Inspection on 07/08/06 for St Stephens Residential Home

This inspection was carried out on 7th August 2006.

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

The inspector 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 Residential Home 05/10/05

St Stephens Residential Home 22/06/05

St Stephens Residential Home 03/11/04

St Stephens Residential Home 30/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE St Stephens Residential Home St Stephens Terrace Droitwich Road Worcester Worcestershire WR3 7HU Lead Inspector Andrew Spearing-Brown Unannounced Inspection 10:30 7 , 8 and 11 August 2006 th th th 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 Stephens Residential Home DS0000018676.V300768.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 Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Stephens Residential Home Address St Stephens Terrace Droitwich Road Worcester Worcestershire WR3 7HU 01905 29224 01905 26574 ststephens@festivalhousing.org 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) Partnership Care Services Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (51) St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home to accommodate one named resident under 65 years of age. 5th October 2005 Date of last inspection Brief Description of the Service: St Stephens is registered to provide accommodation and care for 51 older people who may also have needs relating to physical disabilities and/or a dementia illness. A specialist dementia service is not provided. However care can be offered to people who have mild to moderate dementia care needs. The home is situated on the outskirts of Worcester city, close to local amenities. The building was upgraded and refurbished in 1999. It is a large three-storey building with a shaft lift to enable easy access between floors. There are 44 single bedrooms, 22 of which have en-suite facilities, and 4 double bedrooms, all of which have en-suite facilities. All bedrooms meet or exceed the National Minimum Standards (Older People) for usable space. There is a wide choice of communal lounges and dining areas and all rooms are well fitted and furnished. St Stephens has an attractive level central garden. The pre inspection information received by the Commission on the 27th June 2006 stated that fees at St Stephens currently range from £343.00 (no ensuite and funded via social services block contract) to £462.00 (luxury full ensuite - self funding). Charges / fees do not include newspapers, hairdressing, chiropody (private), transport, contributions towards trips and toiletries. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspector from the Worcester office of the Commission for Social Care Inspection (CSCI) carried out this inspection. The focus of any inspection carried out by the CSCI is to assess the outcomes for people who use the service. As part of the overall inspection of the service offered at St Stephens visits to the home were undertaken. The visits to the home were unannounced and lasted a total of 14 hours and included one visit commencing at 7.30 a.m. The last statutory visit to the home, which was also unannounced, took place during early October 2005. An additional visit to the home was undertaken during early December 2005. This inspection takes into account information received by the CSCI since the previous inspection as well as the visit to the home. Prior to the first visit a pre inspection questionnaire was posted to the manager designate requesting certain information. The inspector received the completed document prior to the inspection. In addition to the pre-inspection questionnaire a number of questionnaires were also sent to the home for residents, relatives and other persons to complete. A total of 18 residents questionnaires were returned to the CSCI prior to the inspection and 1 following the visits. Some of the completed questionnaires included additional comments made on behalf of residents by relatives or their representatives. Comment cards were also returned from other persons including health and social care professionals. Comments from these questionnaires are included within this report. In addition to the manager designate discussions took place with the bursar, a senior and three carers. Discussions took place with a number of residents throughout the inspection. What the service does well: Prospective residents and/or their relatives are able to visit the home prior to making a decision about coming to live at the home. Written information is provided by the home and given to prospective residents. Contracts are issued to new residents so that they are aware of the homes terms & conditions. A representative from the home carries out an assessment of potential residents care needs prior to admission; a visit to the care home is encouraged. Medication was well managed with safe systems in place. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 6 Visitors are encouraged as are links with the local community. Many residents spoke highly of the entertainers who visit the home as well as the party evenings when relatives and friends can join residents for a buffet style tea. A choice of menu is available. Fresh vegetables and fresh fruit are provided. The home is well maintained throughout, the grounds are well maintained and regularly win the Worcester in bloom category entered into. The use of different colours on different floors and on toilet doors can be of benefit to persons with a dementia type illness. The provision of a passenger lift affords assess to all areas of the home. St. Stephens has historically provided regular training up dates for members of staff, this was found to remain to be the case during this inspection covering a range of subjects including infection control and the protection of vulnerable adults. The home has in excess of 50 of carers qualified at NVQ (National Vocational Qualification) level 2. The organisation is currently applying to the CRB (Criminal Records Bureau) to have disclosers originally done 3 years ago redone. What has improved since the last inspection? What they could do better: The recently re-written Statement of Purpose and Service Users Guide need to be reviewed in order to fully meet the associated Regulations and National Minimum Standard. Although some staff recently received training in dementia care others have not or the training was a number of years ago; the shortfall in training needs to be addressed. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 7 Care plans require more detail to provide sufficient information for carers to carry out their duties in a consistent manner. Follow up action was not always recorded or evidenced has having taken place on both care plans and daily notes. Shortfalls were noted in oral care and nutritional screening. Further concerns were evident regarding risk assessments whereby it could not be evidenced how the outcome was established, as the scoring system was not always used. A number of differing complaint procedures are in place some of which are corporative while others are specific to St Stephens. The action taken following two complaints was not sufficiently recorded on to the care plan. The homes procedures regarding action to be taken following any actual or potential adult abuse needs improving. Sufficient staff were on duty to met the physical care needs of residents however there are insufficient staff to meet the social and recreational care needs of residents. The formal supervision of staff needs to be improved in both time and frequency. A number of policies and procedures are in need of further review. Some health and safety concerns were identified and in need of suitable action. 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 Residential Home DS0000018676.V300768.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 Stephens Residential Home DS0000018676.V300768.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is available for potential residents and or their representatives in order for them to made an informed decision regarding moving into the home. The pre- admission assessment ensures that the home has the ability to meet recognised care needs. Staff training in dementia care needs to be improved to fully equip staff with the necessary skills to care for residents with a dementia type illness. EVIDENCE: As part of this inspection the manager designate supplied a copy of the homes ‘Welcome Pack’ which contains a range of documents appertaining to the home including a colour brochure. All care homes are required to provided a Service Users Guide in addition to a Statement of Purpose. The document within the Welcome Pack entitled ‘Statement of Purpose’ was a suitable Service Users Guide but lacked some of the details needed within a Statement of Purpose. The manager designate stated that the organisation had recently united the documents; these do however need to be separate documents. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 10 Information gained from questionnaires sent to the home for residents or their relatives to complete prior to this inspection showed that 16 out of 17 persons who responded to a question regarding whether they had received sufficient information before moving into the home stated ‘yes’. Additional comments included: ‘We were shown around the home by the manager followed by a chat in which she told us all we needed to know’ Signed terms and conditions (contracts) were held on each of the residents files viewed during the course of this inspection. A blank copy of this document was supplied and briefly examined. From this examination it was concluded that it contained the required information as stipulated within the National Minimum Standards. Information on the above questionnaires confirmed that the majority of respondents had received a contract. It was evident that a pre admission assessment is undertaken prior to a potential residents admission to the care home. The manager designate prefers this assessment to be done in the home itself in order that potential residents are able to get a feel for the home. During the week this inspection took place the manager designate carried out an assessment of a resident in hospital to establish whether the home could continue to meet care needs. Although pre admission assessments take place a representative of the home does not write to potential residents or their representative confirming the homes assessment and the homes ability to meet care needs. The manager designate confirmed the statement made within the contract that following admission a trial period of four weeks is in place. The homes newsletter, which is issued periodically, welcomes new residents to the home since the previous issue. St. Stephens has demonstrated a desire to provide training for staff members. Some staff have over the past two years attended training in dementia awareness, while other staff attended training during 2002 – 04. The manager designate has recently secured four places upon some forthcoming training to be lead by a recognised ‘expert’ in dementia care. Nevertheless St Stephens is registered to care for persons with a dementia type illness and although the degree of dementia catered for is described as ‘mild to moderate’ up to date and relevant training for all staff members needs to be provided. Intermediate care is not offered at St Stephens and the home has no plans to provide such a service in the future. St Stephens Residential Home DS0000018676.V300768.