CARE HOME ADULTS 18-65
St Teresas Cheshire Home Long Rock Penzance Cornwall TR20 9BJ Lead Inspector
Paul Freeman Unannounced Inspection 17th July 2006 10:00 St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 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 Teresas Cheshire Home DS0000008937.V306768.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 Adults 18-65. 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 Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Teresas Cheshire Home Address Long Rock Penzance Cornwall TR20 9BJ 01736 710336 01736 710549 chris.proctor@lc-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) Mrs Christine Proctor Care Home 27 Category(ies) of Physical disability (27) registration, with number of places St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up 27 adults with a physical disability (PD), 15 of whom may have nursing needs 7th November 2005 Date of last inspection 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. Teresas 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. Teresas 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 individuals needs are met in a manner that is acceptable to the individual concerned. Qualified nursing staff are on duty 24 hours a day to meet the nursing needs of residents. Currently twenty five people are accommodated on a long-term basis and two beds purchased by Cornwall County Councils Adult Social Care department for short-term care. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned unannounced inspection took place over two days on the 17 July 2006 and 18 July 2006 by two Inspectors Paul Freeman and Diana Penrose. The purpose of the inspection was to consider the work that had been undertaken on the requirements and recommendations set at the last inspection on 7 November 2005 and to inspect key standards. Therefore some of the key standards that were considered include assessment and care planning, health and safety and staff recruitment. The manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. Prior to the inspection the providers had also sent to the Commission written information about the services and facilities provided. No Immediate requirements were set at the inspection. What the service does well:
Each prospective resident is assessed to make sure the providers are able to meet their needs, preferences and choices. The prospective resident has the opportunity to be fully involved in the assessment process and their relatives or representatives are also consulted. The views of any professionals that are in contact with the prospective resident are also taken into account. This means the providers have a clear picture of the care and support required and the information provided forms the basis of the care plan. Residents that had recently moved to the care home said they had felt in control of the assessment arrangements and were pleased about the manner in which they were prepared to move to the home. Residents also said they were positively welcomed and supported when they move to the home. The staff at the home is committed to supporting residents to maintain their independence as far as possible and to have control of their day to day lives. Therefore residents are able to make their own decisions and where required appropriate support and assistance is provided. Therefore the patterns of daily living are flexible and residents are supported to maintain personal relationships at the care home and in the local community.
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 6 Residents are also able to participate in a range of social, educational and recreational opportunities at the care home and in the local community. Staff also support residents to participate in activities when it is possible. Residents said the meals at the home were good and reflect their individual taste and choice. A varied and nutritional menu is offered and residents are provided with a choice at each mealtime. Residents health needs are well met and medical services are promptly accessed when required. Qualified nurses are on duty each day and night and are able to provide assistance where required. Residents said they had confidence in the staff and the manner in which their health needs are met. The care and support arrangements at the home are also reliable and residents said the staff are flexible, efficient and responsive to their needs and requests. Residents are also able to administer their own prescribed medicines when it is safe. The staff also administers medicines where assistance is required and the staff concerned have all been appropriately trained. Medication is stored in secure facilities and suitable disposal arrangements are in place for medication that is no longer required. The majority of the medication records are satisfactory and some good practises are in place. The Providers deals with any concerns or complaints that are raised positively and efficiently. Residents said there no barriers to raising any concerns or complaints they have with the staff or managers and staff were confidant that any matters are dealt with in a satisfactory manner. Suitable arrangements are in place to protect residents from abuse. Any concerns or allegations are reported to the statutory authorities for investigation. The environment and facilities in the home are of a high standard and provide a homely and comfortable setting for residents. The accommodation is provided in a single storey building that has accessible gardens and car parking facilities. Each of the units has their own dedicated communal space and there are other communal areas throughout the building that residents can use. Within each unit there is a sitting room and separate dining area and each bedroom is furnished and equip according to the occupants needs, preferences and choices. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 7 Many of the bedrooms have ensuite facilities and communal toilets and bathroom facilities are also distributed throughout the home. A wide range of disability equipment is evident at the home and this includes hoists, specialist baths and mobility equipment. Where required each resident has a specialist assessment to determine the equipment or adaptations they require to meet their needs and promote their independence. The home is maintained to a good standard of hygiene and cleanliness and the environment is well maintained and decorated. The residents said they were very satisfied with the facilities provided and the manner in which the home is maintained. The staff group are enthusiastic, skilled and well trained and have a good understanding of residents needs. It is evident that positive relationships have been formed between the staff and residents. Sufficient numbers of staff are employed each day and night to meet the needs of the residents. Residents are very positive about the manner in which staff provide the care and support required to meet their needs. Good arrangements are in place to recruit staff that makes sure new staff have the appropriate skills and abilities. Each new member of staff also completes an induction programme in order that new members of staff have a clear understanding of the standards of care and support required. Staff are also well trained and provided with regular opportunities to update and improve their knowledge and skills. The services and facilities are well managed by an experienced qualified nurse and residents and staff expressed confidence in the manner in which the home is run. Satisfactory arrangements are in place to regularly review the services and facilities. The arrangements include regular consultations with staff and visitors and monthly visits by staff that are not directly employed at the care home. The feed back from the consultations is positive and indicates that residents value the care, support and facilities provided. A range of measures is in place to promote safe working practises at the home and satisfactory steps are taken to safeguard residents, staff and visitors. There are no concerns about financial viability and a suitable insurance policy is in place. What has improved since the last inspection?
