Inspection on 28/06/05 for St Stephens Care Home

This inspection was carried out on 28th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Stephens Care Home 17/04/07

St Stephens Care Home 01/11/05

St Stephens Care Home 25/01/05

St Stephens Care Home 13/07/04

St Stephens Care Home 03/03/04

St Stephens Care Home 07/10/03

St Stephens Care Home 30/09/02

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

CARE HOMES FOR OLDER PEOPLE St. Stephens Care Home London Road Elworth, Sandbach Cheshire CW11 4TG Lead Inspector Denis Coffey Announced 28 June 2005 9.00 am 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 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. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Stephens Care Home Address London Road Elworth Sandbach Cheshire CW11 4TG 01270 759565 01270 753425 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Integrated Care Care Home 40 Category(ies) of OP Old Age (21) registration, with number DE(E) Dementia over 65 (19) of places St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 40 service users to include: * up to 21 service users in the category of OP (Old age not falling within any other category) * up to 19 service users in the category of DE(E) 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 25 January 2005 Brief Description of the Service: St. Stephen’s is a single storey purpose built home consisting of two wings for the provision of nursing care for elderly people. Saxon Wing is registered to care for nineteen people with dementia, and Penda Wing for twenty-one people that are elderly and infirm. Bedroom accommodation comprises of 40 single bedrooms. There are no ensuite facilities provided but bedrooms; lounge/dining rooms are close to the bathrooms and toilets. Communal space is adequate for the number of people accommodated. The home is situated in the village of Elworth approximately 1½ miles from Sandbach and 3 miles from Middlewich. In accordance with regulations there are trained nurses on duty at all times. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This announced inspection took place over 5.5 hours and included a tour of the home as well as inspection of care records, staff files, and the home’s general records. The inspector spoke with ten of the residents, and six members of staff. What the service does well: 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. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 7 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 standard(s) 3 & 5 Residents are assessed and given information to make sure that they know their needs can be met at the home and what their rights and responsibilities are whilst living there. EVIDENCE: Records were seen of assessments being carried out with residents by a trained nurse prior to a decision being taken about taking up residency at the home. The assessment focussed on the strengths and problems the residents may have in meeting everyday aspects of living, e.g. nutrition, personal hygiene and continence. Many of the people living at the home did not visit the home before moving there, but a member of their family did so on their behalf. St. Stephen’s does not provide intermediate care so standard 6 is not applicable. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 8 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 standard(s) 7, 8, 9 & 10 Care planning and monitoring means that residents’ social and healthcare needs are on the whole met by the staff at the home. Staff ensure that residents’ dignity and privacy is respected and the medicines are well managed so that residents receive their correct medication. EVIDENCE: Residents have an individual plan of care that shows how their needs will be met. These are reviewed each month and amended to show any changes to their health. Assessments on continence, nutritional needs and the risk of the resident developing pressure sores are made and kept up to date. This information provides staff with guidance on what care they need to give each resident. Records are kept of when residents are visited by their doctors and any other health care practitioners. The daily notes made with regard to the health and welfare of the residents’ were detailed and informative. The care records of one resident identified that they were at risk of developing a pressure sore but a plan of care as to how this problem was to be managed had not been devised. When informed of this the nurse implemented a plan of care for this problem. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 9 The records of another resident showed that they had sustained a weight loss of 4.7Kg between April and June this year. An entry had been made by a speech and language therapist in the resident’s notes regarding their nutrition, but a plan of care had not been implemented with regard to the weight loss as described. All of the residents are registered with a general practitioner, one of whom filled in a CSCI comments card about the standard of care and service provided at the home. These comments were positive. Records were also seen of other healthcare professionals being involved in the care of residents accommodated at the home. The management of medicines was inspected on both units. The Medicine Administration Record sheets of the residents were correctly filled in. A random sample of medicines were chosen on both units for stock reconciliation and found to be correct. Controlled drugs were prescribed for residents on both units; the records for these were well kept, and the stock balances were also correct. Medicines with use by