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More detail needs to be included in the care plans and risk assessments to ensure the health, safety and welfare of residents. Medication records are well maintained and well managed in order to promote the welfare of residents. EVIDENCE: Residents care plans are held on computer. Currently two terminals are available within the office while another is available in the sleeping in room. A further terminal is expected shortly within the staff room. Paper copies of care plans can be generated. As part of this inspection a small but representative sample of care plans and daily notes were viewed on one of the computers or by reading paper versions. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 12 Sufficient evidence was available that residents or their representatives are invited to sign paper copies of their care plans. Carers are able to claim paid overtime in order that care plans can be updated upon the computer. It was evident that care plans are up dated however information was noted on daily records, which was not included on care plans. Previous inspections have highlighted a number of shortfalls some of which have improved while others have not improved to a satisfactory standard. The terminology used within daily notes and care plans was generally in order, in that entries must be factual and not opinionated. The daily notes evidenced that community nurses or medical practitioners (GP’s) are requested to visit although some concern was expressed regarding one resident where a time delay was evident regarding a potential sore area, comments such as ‘staff to monitor’ or ‘reported to senior’ are insufficient as they do not highlight what has to be monitored or what has to be done. On one occasion it was noted that a time-lapse of 11 days had occurred between a community nurse stating some cream was needed and the actual item arriving at the home; the home should of chased this up earlier. In response to a question on the residents questionnaire asking whether medical support is received 12 replied ‘always’ and 6 ‘usually’. One comment received by the CSCI stated ‘extremely happy with care provision for my client who resides at St Stephens.’ Although the additional visit letter written following the visit on the 8th December 2005 noted care plans to be satisfactory it was also noted that further improvement was necessary. The need to improve care plans remains and therefore requires attention. St Stephens operates a keyworker (named worker) system, this should enable care plans to be up to date and person centred. Diary notes are not compiled on a daily basis; although this is not a requirement it is nevertheless necessary for entries to reflect the care needs of residents and actions taken by carers. The notes regarding one resident showed that a GP visited due to concerns regarding a residents health; the next entry was 6 days later therefore no follow up observation by staff was recorded. The information held on the care plans was in many cases scant for example ‘x needs more assistance now’ . This statement failed to give any indication as to what assistance was needed and what additional assistance was now required. Without these details the potential for inconsistency in care delivery exists. Information regarding oral care needs was insufficient and lacked detail. A carer was unable to confirm what oral care needs one resident required and St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 13 the care plan failed to give any information other than ‘encourage to clean teeth twice daily.’ Another care plan stated ‘ false teeth both sets. No problem.’ Diary notes showed concerns regarding a residents dietary intake however the care plan failed to show these concerns stating ‘no special needs – ensure well balanced and nutritional diet’ under the actions section no further details were recorded. Nutritional screening needs to be improved to ensure the well being of residents. While assessing complaints it was evident that some areas of care practice needed to be included as part of an individuals care plan; it was disappointing to discover that information was not transferred to the care plans and therefore a potential risk that the complaint was not suitably addressed. Risk assessments were in place however the majority were not scored therefore making it difficult to establish how the overall level of risk could be determined. Fall prevention risk assessments were not in place, however moving and handling risk assessments and measures to be taken following a fall were available. Despite the comments made in relation to care planning and risk assessments it was nevertheless noted that residents looked well kempt and showed signs of general ‘well – being’ although comments were made regarding the lack of activities (see standard 12 below). As part of the inspection the management of medication was assessed. In order to carry out this assessment the storage and recording of medication was examined. The Medication Administration Record (MAR) sheets were in good order and well maintained with the time of administration highlighted. Areas assessed included ensuring that all medication was signed as given, ensuring that any know allergies were recorded and that medication was signed in as required, all of these areas were met. A representative from the supplying High Street pharmacy visited the home in June 2006, the report following this visit showed no concerns. The date of opening was recorded on boxed medication therefore enabling a full drugs audit to take place. Controlled medication was checked and well maintained with the necessary records in place. Creams and ointments are signed for on separate MAR sheets, these records were found to be satisfactory. In order to ensure that medication is stored at an appropriate temperature an air conditioning unit is used within the treatment room. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 14 Since the last inspection staff have undertaken medication training supplied by a major high street pharmacy. Although this training is likely to equip staff with the necessary knowledge it is possible that training from one source alone will not meet the necessary training outcome for all persons involved in the administration of medication. The registered person must ensure that staff are sufficiently competent in medication administration prior to allowing this to take place. It is necessary for training to include an element of supervision as well as the theory. The manager designate confirmed that it is policy within the home to request a fax confirming any verbal changes to medication especially an anticoagulant. This is good practice and reduces the potential for drug errors. A written policy and associated procedures needs (if not already done) to be included within the homes policies and procedures in relation to this practice. A mixture of practice was observed regarding staff knocking on bedroom doors and awaiting a response. One question on the questionnaire sent to residents enquired ‘ Do the staff listen and act on what you say?’ A total of 9 replied ‘Always’ 5 ‘ Usually’ and 4 ‘Sometimes’. It needs to be acknowledged on care plans that some residents may prefer to use toilet facilities within their own room rather than using communal facilities. Comments made to the CSCI regarding routines within the home involving the removal of drinking glasses and commodes from bedrooms during the daytime were discussed with the manager designated St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a relaxed atmosphere, where residents can speak openly about their experiences within the home. The provision, range and frequency of activities needs to be reviewed and extended to provide residents with a choice as to how they spend their time. Resident spoke highly of the food provided especially following the recent review of the teatime menu. EVIDENCE: Visitors are able to visit at any reasonable time. Visitors are able to use communal areas such as the lounge or dining room as well as resident’s own rooms as they wish. The manager designate undertook to write a suitable policy upon maintaining contact with friends and relations. Involvement with the local community takes place; at the time of this inspection preparations were in hand for the homes summer fete. In addition staff spoke of links with the church situated next door to the home whereby residents are invited to events. The vicar from the church visits the home weekly. At the time of this inspection the home accommodated three Roman St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 16 Catholics who were reported to be non-practicing, a Priest does however visit fortnightly. Regular reports written following visits to the home on behalf of the provider are forwarded to the Commission for Social Care Inspection. These reports contain useful information including details of activities planned or which have taken place. These activities include entertainers, a quiz/ discussion each Thursday and bingo on alternative Sundays. The home has a party night on a Saturday evening once per month when family members can join residents in a buffet style tea. Fund raising events such as the summer fete take place in order to fund entertainment within the home as no budget is provided for this. Contributions from residents are collected to part fund trips out although this did not include a recent trip to the Cotswold Farm Park. It was reported that the Cotswold trip only included 6 residents and 6 members of staff therefore a 1:1 ratio. Residents who attended this outing were reported to be residents who would usually not attend trips. Photographs from the trip were on display from which it appeared everybody had a good time. During this inspection no activities were seen to be taking place. Staff confirmed that although they would like more activities to take place they were unable to due to a lack of time. Residents consulted also made comments regarding the lack of activities although some commented upon how they enjoyed the entertainment while another resident stated ‘have fun . have games’. Care plans have a section entitled interests and skills, this section needs to be developed further as activities are promoted and improved Further comments were made on the questionnaires sent to residents prior to the inspection whereby in answer to a question ‘Are there activities arranged by the home that you can take part in?’ - 7 persons answered always, 4 usually and 7 sometimes. Additional comments made were: ‘An increase in activities would be most welcome as sitting around doing nothing all day with just a t.v playing can be very boring.’ ‘Activities are arranged and I chose what I would like to take part in.’ ‘Could have more varied activities more often anything to pass the time of day.’ St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 17 Although one of the senior team (who works 12 hours per week) has a delegated responsibility for activities this includes other duties. No activities organiser or coordinator is employed. Taking into account the comments under the staffing section of this report below serious consideration to employing an activities person should be considered. Meaningful and purposeful activities must however be improved. It was evident from a number of different sources that the menu at St Stephens and in particular the tea menu was a cause for some concern. Recent questionnaires prepared by the organisation and audited by the organisation highlighted this concern, as did some sent directly to the Commission for Social Care Inspection. Upon the questionnaires returned to the Commission the responses were varied, some of these where however completed prior to the in house review of menus. It was nevertheless evident that the organisation took notice of the comments received and took appropriate action to remedy the situation. It was reported that the new menus take into account the direct wishes of residents consulted as well as advise from a dietician and information within a recent CSCI publication. Copies of the new menus were sent to the CSCI. The menu showed that the 2nd choice at lunchtime. It was noted that around 10 – 12 residents had a salad for lunch on the first day of this inspection; some had ham while others had tuna. The salad was well presented and staff made salad cream and coleslaw available to residents. A small number of residents required minimum assistance with their meal; this was carried out in a discreet and sensitive manner. A cooked breakfast is available on a Saturday morning. Fresh vegetables are used and fresh fruit is available. Staff distribute cut up fresh fruit each afternoon as a means of encouraging residents to have a daily portion. The home holds a ‘Heartbeat’ award given for the use of healthy food for older people. Some residents commented about the food provision at St Stephens. The majority of residents consulted stated that tea is now better following the reduction in the number of sandwiches. Other comments included: ‘Foods good.’ ‘Wouldn’t say a bad word against the food.’ It was noted that a number of residents were sat at dining tables awaiting breakfast and lunch at times over an hour before the meal was due to be served. Following consultation with residents and staff this appeared to be a genuine. The possibility of residents having a drink while waiting for breakfast was discussed. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 18 Although comments on the questionnaire are taken into account it is nevertheless evident that residents consulted are happier with the current menu. The associated National Minimum Standard will be re assessed as part of a future inspection. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To fully safeguard residents the outcome following any complaints or concerns need to be incorporated into care plans. Training regarding vulnerable adults has taken place and staff had sufficient knowledge to safeguard residents. Policies and procedures within the home need to be up dated to reflect current guidance. EVIDENCE: The Commission for Social Care Inspection have received no complaints regarding the service provided at St. Stephens since the previous inspection. As part of the Welcome Pack (mentioned under Choice of Home) information regarding complaints is included in a number of different places. The information is however conflicting in some places. The homes complaints procedure was on display around the home. Residents consulted stated that they would inform the office if they had any concerns or complaints. None of the residents consulted voiced any concerns about the care they receive. A suggestion box was located in the dining room. Since the last statuary inspection at St. Stephens the home has received a number of complaints. Records regarding these were viewed and two in particular were followed up. Elements within the complaints in relation to care St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 20 planning matters could not be evidenced within the care plans to demonstrate suitable action was taken. A number of posters regarding adult abuse recently issued by Worcestershire County Council were displayed around the home. Training records demonstrated that staff had received training upon PoVA (Protection of Vulnerable Adults). The handout from the training was viewed and the content appeared to be satisfactory and relevant to St Stephens. A number of policies and procedure were viewed during this inspection including one on adult abuse. The procedure needs to be revised to ensure it contains the correct action to be taken in the event of actual or potential abuse taking place. The review needs to take into account other documents and guidance issued as well as information regarding external agencies to be contacted including the Adult Protection Coordinator and the Commission for Social Care Inspection. Reference to Whistle blowing within the above procedure was in need of extending to highlight individuals responsibilities. In addition to the above training staff have also received training regarding sexuality and older people in order to understand the rights of older people residing within a communal setting as well as the possible signs of adult abuse. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 21 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): Standards 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The desire to continually improve the environment ensures that residents have an attractive place to live. EVIDENCE: The grounds surrounding St Stephens and especially a small area to the rear of the home are well maintained. The home has in the past entered and won the Worcester in Bloom (small business category) competition. The outcome of the 2006 competition is awaited. Communal facilities within the home are spacious with a large dining room and two lounges (one in which smoking is permitted) on the ground floor and additional lounge areas on the first and second floor. A seating area in the front foyer remains a very popular area for residents to either sit and chat or St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 22 read a book or newspaper. The lounge on the top floor is seldom used other than during reviews or meetings. New chairs were due to be delivered for use in the foyer and downstairs lounges the week after this inspection. It is planned to replace the lounge chairs upstairs next year. A call alarm system is in place, throughout the inspection it was noted that carers answered any calls in a reasonable time taking into account the demands on staff time particularly before breakfast. The system allows for a ‘printout’ to show the time of activation and resetting, however this had run out of paper. The manager designate arranged for a new roll to be fitted as soon as this was highlighted. Communal toilets are located near to lounge and dining areas. All communal toilets seen were clean and free from odour. It was noted that a grab rail in one toilet was missing and in need of replacement. St. Stephens care home is registered to care for up to 51 residents under the categories of registration detailed earlier within this report. There are a total of 44 single bedrooms of which 22 have en-suite facilities. En- suite facilities comprise of a wash hand basin and toilet in 11 bedrooms while the remaining 11 rooms also have a shower. The home has 4 double bedrooms however 3 of these are currently used as ‘luxury singles’. A small sample of bedrooms were viewed all of which were suitably furnished. It was evident that residents are able to bring personal possessions into the home as desired. Wardrobes seen were secured to the wall to prevent them falling over. All bedrooms have a suitable lock fitted to the door; one resident commented that she likes to have a key to her bedroom. Care plans and admission documentation needs to demonstrate that a bedroom key is offered or a reason for withholding a key should that be the case. This inspection took place during a warm period of time; ceiling fans were in use within the dining room area. Information regarding heat stroke during extreme temperatures was displayed around the home. Since the last inspection a number of areas have been redecorated including the middle and top floor corridor, most lounge areas and the laundry. In addition new carpeting has been fitted along the first and second floor corridors. It was noted that the carpet in the dining room is stained and in need of either deep cleaning or replacement. The colours used along corridors and especially on toilet doors may help with the reorientation of residents with a memory loss. Suitable laundry facilities are available whereby two washing machines are in place both of which have a sluice facility. It is believed that these pieces of equipment meet the Water Supply (Water Fittings) Regulations 1999. Hand washing facilities are provided within the laundry. The laundry was clean and St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 23 tidy. Two separate comments were noted upon different questionnaire returned to the Commission stating that laundry at times goes missing, this matter was brought to the attention of the manager designate and should be monitored. The manager designate was able to provide a copy of a handout devised ‘in house’ to provide training to staff in relation to infection control. It was reported by the manager designate that an infection control nurse adviser had confirmed the contents of the handouts to be in keeping with local guidance. It was evident that sufficient hand washing facilities with liquid soap are available as well as personal protective equipment such as gloves and aprons. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not enough staff are on duty to ensure that the social and recreational care needs of residents are met. Staff training is sufficient by means of the events arranged and the training they have undertaken in the majority of areas. EVIDENCE: It is evident from the staff rota as well as discussions with management and staff that 6 carers cover the morning shift while the afternoon shift consists of 5 carers. The night shift consists of 3 wakeful carers. At least one member of the senior team is on duty throughout the waking day and on call and sleeping in during the night. The morning staff commence duties at 7.30 am and are sent around the home to assist residents getting up. Staff consulted believed that the staffing level was sufficient however comments were made regarding the lack of time to partake in the desired level of activities (see standard 12 above). One relative commented upon the questionnaires: ‘Not enough staff’ Another stated: ‘Some staff nice . ’ ‘ Don’t always take any notice.’ St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 25 While another relative / visitor commented: ‘Staff helpful . . . always visible / available’ The pre-inspection questionnaire states that all residents have a high level of care needs; staffing levels must be able to accommodate the high levels of care need. A previous inspection report noted ‘Sufficient numbers of staff were on duty . . . Concern was however voiced regarding the lack of ‘quality’ time to spend with resident.’ Reference to ‘quality’ was in relation to the prevision of social activities as mentioned earlier in this report. Two questionnaires received by the commission raised concerns regarding the attitude of some members of staff, however another commented that staff are ‘polite’. The registered provider needs to be mindful of these comments. A number of appointments have recently taken place for care staff, which should help reduce the reliance on agency staff. It was especially pleasing to note that the home had managed to appoint a number of male carers wishing to take further into account the personal care needs of male residents and thus recognising equality and diversity within the home. A number of vacancies still remain for care assistants at the home. The laundry is staffed between 9.00 am – 2.00 pm Monday – Friday. At other times carers need to carry out laundry duties, in addition to other duties. The file of a recently appointed member of staff evidenced that two written references and a criminal records bureau disclosure (CRB) was obtained prior to the commencement of duties. The application form for this person was not available as it was held at head office, therefore some aspects such as employment history and qualification could not be checked. A new employee was seen to be in possession of the General Social Care Council handbook. It is pleasing to note that in line with good practice St Stephens has embarked on applying for up dated CRB disclosers in relation to staff who first received clearance 3 years ago. The manager designate reported an increase in care staff qualified at level 2 NVQ (National Vocational Qualification) since she completed the pre-inspection questionnaire. As a result of this increase it is reported that the home now has over 50 of carers qualified to level 2 therefore in excess of the government target. While working as deputy manager the manager designate had delegated responsibility for staff training. St Stephens has over a number of years St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 26 provided suitable training for staff to assist them perform their role. Although as mentioned earlier within this report training is needed regarding dementia care the majority of training needs of staff who were interviewed are assessed as met. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The appointment of a manager (designate) ensures the continuing development of the service. Improvements are necessary in record keeping in some areas as highlighted. A small number of health and safety concerns could of potentially placed residents, staff and others at some risk. EVIDENCE: At the time of this inspection the home was being run by a manager designate who was until March of this year working as the deputy manager. The Commission for Social Care Inspection has recently received a completed application form and associated documents in order that the process towards registration can commence. A review of the management team has taken place resulting in the removal of the deputy manager post and the introduction St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 28 of a bursar who manages domestic and catering members of staff as well as having other responsibilities. The home manages the personal monies for some residents. It was noted that money is kept securely, the balance of a small sample of residents were checked and found to be in order. A second signature to verify expenditure was not in place unless the resident had signed for his or her own money. It is strongly recommended that a second signature to confirm the withdrawal is obtained. It was noted that cash was occasionally withdrawn from residents money for items such as collections or raffles, it was confirmed that residents where this had happened were able to make a positive choice to spend their own money. Under Regulation 26 of the Care Homes Regulations 2001 the registered provider or a representative is required to visit the home at least once per month and write a report. Copies of these reports are routinely sent to the local office of the CSCI. The manager designate has devised a development plan, which contains some realistic aims for the coming months. The results of questionnaires issued to residents, relatives and visitors and professionals by the home were displayed around the home. A copy of the results was also sent to the CSCI. The findings were generally very positive in relation to the care provided and how staff members work together. Where shortfalls were identified action was seen to of taken place. Minutes from a recent residents meeting were on display within the home. Further development to monitor standards within the home is needed to fully comply with the requirement to have a full quality assurance system in place. The previous unannounced inspection report was on display around the home, in addition to other information regarding the work undertaken by the Commission for Social Care Inspection. Supervision and appraisal records were held on individual staff files. Although evident that sessions are taking place it was noted that meetings tend to last between 15 and 25 minutes therefore how worthwhile these meetings and the depth of discussion possible within this timescale needs to be questioned. Supervision is a means whereby staff practice issues are able to be managed, as well as training needs discussed. As reported elsewhere within this report it was evident that some records are not sufficiently up to date in order to ensure effective and efficient running of the home. Copies of the homes policies and procedures are shortly to be issued to all members of staff. A representative sample of policies and St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 