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 8 The providers have continued to improve the care planning arrangements in each of the units so that a satisfactory standard is maintained. Each resident has a care plan that details the facilities and care they require to meet their needs. The residents said they were very satisfied with the care and support provided and all residents commented they had confidence in the staff. The residents also stated they were regularly consulted about the contents of their plans to make sure they are up to date and reflect the needs, preferences and choices of the person concerned. The staff and providers have continued to develop and improve the arrangements to manage risks around the care home and where experienced by individual residents. Where required a suitable risk assessment is completed and an action plan established. This makes sure that every reasonable step is taken to protect residents and staff and visitors to the home. The kitchen facilities were in the process of refurbishment during the inspection visit. The improvements should make sure the facilities are fit for purpose. The record keeping arrangements have significantly improved and many of the records required by regulation meet the standard required. There continues to be certain instances when the record keeping practise fall below the standard required and further improvement is required in these areas. What they could do better:
Although residents care plans are regularly reviewed the records of the review are not always sufficiently detailed. Therefore staff are not always provided with clear information or guidance about the care and support required. In some instances the records of the risk management arrangements are also not sufficiently detailed to provided staff with adequate guidance and direction. Improvements in this area will make sure that robust arrangements are in place to safeguard everyone at the care home. A number of residents said they wanted to plan for a broader programme of educational and social activities. Other residents want to have more spontaneity about their leisure pursuits and some residents want more formalised plans of when their interests can take place. The information provided in assessments and care plans also require improvement to make sure that all of the residents social needs are taken into account and suitable arrangements are in place. The records about the administration of medication require improvement in certain areas to make sure that consistent and robust practises occur. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 9 The induction programme for newly appointed nursing staff would benefit from development in order that staff have a comprehensive introduction to the work of the service. Following a fire incident that resulted in a resident’s death the matter has been referred to the Coroner for consideration. In the interim the providers have reviewed the fire safety measures in place and taken steps to make sure that every reasonable effort has been made to safeguard residents, staff and visitors. Further improvements may be required in the light of any conclusions or recommendations the Coroner may make. 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 DS0000008937.V306768.R01.S.doc Version 5.2 Page 10 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 Outcomes Statutory Requirements Identified During the Inspection St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 2. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Each prospective resident is assessed to make sure the providers have a clear understanding of their needs and are able to provide the care and support required. EVIDENCE: The providers undertake an assessment on each prospective resident to make sure they are able to meet the needs of the person concerned. The prospective resident is fully involved in the assessment process in order that their needs, preferences and choices can be fully taken into account. In certain instances it is unclear who has completed the assessments and it is recommended that the assessor and wherever possible prospective resident sign and date the record. Residents that had recently moved to the care home said they had felt in control of events and had also been provided with appropriate information about the services and facilities provided. Relatives and representatives of the prospective residents are also invited to contribute to the assessment process. The providers also take account of the views and assessments of any professionals that are involved with the prospective resident at that time.
