CARE HOME ADULTS 18-65
St Teresas Cheshire Home Long Rock Penzance Cornwall TR20 9BJ Lead Inspector
Paul Freeman Announced 16 May 2005 0930 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Teresas Cheshire Home Address Long Rock Penzance Cornwall TR20 9BJ 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) 01736 710336 01736 710549 Leonard Cheshire Mrs Christine Proctor Care Home 27 Category(ies) of Physical Disability (27) registration, with number of places St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 27 adults with a physical disability (PD), 15 of whom may have nursing needs Date of last inspection 4 October 2004 Brief Description of the Service: The care home is situated on the outskirts of Marazion and overlooks St Michaels Mount and the bay on one side. The town of Penzance is within easy reach and therefore there is a wide range of amenities available.St. Teresa’s provides a home for up to 27 younger adults who experience disabilities and are registered to provide nursing and residential care. The Home comprises of a new purpose built setting that was opened in 2000 and an established building that has acted as a care home for many years. The two settings are interconnected. Internally the accommodation is maintained to a high standard and service users have personalised and furnished their own rooms. St. Teresa’s provides four distinct self-contained units two of nine residents, one of four and one for five. Each unit has dedicated staff allocated and a Care Coordinator to facilitate efficient and smooth functioning. Each service user is allocated a key worker who takes a key role in ensuring the individual’s needs are met in a manner that is acceptable to the individual concerned. Quzalified nursing satff are on duty 24 hours a day to meet the nursing needs opf residents. Currently twenty five people are accommodated on a long-term basis and two beds purchased by the Social Services Department for short-term care. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days and lasted for eleven hours. The Inspector looked over the building and at a number of records and documents. The registered manager, fourteen of the residents and ten of the staff from all the units were spoken to. The Inspector found the requirements and recommendations set at the last inspection had been acted upon. What the service does well:
The written information given to prospective residents is comprehensive and tells people about the facilities and service provided. Prospective residents and their families or representatives are able to visit the care home and information about the individual’s needs and choices is collected before they move to the home. This helps prospective resident to make an informed choice and makes sure they are provided with the care they need and want. Each resident has clear and detailed care plans that tell the staff of the care and support they require and to make sure the care provided happens in the most acceptable way for the resident. The plans are regularly reviewed with resident to make sure they are up to date and reflect the resident’s choice and preference about the care they receive. Residents play a central role in deciding the best way to meet their needs. Residents are consulted about every aspect of the care and support provided and encouraged to make their own decisions. The staff help residents to have access to the community and participate in the activities of their choice at the home. Residents are very positive about the enthusiastic manner staff provide support and in the way staff respect their dignity and rights. The Registered Manager deals with any concerns or complaints the residents raise positively and efficiently. Three complaints have been made over the last year and all have been resolved to the resident’s satisfaction. The staff group are enthusiastic, skilled and well trained and have a good understanding of residents needs. It is evident that positive relationships have
St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 6 been formed between the staff and residents. The recruitment arrangements for new staff are good and residents can participate in the selection process. The home is well managed and residents are provided with a number of opportunities to comment upon the services and facilities provided. The managers are open and respond positively to any issues raised by residents. 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 Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4 The homes statement of purpose and service users guide provide prospective residents with good information about the services and facilities provided and this helps them to make an informed decision about moving to the home. The admissions process is well managed and takes account of the needs of residents in order that their needs can be met appropriately. EVIDENCE: No new residents have been admitted to the care home since the last inspection. The owners operate the home in line with the statement of purpose and prospective residents are provided with good written information about the home. Each person is assessed as part of the preadmission process and positive arrangements are in place for this to occur. The preadmission arrangements also include any specialist worker assessments that have been completed. This makes sure that all of the prospective residents needs are taken account of. Prospective residents and their relatives or representatives are able to visit the home to help them make an informed choice about the move. The
St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 9 arrangements for visiting are flexible according to the person choice about the best way to find out about the care home. The care home does not provide a dedicated intermediate care service but are keen to help residents maintain their independence. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Resident’s needs and choice are central to the care provided. The individual care plans clearly state the care and support provided and the most appropriate way of meeting assessed needs. This means that staff and residents are clear about the service required and the best way of giving the assistance. The plans are also regularly reviewed with the resident to make sure they are up to date. Further attention needs to be given to the arrangements to manage risks that may occur to residents and staff in order that their health and wellbeing are not compromised. EVIDENCE: Each resident has a care plan that details their needs and the appropriate way to meet the needs. The staff have worked hard to improve the care planning arrangements in recent months and there are no restrictions to residents accessing their records. Residents commented they were very pleased with the care they received and felt in control of the arrangements. The care plans provide a full picture of the assistance, support and care each resident requires. The contents of the plans are regularly reviewed with residents to