29 procedures were viewed and found to need amending. For example the missing person procedure needed to be expanded in a number of areas to ensure the health safety and welfare of all persons within the care home. It was brought to the attention of the manager designate that some staff were wearing some heavy jewellery. Rings with stones can be hazardous to residents as well as a source of infection. Jewellery such as necklaces and earrings can be hazardous if pulled or caught while carrying out care tasks. A notice near to the passenger lift highlights an intermittent fault. This fault was reported to be sorted however the notice remains in place to remind everybody of potential faults and to remind people to check the floor level of the lift. Information attached to portable hoists evidenced that they are serviced as required every six months. The homes fire risk assessment was not viewed on this occasion. The manager designate was aware of the new Fire Safety Order recently issued by the Department for Communities and Local Government. Fire safety records evidenced that the required weekly / monthly tests are taking place; some gaps were noted regarding staff attendance at fire drills. The electrical hard wiring five year inspection was recently undertaken and the necessary certificate issued. Water temperatures are recorded on a weekly basis as recommended by a health and safety officer from Worcester City Environmental Health. Bath temperatures must be checked prior to bathing residents. In one bedroom is was noted that the window restraint was released and therefore allowing the window to open wider. The practice of taking restrains off can be potentially hazardous in the event of other persons entering the room. It was stated that all points identified following a recent food safety inspection were actioned. The first day of this inspection coincided with a very warm day; it was noted that the back door leading into the kitchen was wide open therefore allowing free access to flying insects. As mentioned elsewhere within this report St Stephens has a good record regarding the provision of training. All senior staff and some others hold a full first aid certificate therefore ensuring at least one first aider is always on duty. Other staff have undertaken emergency first aid and therefore have a basis knowledge. St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 2 3 3 2 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 5 Requirement The document entitled Statement of purpose must be reviewed. A statement of purpose and service users guide must be provided. Copies must be forwarded to the CSCI All staff must receive suitable training in dementia care. A letter confirming the homes assessment and the ability to meet care needs must be sent to potential residents or their representative. The registered manager must ensure that each residents care plan sets out in detail the action, which needs to be taken by care staff to ensure that all aspects of need are met. The time scale given is set to ensure that suitable action can be taken covering all care plans Timescale for action 31/10/06 2. 3. OP4 OP4 18 (1) 14(1)(d) 31/10/06 31/08/06 4. OP7 15 30/09/06 St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 32 5. OP7 15 (2) (a) The registered person must ensure that care plans are reviewed on a monthly basis or more frequently to reflect the changing care needs of residents. Suitable action must be taken regarding residents health care needs. Action taken and follow up action must be suitably recorded The registered person must ensure that suitable risk assessments are in place. Risk assessments must show how the risk element is reached and how the level of severity can be reduced. The privacy of residents of residents must be respected. Sufficient staff must be on duty throughout the day to meet the care needs including the social and recreational of residents. Complaints are fully documented and necessary action incorporated into the care plan Review the homes policy and procedures in relation to actual or potential adult abuse. The policy must include contact details of the local authority contact and CSCI. All areas of the home must be well maintained. The current quality assurance program must be developed in accordance with Regulation 24 and Standard 33. DS0000018676.V300768.R01.S.doc 31/08/06 6. OP8 13 (1) 11/08/06 7. OP8 14 17 (1) (a) 30/09/06 8. 9. OP10 12 (4) (a) 18 11/08/06 30/09/06 OP12 OP27 10. OP16 17 (2) Schedule 4 (11) 12 (1) 11/08/06 11. OP18 30/09/06 12. 13. OP21 23 (2) 24 30/09/06 30/09/06 OP33 St Stephens Residential Home Version 5.2 Page 33 14. OP36 18 (2) Systems for the formal supervision of staff must be reviewed to ensure that they are sufficient in time and frequency to meet the needs of carers and to fulfil the associated standard. Records including policies and procedures must be in order and up to date The policy and associated procedures already in place must be adhered to regarding staff wearing jewellery Window restrictors must not be released to increase ventilation while a risk to residents gaining access remains Suitable procedures to prevent flying insects access to the kitchen 30/09/06 15. OP37 17 30/09/06 16. OP38 13 11/08/06 17. OP38 13 (4) 11/08/06 18. OP38 13 11/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP35 Good Practice Recommendations A second person should witness financial transaction St Stephens Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Residential Home DS0000018676.V300768.R01.S.doc Version 5.2 Page 35 - 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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