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 12 Prospective residents are also able to visit the care home and the visiting arrangements are flexible. Residents that have recently been admitted to the care home said they had felt in control of events during the assessment process and had been positively welcomed and helped to settle when they moved to the home. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The providers have improved the care planning arrangements and there are some good examples of care planning. The plans provide staff with clear information and guidance about the care and support required. The plans are regularly reviewed but in certain instances the records of the review are incomplete. Residents are able to have control of their lives and make decisions. Where appropriate suitable support advice and guidance is provided. Risks around the home or experienced by individual residents are managed in a satisfactory manner although in some instances the risk assessment or risk managements plans do not provide adequate detail or guidance for staff. EVIDENCE: Each resident has a care plan that is developed from the assessments that have been undertaken by the providers. The care plans detail the care and
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 14 support required and provide staff with the information, guidance and direction about services and facilities needed. The care plans are accessible to the staff and are written in a manner that promotes the resident’s independence and control over the events that occur. Residents said the care and support provided was of a good standard and they were generally satisfied about the contents of their care plan. Residents stated they were able to direct the care and support they received and clearly felt in control of their daily lives. Residents also commented they had confidence in the staff who they found to be reliable, efficient and responsive to their needs. It is clear the providers have continued to improve the care planning standards and the arrangements in place. In certain instances the information and direction to staff could be recorded more clearly to make sure they are provided with a comprehensive picture of each residents needs. The evidence indicates that care plans are regularly reviewed and residents confirmed they are regularly consulted about the care and support provided. Records are made of each review but on occasions do not detail any conclusions that have been reached or if any additional action is required to be taken by the staff. More comprehensive records will make sure that staff have a full picture of the residents needs. Some of the care plans also did not provide sufficient information about the residents social and leisure interest and how these were accommodated during each week. This area will be considered in more detail later in the report. It is clear that residents are able to make decisions about their lives and how they spend their time. The care plans confirm that residents are encouraged to maintain their independence as far as possible and are provided with appropriate support to make decisions where required. There are also no barriers to residents accessing independent advocates if they wish. The providers have also continued to develop and improve the arrangements to assess and manage risks around the care home and in respect of individual residents. A satisfactory assessment of the environment has been undertaken and where necessary guidance has been provide in order to promote a safe setting. The providers have also established a regular arrangement to review the environment risk assessments. Where any situation arises that could potentially compromise the health and safety of a resident an individual risk assessment is completed and a suitable management plan is put in place where necessary. This is also designed to protect the residents and staff.
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 15 In certain instances the directions given to staff were not sufficiently detailed or written in a clear manner. Improvement needs to occur to make sure that every reasonable step is taken to safeguard the residents and staff. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The daily living arrangements at the home are flexible and residents are able to determine their patterns of daily life. Good arrangements are also in place to support residents to maintain personal relationships at the care home and in the community. Residents are able to participate in a range of social and educational opportunities that are based upon their interests and choices. A number of residents are not satisfied with the range and frequency of the arrangements in place and wish to expand their opportunities. A balanced and nutritional diet is provided that meets with residents’ choice and preference. The kitchen facilities are in the process of refurbishment and when completed this will assist the staff to maintain a high quality service. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 17 EVIDENCE: Daily routines at the care home are flexible and residents are able to determine how they spend their time. There are also no restrictions to residents maintaining links with family or friends and this occurs at the care home and in the local community. Where visitors come to the care home the residents are also able to decide where they meet. Residents said that all visitors received a positive welcome. Residents are also able to decide upon how they spend their leisure time and this includes participation in educational opportunities. Residents’ interests are initially identified in their assessments but the information recorded tends to be a summary of interests. The care plans also tend to summarise the persons interests but do not always give guidance about the frequency or when a particular activity should take place. Some of the residents said they would like the arrangements to be more formalised while others commented that there is a lack of spontaneity in making decisions about their leisure time. Other residents said they were happy with the arrangements in place for the summer months but were concerned that no plans had been established for the autumn and winter. Other residents also stated they wish to improve and develop the opportunities available. This is an area that requires further consideration by the providers. The staff at the home will also accompany residents to participate in community activities but this can only occur within the resources available. Residents also have access to adapted transport, which they can use, for a nominal fee. The drivers’ have all been appropriately trained and the vehicles are kept in good working order. Residents stated they were very satisfied about the meals at the care home and a varied nutritional menu is in place that reflects the residents’ choice. Residents are provided with a choice at each mealtime and special diets are also catered for. The kitchen was in the process of refurbishment during the inspection and satisfactory temporary arrangements were in place to make sure there were no interruptions to the service. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Good arrangements are in place to provide personal support and meet resident’s health needs. Some improvements are necessary to make sure the arrangements to administer medicines safety are robust and safeguard residents. EVIDENCE: Residents said they were very satisfied with the care and support they receive from the staff. It is evident that positive and trusting relationships have been established between the staff and residents. Residents also said the staff were flexible, reliable and responsive to needs where required. The residents also stated they are treated in a respectful and dignified manner at all times. Residents’ health needs are also well met and medical services are promptly accessed when required. A qualified nurse is also on duty each day and night and other health professionals are in regular contact with residents. Where required the providers also assist residents to participate in physiotherapy and a specialist worker is employed on a part time basis.
