Inspection on 31/10/06 for St Teresa`s Home for the Elderly

This inspection was carried out on 31st October 2006.

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

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

Other inspections for this house

St Teresa`s Home for the Elderly 09/10/07

St Teresa`s Home for the Elderly 02/03/06

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

St Teresa`s Home for the Elderly 23/02/05

St Teresa`s Home for the Elderly 09/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE St Teresa`s Home for the Elderly 12 Lansdowne Road Wimbledon London SW20 8AN Lead Inspector Jon Fry Unannounced Inspection 31st October 2006 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Teresa`s Home for the Elderly Address 12 Lansdowne Road Wimbledon London SW20 8AN 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) 020 8879 7366 020 8879 1070 Patriciaheller@btinternet.com The Congregation of the Sisters of St Ann Mrs Loyola Maria Goodsell Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: St Teresa’s Home for the Elderly provides nursing and residential care for up to 28 residents. Accommodation is provided over three floors that are served by a passenger lift. The home is run by the Congregation of the Sisters of St Anne and is located in a residential area of Wimbledon. The current range of weekly fees are: £520 to £740 Nursing £442 to £654 Residential St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector who spent eight hours in the home over three separate visits. The inspector talked individually with nine people living at the home. A number of records were examined and discussions took place with the manager and three staff members. Completed surveys were received from six people who live at the home, ten relatives or friends of residents and five members of staff. What the service does well: What has improved since the last inspection? What they could do better: They could improve the information in care plans to make it more person centred. Care plans for social and emotional needs must be put in place for everybody living at the home. Concerns voiced to us by a number of residents about the availability of care staff must be taken seriously. Staffing numbers and how they are deployed needs to be kept under constant review. The frequency of supervision for care staff must be improved. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place if the home is confident that it can meet the assessed needs of the prospective resident. EVIDENCE: Residents who completed surveys all said that they received enough information about the home before they moved in. This helped them to decide if the home was the right place for them. One newer resident said that “there was a very helpful brochure and subsequent discussion”. Residents spoken to said that either they or their relative had chosen the home. An important factor for many individuals was the Mass held in the home’s own Chapel each day. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 9 We saw that assessments are completed before admissions take place. Once an individual comes to live at the home, a care plan is written based on these assessments. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual needs are generally met well by the home. There are opportunities to make the care more personalised to the individual. EVIDENCE: Residents spoken to all said that staff were polite and treated them with respect. Comments included “they are very good” and “all very polite and helpful”. We saw that each resident has a care plan which sets out how their needs are to be met and that this document is reviewed regularly. The plans could however be improved to contain more individual information and to better address social needs. One example was seen where a resident wanted to go out for walks but there were concerns about them getting lost if they went out on their own. We saw St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 11 that the home had taken action to make sure the resident was able to go out safely. The care plan for the resident did not however provide detailed guidance to staff who were clearly concerned about the issue. There were also no specific care plans in place for social and emotional needs. Health needs are being met. Residents who completed a survey all said that they received the medical support they need. One resident said that this support was “very good”. Issues around wound care at the home were identified by the CSCI when looking at some concerns raised about the home in July 2006. We found that wound care practice has improved at the home and a tissue viability nurse is also consulted to ensure this. Further recommendations have been made in this report to build on these improvements. Medication is managed well by the home. We saw that items of medication are securely stored and given to residents at the right time with full records kept. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s lifestyles generally match their expectations and preferences. There is scope to further improve and individualise the activities provided. The dietary needs of residents are very well catered for. EVIDENCE: The lunch looked and smelled good. A very appealing sweet trolley is offered to residents each lunchtime. Most residents spoken with said that they enjoy the food offered with comments including “very good”, “excellent” and “ok”. Two residents did say that they felt that the meals served in recent weeks were not of the same quality that they were used to. In completed surveys, two of the six residents said they ‘always’ liked the meals served. The other four individuals said ‘usually’. One person said “very good balanced and wholesome meals” and another resident said “I do not relish having sandwiches every evening”. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 13 More activities are now provided at the home. An activities organiser spends five hours there each week and we saw a bingo session being held in the main lounge. There is a weekly art group and regular visits by musicians to play for the residents. Trips out have been made to Richmond Park and Morden Hall Park. Comments from residents in surveys included “a good range of activities” and “a varied activities programme”. One resident said “there’s enough going on” and another person said “I’m not interested” but did confirm that they were still regularly asked to join in. Another person said “they would like to get out more” and a relative of a resident thought “outings could be increased in winter months”. One resident said that they would like “a better library” and this was discussed with the manager at the time of inspection. One staff member who completed a survey said that they felt strength of the home was “entertaining the residents”. Another staff member reported that recent changes to shift patterns had increased the amount of time staff could spend with residents but that they would still like “more time” to do this. As stated previously we saw that care plans could be improved to include more information about social and emotional needs. This could be used to tailor and further improve the activities on offer at the home. This is especially important for the residents who spend a lot of time in their bedrooms. Surveys received from relatives or friends of residents all said that they felt welcomed at the home when visiting. Feedback included “always a cheery welcome” and “always very friendly and helpful”. