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Inspection on 11/07/05 for St Teresa`s Home for the Elderly

Also see our care home review for St Teresa`s Home for the Elderly for more information

This inspection was carried out on 11th July 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

St Teresa`s provides a homely environment for residents. One resident commented that they were satisfied with the accommodation and care given. The staff of the home treat all residents as individuals and with respect. The accommodation is comfortable and residents are able to personalise their rooms. Appropriate and varied activities are provided for residents to participate in if they wish.

What has improved since the last inspection?

Requirements from the previous inspection relating to Criminal Records Checks and records relating to wound care have not been met, and therefore these requirements have been carried forward with new timescales.

What the care home could do better:

Residents` assessments and care plans must reflect involvement of the resident/representative, to evidence that they are involved in the process. Daily records must indicate what care has been given to a residents to demonstrate that care needs are being met. Residents` wishes on death and dying were not consistently recorded. Hot water temperatures must be monitored closely, to ensure that there is no risk to residents from scalding. Policies and procedures relating to employment must be reviewed to ensure equal opportunities when recruiting staff.

CARE HOMES FOR OLDER PEOPLE St Teresas St Teresas Home for The Elderly 12 Lansdowne Road Wimbledon London SW20 8AN Lead Inspector Janet Pitt Unannounced 11 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Teresas Address St Teresas Home For The Elderly 12 Lansdowne Road Wimbledon London SW20 8AN 020 8879 7366 020 8879 1070 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) The Congrefation of the Sisters of St Annn Loyola Goodsell Care home with nursing (N) 28 Category(ies) of Old age, not falling under any other category registration, with number (OP) of places St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2005 Brief Description of the Service: St Teresas Home for the Elderly is registered to provide residential care for eleven people and nursing care for seventeen people. Accomodation is provided over three floors which are served by a passenger lift . There are three lounges, a dining room and two offices. The home has adequate numbers of toilet and bathing facilties. All rooms are single apart from five. The residents have access to a garden to the side and rear of the home. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken unannounced by one inspector. The inspection commenced at 11:50am and concluded at 3:30pm. During the course of the inspection, care documentation was examined. The inspector spoke with one relative, three members of staff and two residents. A tour of the premises was undertaken. Staff files were examined. What the service does well: What has improved since the last inspection? What they could do better: Residents’ assessments and care plans must reflect involvement of the resident/representative, to evidence that they are involved in the process. Daily records must indicate what care has been given to a residents to demonstrate that care needs are being met. Residents’ wishes on death and dying were not consistently recorded. Hot water temperatures must be monitored closely, to ensure that there is no risk to residents from scalding. Policies and procedures relating to employment must be reviewed to ensure equal opportunities when recruiting staff. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 6 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 G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5 Appropriate assessments are carried out prior to a resident moving into the home; this ensures that the home is able to determine whether it will be able to meet the care needs of the resident. EVIDENCE: Assessments are undertaken on admission and five assessments examined contained relevant information on health, social and other needs. There were also details of family/friends involvement in the process, but this was not consistent. However assessments lacked information on sexuality needs of residents, which indicates that this area is not considered an important part of residents needs. Hobbies and interests were documented well and religious needs were also noted. The manager explained that prospective residents are able to visit the home if they are able and she will always visit a prospective resident to assess them. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 and 11 Inaccurate recording of care given fails to ensure that there is evidence that all care needs are being met. There should be consistent involvement of the resident/representative in the process. EVIDENCE: Residents care plans were noted to lead from assessments. However wound care was not always documented accurately and did not give details of if healing had occurred. This places residents at risk of not receiving appropriate treatment. Waterlow pressure risk assessments were noted to be completed on admission, but not routinely reviewed, which places residents at risk. Some care plans were observed to contain good information on how care needs were to be met. All care plans were noted to be reviewed monthly, with changes noted, which indicates that residents are reassessed at appropriate intervals. Daily records require improvement to reflect the care given. Phrases such as ‘all care given’ must not be used, as this does not detail the actual care given and provide information on the condition of the resident. Wound care was not consistently recorded, when a dressing was changed. There was a lack of resident/representative involvement in the care plans. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 10 Residents’ wishes relating to death and dying had not been consistently recorded, but religious needs were noted in the five care plans examined. The home has a Roman Catholic chapel, and the manager said that all residents are able to participate in services and a Church of England Minister visits the home. Residents were observed to be treated with respect and staff knocked on doors prior to entering. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Residents are enabled to enjoy meals in pleasant surroundings and have a variety of activities, which they can choose to participate in, thus enabling them to lead a fulfilling life. EVIDENCE: Residents are able to participate in appropriate activities, which ensures that their social needs are met. One relative spoken with praised the home and said it provided ‘a homely environment’, the relative continued to state that they had high regard for the staff and the care provided and they were always made to feel welcome when they visited. Activities provided included a Chapel service daily, outings every two weeks and Pet therapy dogs visiting the home. Residents are able to enjoy meals in pleasant surroundings and are able to choose what they want to eat. Lunch was observed being served, this was done in an unhurried manner and the tables were attractively set, with fresh flowers and linen napkins. There was a choice of beverages and orders for the main meal were taken the day before. Special diets can be catered for and there were sufficient staff to offer assistance to those residents who required it. Residents are able to take their meals in their rooms if they wish. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents and their representatives can be confident that complaints will be listened to, but the home needs to ensure that information of the correct regulatory authority is available within the complaints procedure. Residents are protected from abuse by clear guidance, being available to staff. EVIDENCE: Examination of the complaints record indicated that there have been no complaints since the previous inspection. This indicates that residents are satisfied with the service received. The complaint policy requires updating to ensure that it contains details of the correct regulatory authority. Adult Protection Policies were noted to be consistent with the requirements of the Standard, which means that there are clear procedures to be followed in the event of an investigation. There have been no Adult Protection investigations since the previous inspection. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24,25 and 26 The standard of the environment is good, providing residents with a clean tidy place to live. EVIDENCE: Residents live in a home, which is clean and tidy and furnished according to their needs. The environment is well maintained. Residents’ rooms were observed to be personalised and residents’ are encouraged to bring small items of furniture in. The majority of rooms were single. There were adequate bathing and toilet facilities situated near to residents’ rooms. There is a garden, which has a marquee for garden parties and other events. There is a kitchenette on each floor for the provision of snacks and drinks. Residents are able to have their own telephone if they choose. The lounge and dining areas were noted to be comfortable. The home was clean and tidy on the day of inspection. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Residents are supported by sufficient numbers of staff, ensuring that their care needs can be met. However, recruitment procedures need to be followed correctly to ensure that residents are not placed at risk. EVIDENCE: There are sufficient staff to enable residents care needs to be met. The duty rota indicated that there is an appropriate skill mix available day and night and adequate numbers of staff available. Staff files examined indicated that there was a clear recruitment process in place, but this was not supported by the Equal Opportunities Policy and Recruitment and Retention Policy, which both require updating to be consistent with employment law. The application form requires updating to allow for previous cautions to be declared, in line with Criminal Records Bureau Disclosures. Criminal Records Bureau Disclosures must be obtained via the home and the home should not rely on other services checks, to ensure that residents are protected from harm. Only one of the disclosures on the current staff members was undertaken via the home. One of the two staff files examined included a recent photograph of the employee. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health, safety and welfare of residents is promoted and protected, apart from the monitoring of hot water temperatures in baths, showers and sinks. This places residents at risk of harm. EVIDENCE: Residents’ health and safety is protected by monitoring procedures within the home, apart from checking of hot water temperatures. Daily fire risk assessments are carried out and there is a weekly fire alarm test, which is recorded. Equipment used in the home is routinely serviced and maintained. Hot water temperatures of sinks were recorded as being above fifty degrees centigrade, which places residents at risk of scalding. An immediate requirement was issued on the day of inspection to monitor water temperatures weekly and supervise residents when they are using hot water at sinks. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 16 Weekly temperature recording of hot water in baths and showers is not consistently undertaken. This must be done to ensure that residents are not placed at risk of harm. Consideration should be given to installing thermostatic mixer valves in sinks, to enable residents to use sinks safely. Water temperatures in bathing facilities were noted to be within safe limits and were controlled by thermostatic mixer valves. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 18 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 3 3 Regulation 14 (1) (a) 14 (1) (c) Requirement The registered person must ensure that assessments of residents are fully completed. The registered person must ensure that residents/representatives are involved in the assessment process. The registered person must ensure that daily records reflect the care given. The registered person must ensure that residents/representatives are involved in the care planning process. The registered person must ensure that clear records are maintained of wound dressing changes and changes in wounds recorded. (previous timescale of 07/04/05 not met) The registered person must ensure that Waterlow pressure risk assessments are routinely reviewed monthly. The registered person must ensure that residents wishes on death and dying are documented. The registered person must Timescale for action 30th October 2005 30th October 2005 30th October 2005 30th October 2005 30th October 2005 3. 4. 7 7 15 & 17 (1) (a) 15 (2) (c) 5. 8 Schedule 3 (3) (k) 6. 8 13 (4) (c) 30th October 2005 30th October 2005 Immediate Page 19 7. 11 12 (1) (a) 8. 38 13 (4) (a) St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 9. 25 13 (4) (a) 10. 29 19 (1) (b) and Schedule 2 (7) Schedule 2 (1) 10 (1) 11. 29 12. 29 13. 29 10 (1) ensure that hot water temperatures of sinks are monitored weekly. Subject of an immediate requirement. The registered person must ensure that residents are supervised when using hot water at sinks. The registered person must ensure that staff files contain a Criminal Records Bureau check completed by the home. (previous timescale of 07/04/05 not met). The registered person must ensure that staff files contain a recent photograph of the employee. The registered person must ensure that the Equal Opportunites Poicy and the recruitment and Retention policy are consistent with Employment law. The registered person must ensure that application forms request details of previous cautions. 30th September 2005 30th September 2005 30th October 2005 30th October 2005 30th October 2005 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 25 Good Practice Recommendations It is recommended that consideration is given to installing thermostatic mixer valves at sinks. St Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Teresas G54-G04 S19128 St Teresas V230950 110905 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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