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 19 Residents said they had confidence in the manner their health needs are met and there were no barriers to raising any issues or concerns with the staff or managers of the home. Residents are also able to administer their own prescribed medicines when it is safe. Staff also administers prescribed medicines where the residents requires assistance. The staff involved in administration of medication have all been appropriately trained and the providers have established a policy and procedure to guide, direct and inform the staff. It is recommended the policy is reviewed and developed so that comprehensive and robust arrangements are in place. The records are generally good and confirm that medicines are being administered according to the prescription. In one unit some of the records require improvement given there are occasions they are incomplete or inconsistent practices are being adopted. It is also recommended the procurement records are improved. Suitable arrangements are in place to dispose of unwanted medicines and medicines are stored securely. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 20 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 the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements for responding to residents concerns or complaints and to protect residents from abuse are positive. EVIDENCE: A suitable complaints policy and procedure is in place and residents are provided with a copy. Residents’ comments showed that people feel very comfortable about discussing any issues of concern with the managers or staff. Four complaints have been made over the last year and three were substantiated. All the complaints were dealt with efficiently and to the satisfaction of the complainant. A satisfactory policy and procedure is in place to protect residents and any concerns or allegations about abuse are reported to the statutory authorities for investigation. In addition a suitable whistle blowing policy and procedure has been established. This enables staff to report concerns to a third party if they do not feel in a position to report the matter to the providers. This provides residents with further protection. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 24 and 30. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The standard of the environment is high and a regular programme of redecoration and furniture and equipment replacement occurs. This provides residents with an attractive and homely place to live. EVIDENCE: The care home is a detached single storey facility that is maintained to a high standard. Wherever possible the fixtures and fittings and furniture are domestic in nature and therefore a homely atmosphere is provided. Residents describe the home as comfortable and had no significant concerns about their safety. There are accessible gardens around the care home and ample car parking facilities at the entrance to the home. One of the residents has also been instrumental in developing a sensory garden. Each unit is decorated in the preferred manner of the people who reside there and it is evident that residents have personalised their own bedrooms. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 22 Each of the units has its own communal space that comprises of a sitting room, dinning area and kitchen. In addition there are other communal rooms at the home that residents are able to utilise if they wish. Residents’ bedrooms are also furnished to a high standard and the resident is able to choose their own colour scheme. If they wish they can provide their own furniture, furnishings and fittings. In addition the rooms are set up to enable the occupant to maximise their independence. Many of the bedrooms have ensuite facilities and there are also a number of shared bathroom and toilet facilities distributed throughout the care home. A wide range of disability equipment is evident at the home and this includes hoists, specialist baths and mobility equipment. Where required each resident has a specialist assessment to determine the equipment or adaptations they require to met their needs and promote their independence. The home is clean and a good standard of hygiene is maintained on a daily basis. Residents said they were very satisfied with the facilities and equipment provided and the standard of cleanliness throughout the home. A regular programme of maintenance, replacement and redecoration is provided. The providers also employ maintenance staff who residents described as efficient and responsive to any repairs that are required. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 23 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 and 35. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. 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. Robust arrangements are also in place to recruit, select and vet staff and all new staff members complete an induction programme. Satisfactory arrangements are also in place to supervise and provide guidance and assistance to staff when required. 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. A registered nurse is on duty at all times and a reliable out of hours on call arrangement is in place for any emergency assistance required. Every unit has a manager who coordinates the care provided and named nurses assist the unit manager with their duties.