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse. Satisfactory procedures are in place for the management of complaints. EVIDENCE: We saw that the home has satisfactory procedures for responding to allegations of abuse and for managing any complaints made about the service provided. All six residents who completed surveys said that they knew how to make a complaint. The manager said that the home had not received any complaints from residents or their representatives since the March 2006 inspection. Separate issues concerning wound care and daily routines have been referred to the CSCI directly since the previous inspection. One concern was looked into by the home and we saw that changes were made to the daily routines at the home following this. The issue about wound care was investigated by a Safeguarding Adults investigation involving the Local Authority and the CSCI. The home responded in an open manner and we saw that the findings of the investigation had been used to improve practice at the home. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a comfortable and homely living environment. The premises are well maintained and kept to a good standard of cleanliness. EVIDENCE: Residents spoken to said “the home is very clean”, “my room is fine” and “very homely”. Five out of the six surveys received from residents said the home is ‘always’ fresh and clean. One person said ‘usually’. We saw that the home was clean and hygienic during this inspection. The communal areas provide a comfortable and well-maintained living environment for residents. Bedrooms are individualised to resident’s preferences. Residents are able to bring personal items, including furniture, St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 16 with them on admission and are able to have a private telephone line should they wish. One disadvantage with the home environment is the layout of the upper floors. This seems to contribute to residents sometimes feeling isolated in their rooms as they cannot easily see or hear carers on the same floor. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are adequate numbers of staff on duty with the right skills and knowledge to meet resident’s needs. Staffing levels and how they are deployed needs to be kept under review. EVIDENCE: Feedback about the way the staff carried out their duties was very positive. Residents said “they are nice kind people”, “the ethos is excellent”, “kind”, “very good” and “they do their best for everybody”. Relatives and friends of residents said “very caring” and “staff make a caring fuss of my relative – she appears to be loved”. We saw that staff interacted well with residents and these relationships appear very positive. There was however mixed feedback about the availability of staff. Five residents who filled in surveys said that staff were ‘usually’ available when needed. One other individual responded ‘always’. Comments from residents included “understandably the staff are very busy”, “we could do with a few more staff” and “they do their best but it’s too busy”. Other residents said “I feel sorry for them” and “enough staff around – especially downstairs”. A St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 18 relative of a resident commented that it was sometimes “difficult” to find staff particularly “between 3 and 5.30pm”. As stated previously, the layout of the home seems to contribute to the impression that there are less staff around. It is however strongly recommended that the home keeps the staffing under review and continues to talk with residents about this issue. We looked at the recruitment records for three members of staff and these contained all the necessary checks including Criminal Records Bureau (CRB) checks. Staff spoken to reported that they received the training they needs to do their jobs. Recent courses have included wound care, dementia and epilepsy. Two newer staff confirmed that they had received an induction as well as training in manual handling and Fire Safety. It is recommended that the home keeps individual records of training and updates these at each supervision. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is safe, well managed and run in their best interests. EVIDENCE: “The home is extremely well run”, “the leadership by senior staff is excellent” and “they have encouraged interaction with us” were comments received from residents and their representatives about the management of the home Feedback from care staff was positive about the support they received from the home. Comments included “very supportive” and “the management St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 20 follows up the concerns of residents and staff”. Both managers of the home are studying for the NVQ level Four qualification. Care staff have supervision with their line manager that helps them to develop their own practice. The frequency of these 1-1 meetings needs to be increased to make sure that each individual staff member receives this at least six times per year. The records we looked at did not show that this was happening yet. Health and Safety records are well maintained by the maintenance person. One resident commented that “the maintenance manager is liked by all – always willing and cheerful”. The home must make sure that records are kept for monthly checks of First Aid boxes as this is not happening consistently according to records seen. A risk assessment of the premises for Legionella was being carried out at the time of this inspection. Residents meetings are held quarterly. We saw that residents are asked about the way the home is run and the quality of care provided. Letters of compliment are displayed in the communal areas of the home and feedback from relatives and friends in completed surveys was all very positive about the home. St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) Requirement The Registered Persons must ensure that the care plan for each resident contains detailed and individualised information about how their care needs are to be met. The care plans must address how social and emotional needs are to be met. 2. OP36 18 (2) The Registered Persons must ensure that all care staff have supervision with their line manager at least six times annually with full records kept. The Registered Persons must ensure that: monthly checks are undertaken of the contents of First Aid boxes with full records kept. a risk assessment of the premises is completed by a suitably qualified person with regard to Legionella. 01/03/07 Timescale for action 01/03/07 3. OP38 13 (4) 01/03/07 St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations It is recommended that the systems for care planning be developed to make sure that good quality ‘person centred’ information is recorded. The care plans should better reflect the person - their preferences and life experiences. It is recommended that the wound care documentation for individuals be kept in one place. A clear up to date plan of care needs to be specified for each wound at the front of the document. Wound sizes should be recorded at the frequency specified in the plan of care. 3. OP27 It is strongly recommended that the staffing levels and their deployment within the home be kept under review. Residents need to be regularly consulted about this issue. The provision of dementia and person centred care training for care staff should be considered. 2. OP9 4. OP30 St Teresa`s Home for the Elderly DS0000019128.V317434.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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