date once they had been opened were dated with the date their use commenced. Staff were seen interacting appropriately with residents, knocking on doors before entering rooms. Residents who needed support with eating were assisted by the staff in a friendly and supportive manner. See Requirement 1 St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 12, 13, 14 & 15 Activities are provided for residents to take part in to keep them active and stimulated. The standard of food provided at the home is satisfactory, providing residents’ with a well balanced and nutritious diet. EVIDENCE: A full time activities organiser is employed at the home to arrange activities for residents on both units. The week’s activities programme was on display, and included an arts and crafts session, bingo, gentle exercises and one to one sessions with residents. Contact with the community is done through shopping visits to the local town centre, theatre trips, outings to garden centres, coffee mornings at a local church, and with recitals in the home by pupils from a local school. Visitors can come to the home at any reasonable time, and residents spoken with confirmed that they could see their visitors in the privacy of their bedrooms if they so wish. Residents spoken with said that they were happy with the level of choice they are able to exercise. Menus are run over a three-week period, and appeared varied and nutritious in content. A choice of three main courses is offered at lunchtimes and staff were observed asking residents’ what their preferences were for the following day. Residents spoken with said that they were happy with the standard of food provided. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 16, 17 & 18 There is information available to guide residents and relatives on how to make a complaint and who to make it to. There are procedures and guidance available for staff to ensure that residents are protected from abuse, harm and poor practice. EVIDENCE: There have been no recorded complaints received at the home since the last inspection. The home’s complaints procedure was on display, and this gave the name and contact details of the relevant people to who complaints can be made. The residents’ family members or their representatives act as advocates for residents’ who require this. One resident who does not have anyone in this category is receiving advocacy provided by the local Social Services Department. The home has an adult protection and whistle blowing policy, both of which are available for the staff to read. A member of staff spoken with demonstrated a good awareness of their responsibilities with regard to the protection of residents from abuse. The home had concerns regarding the protection of one resident earlier in the year and achieved a satisfactory outcome to this in liaison with the Social Services. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 19, 22, 24 & 26 The home provides comfortable and safe spaces for the residents to live in. Bedrooms were carpeted and comfortably furnished, many with items residents had brought into the home with them. EVIDENCE: The standards of décor and furnishings throughout the home have been well maintained. Thirty-one of the bedrooms have been re-carpeted since the last inspection; the other nine had been re-carpeted last year. Bedrooms were comfortably furnished, and the residents or members of their family have decorated a number of these with personal items such as pictures. A programme of redecoration of the residents’ bedrooms is currently being undertaken. Separate lounge and dining facilities are provided on both units, and additional seating is provided in small alcove areas. The gardens are accessible to residents who have difficulty in negotiating steps, and these were well tended with flowerbeds, paved walking areas and small lawns. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 13 Handrails are fitted in all of the corridor areas, and grab rails were sited within close proximity to the toilets. A number of height adjustable beds were provided for residents who require nursing care whilst in bed, and suitable pressure relieving mattresses were fitted to the beds of residents who had been identified as being at risk of developing a pressure sore. An electronic call system was in place in all bedrooms, toilets and bathrooms, was found to be in good working order, and responded to appropriately. All areas of the home were visited at this inspection and were found to be clean, tidy and free of unpleasant smells. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 There are enough staff rostered to be on duty to meet the needs of the residents. Recruitment procedures include checks of new staff, but there is a need for these to be followed more thoroughly to ensure that the residents are protected from any possible harm. EVIDENCE: A review of the staffing rotas showed that the following staffing levels were being provided: Trained Nurses 3 2 2 Care Assistants 7 4 3 8am to 2pm 2pm to 8pm 8pm to 8am There is a unit manager employed on each of the units who has time allocated each week when they are not responsible for providing care directly and can undertake management tasks. Staff spoken with said that they felt the dependency levels of the residents have increased, and that they have less time to spend with the residents than previously. The home manager was asked to carry out an assessment of dependency on all residents to ascertain if the appropriate numbers of staff are on duty. