CARE HOMES FOR OLDER PEOPLE
St Thomas Rest Home Belgrave Terrace South Shields Tyne and Wear NE33 2PX Lead Inspector
Mrs P A Worley Announced 22 June 2005 9:00am 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 Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service St Thomas Rest Home Address Belgrave Terrace South Shields Tyne and Wear NE33 2PX 0191 454 6662 0191 454 6662 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) Mr Khalid Hamodi Care Home only 28 Category(ies) of OP Old age (27) registration, with number PD Physical disability (1) of places St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8/12/2004 Brief Description of the Service: St Thomas Complex comprises of two large converted houses linked by a long winding corridor, although at the present time temporary access between buildings is for staff only as it is assessed as too steep for residents to use safely. Access into the Home is available at either building and passenger lifts are avilable within the Home for access to the first floor. The Home is located on the outskirts of the town centre, close to the park and sea front. There are many community amenities in close proximity including shops, churches, park and medical centres, and a frequent bus service is available outside the Home. The Home provides personal care for up to 28 older people and has an identified bedroom for service users requiring respite care. The Home does not provide nursing care. The Home is currently undergoing major building work to extend and upgrade the facilities and services. Appropriate arrangements have been made that comply with Fire Regulations and Environmental Health requirements during this development. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and carried out by one Inspector over one day, at a time agreed with the Acting Manager. Before the inspection a questionnaire had been completed by the Acting Manager, which gave up to date information about the Home to allow more time to be spent with residents on the day. A tour around the home to check the cleanliness, health and safety matters, and maintenance and decoration was carried out. The Inspector spoke with all the residents, two visiting relatives, and seven staff including the cook, and the Acting Manager. The Inspector also had lunch with some residents in one of the two dining rooms. A number of records and documents were examined including residents’ care plans. An action plan had been received from the Provider following the last inspection and all but two of the requirements from that inspection have been dealt with. What the service does well:
The Home had a very welcoming and friendly atmosphere, which residents and visiting relatives informed the Inspector, was always the case. All visitors to the home were made welcome and treated with courtesy and respect by the staff. The majority of staff employed have worked at the home for a considerable time and provide consistency and continuity of care to the residents. Residents and visiting relatives spoke well of the staff and one said “you wouldn’t find a better place and the staff are wonderful”. The meals are ‘home style’ cooking and said by residents to be ‘always good’. Work continues on the building extension to the Home. Satisfactory and acceptable arrangements have been made to make sure that the disruption to
St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 6 the daily lives of residents is kept to a minimum. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 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 Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 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 and 4. Appropriate assessments are carried out prior to residents moving into, and following admission to the Home, to ensure that their needs are met. EVIDENCE: Examination of resident’s records and discussion with the Acting Manager indicated that prior to admission to the Home prospective residents had an assessment carried out by the Care Managers and a pre-admission assessment by the Home staff. Following admission a further assessment is carried out. A number of residents in the Home stated that their needs were being met to their satisfaction and activities that could be observed throughout the day indicated that they were. One resident in particular, also his relative, stated that it was because this home was able to accommodate his needs and wishes to continue going out to maintain his independence, that he moved in. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 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 and 10. Each resident has an individual plan of care that sets out their health, personal and social needs and care. The records show improvements since the last inspection but insufficient information is documented. Residents appeared well and spoke of staff meeting their health care needs. Staff demonstrated respect for residents and upheld their privacy and dignity. EVIDENCE: Conversations with the Manager and staff indicated that residents’ healthcare needs where identified were known by them, monitored and met. A good effort has been made by the Acting Manager to improve the documentation format of residents care plans and a good level of basic information is recorded including input by GP’s and other relevant professionals. However, further amendments and developments are necessary and discussion took place regarding this, with some advice and suggestions given to assist with the process. Residents who were spoken with described how their health care needs were met and of access to healthcare services when they required them.
