely stored. It is recommended that the receipt, administration and disposal of the Controlled Drugs received into the service be more robustly recorded so that all are accountable and don’t pose a risk to people who use the service. It is recommended that staff be trained on the use of nebulisers so that help to the resident can be offered when required. It is recommended that written instructions for those medicines that have been prescribed with “as directed” directions are sought so that the danger of residents receiving the wrong dose is eliminated. It is recommended that risk assessments for those residents wishing to self-administer be carried out to identify if the residents are capable of managing their own medication. The service should also initiate a programme of monitoring these residents compliance to take their medication. It is recommended that the ordering and receipt for all medicines are brought into coincide with each other. To ensure that all safeguarding incidents are referred to the local authority. That bedrooms be fitted with locks to increase the privacy of the people that live there. That environmental changes in line with current good practice be introduced to help people with dementia care needs to orientate themselves That the system for the review of the service be further DS0000005004.V335179.R01.S.doc Version 5.2 Page 29 OP8 OP9 OP9 6. 7. OP9 OP9 8. OP9 9. 10. 11. 12. 13. OP9 OP18 OP19 OP19 OP33 St Quentin developed to include for example the views of professionals and audits of care practices St Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES 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 Quentin DS0000005004.V335179.R01.S.doc Version 5.2 Page 31 - 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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