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 15 The personnel files of two staff employed at the home were inspected. One of the files contained all of the documentation required, but the second file only contained one reference, with an indication from the person’s previous employer that they would not give the person a reference, but that they would not re-employ. Staff training records showed that training had been provided in communication skills, continence management, diabetes care, care of the skin, and updated training for the trained nurses in nutrition for residents who experience problems with their swallowing reflex. One member of staff spoken with said that they would appreciate training in the management of challenging behaviour as some of the residents displayed aggression when being cared for. The training schedule showed that further training is planned on respiratory diseases, infection control, the management of medicines, care planning, and speech and language therapy. All of the domestic staff at the home have completed an NVQ level 1 in housekeeping/cleaning. See Requirement 2 and Recommendation 2 St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 , 34, 35 & 38 The home is well managed and residents’ views are taken into account so they have an influence in how the home is run. The practices in the home ensure that that residents are safe and their welfare is promoted. EVIDENCE: The home manager is a trained nurse and was appointed to this post in December 2004, prior to which she had been employed as the unit manager on Penda Unit. She said that she has recently completed an NVQ level 4 in management and was awaiting confirmation that she had been successful in this. An application has been received by the Commission for the manager to become the registered manager of the home. Staff spoken with were very positive in their comments about the style of management employed by the manager. They described her as being ‘easy to approach, and the team spirit at the home was happy and supportive’. St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 17 A current employer’s liability insurance was on display. The company insures residents’ personal belongings up to £3,000, limited to £1,000 per single item. The company acts as appointee for one resident whose personal allowance is paid directly into the accounts department at the company’s main office, and the home request money for the resident when it is needed. Records were seen of money received, and for receipts of purchases made on behalf of the resident. Cash held in the home for the resident was checked against the receipts and found to be correct. Families leave small amounts of money for other residents for the cost of hairdressing, sweets, newspapers, toiletries, etc. Two lots of residents’ money were checked and the balances were found to be correct. A new fire alarm system was fitted at the home three weeks prior to this inspection. Records were maintained of the fire alarm system being tested on a weekly basis, and of the emergency lights being tested monthly. One fire drill was recorded as being held since the last inspection and the home manager said that further drills would take place throughout the course of the year. Fire safety training was held in May, and further training is to be held this year to ensure that all staff employed at the home receive this mandatory training. Automatic closures that are activated in the event of a fire have been fitted to the bedroom doors on Penda Unit, but as yet are not operative as the electrical wiring to these is awaiting completion. A record was seen of all the portable electrical appliances being safety tested, and of a current landlord’s gas safety certificate being issued. The home has a contract for the removal and disposal of soiled waste and ‘sharps’ (syringe needles). Records of accidents to residents are reviewed monthly by the home manager. The records of these show that there had been a total of twenty-seven recorded in this period on Saxon Unit and five on Penda Unit. The majority of these were attributed to falls/trips. Portable mobile hoists used for residents who are unable to walk unaided, and bath hoists used for residents who are unable to get into and out of a bath unaided were serviced by an engineer in December 2004. A disinfection of the home’s cold water system was carried out in March this year. See Recommendation 3 St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 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 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x 3 3 x x 3 St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Care plans must be in place that address all of the identified needs/problems of the residents accommodated at the home. Two satisfactory written references to be received for all staff employed at the home. Timescale for action 21/07/05 2. 27 19 21/07/05 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 27 Good Practice Recommendations An assessment of dependancy should be carried out on all residents at the home to assess whether their needs can be adequately met by the current numbers of staff on duty. Arrangements should be made for staff to receive training on the management of challenging behaviour. A risk assessment of the premises should be carried out in relation to falls/trips hazards. 2. 3. 30 38 St. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire CW9 7LT 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. Stephens Care Home F51 F01 S18741 St Stephens V227081 280605 Stage 4.doc Version 1.30 Page 21 - 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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