St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 10 Residents gave some examples of how staff were respectful and maintained their privacy and dignity. Some made such comments as “staff always knock on my door before coming in” and “the staff treat me kindly”. Staff interactions with residents and visiting relatives were seen to be friendly, courteous and respectful. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 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) 15. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices, as well as their dietary needs, and in a pleasant environment. EVIDENCE: At the present time the dining arrangements that are in place offer temporary dining room facilities, one at each end of the Home. The arrangements are well managed by the staff with minimal inconvenience to residents. The Inspector joined residents in one of the two temporary dining rooms, for lunch. The tables were very pleasantly set with condiments, serviettes, sugar, milk jugs and a teapot on the tables. Cold drinks were offered during the meal and the meal was well presented with vegetables served in tureens and gravy in gravy boats. Alternative choices were served to those people who requested them. Residents confirmed that such facilities and choices were offered on a daily basis. Staff were attentive and offered assistance to those who needed it, in a discreet, courteous and unhurried manner. The environment and the atmosphere were sociable and pleasant. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 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) 18. The Home has satisfactory arrangements in place to protect vulnerable adults from abuse. EVIDENCE: The Home has a Protection of Vulnerable Adults Procedure (POVA) in place and a copy of the Local Authority’s Procedural Framework for the Protection of Vulnerable Adults, is available to staff. Staff who were spoken with confirmed that they had received POVA training and were able to satisfactorily describe what actions and procedures should be taken on suspicion of abuse or if abuse was seen to take place. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 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, 21, 22, 25 and 26. Residents live in a safe, clean, well-maintained home that is comfortable and pleasant. Sufficient and appropriate facilities are provided to suit their needs. EVIDENCE: A selection of bedrooms was viewed, also the communal areas including bathrooms and toilets. Matters that required attention from the last inspection have been addressed i.e. the flooring in one bathroom has been repaired and made safe, and the water temperatures were recorded at satisfactory levels and were consistent. The Home was clean and generally well maintained with some areas within the existing buildings needing some upgrading and decoration. The Proprietor stated that this would be dealt with as part of the total refurbishment programme when the extension building was completed. During a tour of the building and in discussions with residents it was observed that new windows has been fitted into the lounge of the ‘Belgrave’ end house.
St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 14 Whilst this was an improvement and would fall in line with the overall refurbishment of the Home, the works programme to do this had not been made known to the CSCI through the Regulation 37 reporting process, as a potential adverse affect on residents. It was made known to the Inspector by the residents however, that the procedure took only one day and residents were happy to spend the day in the ‘Beach Road ’ end of the house, in order to achieve the improvement. Appropriate and adequate facilities are provided in bathrooms and in the Home generally to allow residents to maintain or maximise their independence, such as bath hoists, a mobile hoist, grab rails and call system facilities. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 15 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. The numbers, skill mix and competence of the staff in the Home enables residents needs to be met. EVIDENCE: Discussion with the Acting Manager and inspection of staffing rotas confirmed that sufficient staff were provided to cater for, and meet the needs of the residents. However, on occasions there were only three staff provided at night and this is considered potentially unsafe particularly at present when staff are working between two buildings. The Acting Manager gave assurance that a minimum of two staff in each building would be provided. The staff training programme indicates that staff are provided with appropriate training to enable them to carry out their work competently and safely. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 16 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) 31, 36 and 38. There is currently good leadership and support provided by the Acting Manager and support from the Provider enhances this. This has ensured that staff receive appropriate direction and supervision and residents health and safety is promoted and protected. EVIDENCE: There is currently no permanent manager in post and the Provider is actively trying to recruit a suitable person. The Acting Manager however, is providing a good level of support and leadership to the staff at present. A number of staff indicated that they felt supported by her and could approach her comfortably with any issues regarding the Home. She has considerable experience of the Home and of working at a senior level, although is not qualified in management. The staff and residents spoke very highly of the way in which she has managed the Home in the absence of a permanent manager.
St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 17 She has introduced a formal system of supervision for staff, which previously was not in place and staff confirmed the benefits of this arrangement, which offered them support and guidance in their work. Staff practices concerning health and safety were generally satisfactory but discussion took place regarding the need for risk assessments where fire doors need to be held open for operational purposes or to enable residents to remain independent. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 18 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 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 3 3 x x 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 2 x x x x 3 x 2 St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 19 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. Standard 19 Regulation 37 Timescale for action The Commission must be With informed of any event that may Immediate adversley affect the well being or Effect safety of service users. The Home must ensure that With appropriate numbers of staff are Immediate provided at all times to meet the Effect needs of service users. The Provider must pursue the 1st October recruitment of a permanaent 2005 manager to be registered with the Commission. Staff must ensure that fire With safety is mainatained at all Immediate times, within a risk assessment Effect framework. Requirement 2. 27 18 3. 31 8 4. 38 23(4)(d) 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 7 Good Practice Recommendations Further development of residents care plan records should continue. St Thomas Rest Home B52 B02 S241 St Thomas V214089 21 Jun 2005 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shield NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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