St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 24 The evidence indicates that minimum staffing levels are maintained and where any shortfalls occur additional staff are provided from the staff group or from an agency. Residents are very positive about the manner in which the staff undertake their duties and provide the care and support required. It is clearly evident the staff build and maintain positive relationships with residents and have a good understanding of residents support needs. It is also evident the kitchen and maintenance staff have the appropriate skills and abilities and provide a good service. The staff at the home said they were well supported by the managers and informal advice and guidance was readily available when this was required. In each unit the managers have established regular opportunities for staff to be formally supervised about their work and each staff member has an annual appraisal. Robust arrangements are in place to recruit, select and vet new staff and all staff newly appointed complete an induction programme. It is recommended the induction format for qualified nurses is developed to make sure the staff have a clear understanding of the roles and responsibilities of the post and the standards of practise required. A suitable programme of training is also in place for all staff and each staff member has an individual training programme for the year ahead. The training provided centres around core skills and professional qualification and many of the care staff are trained to NVQ 2 and NVQ 3 standard. Regular training assists staff to develop their skills and knowledge and has a positive impact on the quality of the care and support provided. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 25 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service is well managed by an experienced qualified nurse and satisfactory arrangements are in place to review the quality of the service and facilities provided. Records at the home have improved significantly but there continues to be instances where the records are not satisfactory. Further improvement is required to make sure that all the records required by regulation are in place. A wide range of suitable safe working practises are in place but the arrangements about fire safety need to be considered in the light of any recommendations or conclusions reached by the Coroner. This will make sure that every reasonable effort is made to safeguard residents, staff and visitors. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 26 EVIDENCE: It is evident the home is well run and well managed. The registered manager is a qualified nurse and has considerable experience of care provision. The registered manager is appropriately qualified and is working towards the Registered Managers Award. Staff and residents were positive about the manner in which the home is run and organised and commented they found the registered manager to be approachable and responsive to any concerns or suggestions they raise. The providers have established a range of methods to review the quality of the services and facilities provided each year. The arrangements include consulting with residents and staff, monthly reviews of the facilities and regular visits by staff that are not directly employed at the care home and this includes the monthly regulation 26 visits undertaken at the home. The indications are that residents and staff are very satisfied with the services and facilities provided. It is also clear that any suggestions or recommendations to improve the services or facilities are carefully considered by the providers and acted upon wherever possible. The record keeping arrangements at the home have continued to improve and generally now met the standard required. However there continues to be certain instances where further improvement could be made to make sure that comprehensive records are in place. This can be highlighted by the records about the administration of medicines given certain records are incomplete. Suitable policies and procedures are in place to promote safe working practises and provide a safe environment for residents and staff. The equipment and services at the home are also regularly serviced and maintained. Residents and staff said they were confidant that every reasonable effort was made to provide a healthy and safe environment. Sadly a resident died at the home earlier in the year in a fire related incident and this is a matter that is currently being considered by the Coroners Office. In the interim the providers Health and Safety Officer has reviewed the fire arrangements in place to make sure that every reasonable step is taken to safeguard residents, staff and visitors to the care home. There are no concerns regarding the financial viability of the home and an appropriate Insurance Policy is in place. The registration and Insurance certificates are publicly displayed in the reception area. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 27 St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 28 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 2 X St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement Care plan reviews must provide sufficient information to satisfactorily guide, inform and direct the staff. Where situations arise that could compromise the safety and well being of a resident a suitable action plan must be recorded that guides, directs and informs the staff. Social, recreational and leisure opportunities must be reviewed and developed for service users. The kitchen area, facilities and food storage areas must be improved to meet the required standard. Records regarding the administration of medicines must be complete. Records required by regulation must be completed to the appropriate standard. Every reasonable step must be taken to safeguard residents, staff and visitors against fire. Timescale for action 30/10/06 2. YA9 13 (4) (b-c) 30/09/06 3. 4. YA13 YA14 YA17 16(2) (m-n) 16(2)(g) 30/11/06 30/09/06 5. 6. 7. YA20 YA41 YA42 13(2) 17 Sch 3 24(4) (a-e) 30/09/06 30/10/06 30/09/06 St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA2 YA12 YA20 YA35 Good Practice Recommendations Assessments that are completed should be signed and dated by the member of staff undertaking the assessment and the service user wherever possible. The records about the activity programme chosen by services should be more detailed to reflect the current provision and include all the choices made. Comprehensive transcription and procurement records should be in place. A suitable induction programme for qualified nursing staff should be in place. St Teresas Cheshire Home DS0000008937.V306768.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection St Austell Office 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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