St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 11 make sure they are satisfied with the care and to take account of any changing needs. The arrangements to make sure residents and staff are not placed in a position of unreasonable risk to their health and safety have improved. Further improvement is required to make sure that no one is placed in a position of risk. Attention to assisting residents with their mobility and taking positive action following an accident or incident experienced by the resident is required. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 16 Residents are encouraged to be independent and make their own decisions where this is possible. The staff positively support residents to participate in the local and wider community and to undertake activities in the care home. The records about the activities chosen by residents could be improved. This will make sure that all of the resident’s choices are accommodated. EVIDENCE: Each resident has an activity programme they have chosen to undertake in the care home or the local community. The staff on each unit play an active role in supporting residents in activities and residents commented on the positive assistance provided by the staff. The records about activities should be more detailed to provide a clear picture of the activities chosen by the residents. The home has a small pool of mini buses that residents can use at a nominal cost. No residents are excluded from community activities unless it is unsafe for this to occur. A number of residents who have complex needs regularly participate in the local community and have holidays. The staff at the home treat residents and visitors in a positive way and make sure their rights are not compromised. Every effort is made to help residents
St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 13 to be independent, have control of their lives and in making decisions. Residents commented that staff were flexible, reliable, approachable and skilled in the way they meet their needs. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 There has been improvement in systems for the administering of medication but the records are not satisfactory and require further improvement to make sure that residents are not placed at risk or harm. EVIDENCE: Residents are able to manage their own prescribed medicines when it is safe to do so. The arrangements for the safekeeping and administration of medication have been improved in recent months. The staff who assist the residents have all had appropriate training and there are no concerns about the arrangements for storing and keeping safe the medicines. Where staff administer medicines on behalf or residents the records that are kept need to be improved. The current arrangements could place residents at risk or harm. An immediate requirement was set at the inspection to address this issue. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Arrangements for responding to residents concerns or complaints are positive. EVIDENCE: A suitable policy and procedure are in place and residents are provided with a copy. Three complaints have been made to the home over the last year that were efficiently managed by the Registered Manager and resolved to the resident’s satisfaction. Residents comments showed that people feel very comfortable about discussing any issues of concern. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) NA The facilities are well maintained to a high standard. EVIDENCE: Residents comment they are very satisfied with the facilities and that the environment is maintained to a high standard.. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 The staff have a good understanding of the residents support needs and positive relationships have been formed between the staff and residents. The work force is enthusiastic and employed in sufficient numbers to meet the needs of residents. The recruitment and selection arrangements for new staff are good and help to ensure that staff are employed with the appropriate skills to provide a quality service to residents. EVIDENCE: Each unit has a core group of staff and the numbers of staff on duty are determined by the needs of the residents. There are no issues about the staffing levels at the home. Every unit has a manager who coordinates the care provided and named nurses who assist the unit manager with their duties. Qualified nurses are duty at all times. Residents are very complimentary and positive about the way that staff undertake their duties. The staff group have considerable experience, skills and abilities about providing care. Staff training is well organised and each staff member has a training plan for the year ahead. Twenty one of the twenty seven care staff hold NVQ 2 or above and two staff are currently in the process of completing the qualification.
St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 18 Three staff files were looked at during the inspection and showed that records are well managed and the Registered Manager is diligent about the recruitment and selection of new staff. Residents are also involved in the selection of new staff. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39 and 40 The home is well run and managed and residents are provided with a number of opportunities to comment upon the services and facilities provided. The record keeping arrangements are satisfactory and safeguard the resident’s rights and best interests. EVIDENCE: Residents commented about the open nature of the management of the home and are consulted about the quality of the services and facilities and any plans for the future. One resident has taken the lead role in planning and funding a sensory garden in consultation with other residents and the work will commence in May 2005. This will be a valuable facility for the home. There is a clear sense of leadership and the management structure positively supports the work of the home and to achieve compliance with the Care Home Regulations. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 20 The records about residents have improved, are in good order and include a daily record of events that have occurred for each resident. Some of these daily records could be further improved by including more detail about actions that staff have taken and the outcome of the action. The home will be providing staff with training in this area in the near future. Four service users are assisted by the home in the management of their personal allowances and good records are maintained that ensure residents rights and interests are safeguarded. St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x x 2 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Teresas Cheshire Home Score x x 1 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x 3 x x D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 22 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 9 Regulation 13 Requirement Timescale for action 30.8.05 2. 20 13, 17 Detailed risk assessment must to be completed whenever a situation potentially compromises an individual’s health and well being. Records regarding the 1.6.05 administration of control drugs must be completed according the care homes policy and procedure and the British Pharmaceutical Society Guidelines. (Previous timescale of 11 October 2004 not met). 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. Refer to Standard 12 41 Good Practice Recommendations The records about the activity programme chosen by services should be more detailed to reflect the current provision and include all the choices made. The daily records maintained for each service user should detail the events, incidence or concerns that have arisen, any action taken and the outcome of that action St Teresas Cheshire Home D52-D04 S8937 St Teresas V215939 160505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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