Inspection on 28/05/08 for St Vincent House

This inspection was carried out on 28th May 2008.

CSCI found this care home to be providing an Adequate service.

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 Vincent House 11/07/06

St Vincent House 13/02/06

St Vincent House 21/07/05

St Vincent House 25/01/05

St Vincent House 07/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Vincent House Forton Road Gosport Hampshire PO12 4TH Lead Inspector Jan Everitt Unannounced Inspection 28th May 2008 09:30 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 Vincent House DS0000011868.V363737.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 Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Vincent House Address Forton Road Gosport Hampshire PO12 4TH 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) 023 9235 1668 debbie-stvch@tiscali.co.uk St Vincent Care Homes Ltd Mrs L Lawrence Care Home 34 Category(ies) of Dementia (13), Dementia - over 65 years of age registration, with number (26), Old age, not falling within any other of places category (34), Physical disability (16), Physical disability over 65 years of age (16) St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the categories DE and PD must be at least 55 years of age 11th July 2006 Date of last inspection Brief Description of the Service: St Vincents House is a large well maintained detached house set in its own grounds; the house is a grade II listed building and has a large enclosed rear garden. There is parking at the front of the building. The home is registered with the Commission for Social Care Inspection (CSCI) to provide residential care for up to 34 older people 26 of which may be suffering from age related mental health problems. There are 22 single rooms and 6 double rooms and the house is situated on the main road into the town centre of Gosport and is close to local amenities. Currently fees are between £415 and £540 per week. These fees include all activities and entertainment and the aromatherapy service. These fees do not include hairdressing, chiropody, other than diabetic service users, daily papers and other personal items. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The unannounced, inspection visit to St Vincent House, took place over a oneday period on the 28th May 2008. The registered manager was not available until later in the day and the senior carer assisted us throughout the visit until the manager attended the home. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager and provider had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI within the stated timescales and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit of 11th July 2006. Documents and records were examined and staff’s working practices were observed. We looked around the building. Due to a number of the residents having a diagnosis of dementia verbal feedback was sometimes difficult to establish. However feedback was gained verbally from service users and from observations and non-verbal communication. Those spoken to were generally complimentary about the their home and the care they receive. One visiting relative was also spoken with. Surveys had been distributed to service users, relatives, care managers, GP and other visiting professionals. Three service user surveys, ten staff, one GP, four visiting professional and two care manager surveys were returned to the CSCI. The outcome of the surveys indicated that there was generally a high level of satisfaction with the service and that people were pleased with the care the home provides. There were thirty four residents living in the home. None were from any other ethnic group and one service user whose faith is other then a Christian denomination. What the service does well: The home is clean, comfortable and homely and service users say they are happy living in the home. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 6 The garden is pleasant with sitting areas in shaded parts. The activities programme is varied and service users say they enjoy participating in them. There are lots of activities going on’. There is always an activity arranged for us’. ‘Regular craft sessions, sometimes musical entertainers although my mother is beyond taking advantage of this’. Staff are respectful and kind and were observed to be sensitive to those who were more mentally fragile. Service users and relatives told us: ‘The staff are very caring and they do listen to what I ask them’. ‘I do receive the support I need’. ‘I truly cannot fault St. Vincent and never have any doubt about mother’s care in my absence’. ‘’Carers are cheerful and smile when you enter the home’. ‘They let clients wander and the home is kept safe to allow them to do so’. ‘The staff are warm and affectionate and my privacy is respected and carers have personal knowledge of every resident’. Comment from a health professional said: ‘I have a patient who is alive many years longer that I thought she would ever be simply because of good care’. Staffing levels meet the needs of service users. Training is provided in the home and all staff have achieved a National Vocational Qualification (N.V.Q.) Level 2. Service users spoke of their enjoyment of the meals and commented: ‘The food is always presented well and a good selection’. ‘The meals are usually good’. ‘There are always choices and most importantly a record of what actually is eaten is recorded in the resident’s records. What has improved since the last inspection? The home has put in place a mesh cover over the grills that cover the basement void and this has eliminated a safety risk to service users. The gas servicing has been certificated and is current. New safety flooring has been put down in some of the communal areas. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 7 A redecoration programme is in place for refurbishment and renewal of bedrooms. The programme includes the replacement of old beds for hospital type beds, some of which have been purchased since the last inspection. The home now has two sittings at mealtimes as suggested on questionnaires that had been distributed and this has provided a better service for residents. What they could do better: Safe procedures for the management of service users daily medication must be followed. The manager should review staff training in the safe management of medication. The controlled drugs register must reflect the balances of the drugs remaining in the home. A fridge for the storage of medication should be purchased. The home should obtain a copy of the Royal Pharmaceutical Society guidelines for the management of medicines in care settings. Basement rooms could have a brighter outlook if brick walls were painted white and pot plants adorn the walls. The room on the ground floor, that was identified as being dark and the need for artificial lights to be on at all times, must have the undergrowth and foliage cleared from outside of the window to allow more natural light into the room for the well-being of the service user. Staff supervision and appraisal must be organised. This was a requirement from the previous report and is a repeated requirement from the findings of this visit. The registered person must ensure that prompt action is taken to meet this requirement. The fire alarm and fire systems must be tested at the stated intervals and records maintained in fire log of when these take place. The staff must be reminded of the fire procedures when the fire alarm sounds, even if they are aware of it being a false alarm. Cleaning routines of the kitchen and equipment must be maintained and records of this must be kept. All personal toiletries must be returned to the service user’s bedrooms and not left in the bathrooms. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 8 A staff training matrix should be created to identify staff training and training needs. 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 Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 9 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 Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 10 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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential service users have their needs assessed prior to moving into the home and this enable the home and the service users to see if the home can meet their needs. EVIDENCE: We viewed a sample of five care plans. The manager and/or her deputy undertake an individual needs assessment prior to service users moving into the home Pre-admission assessments were in the care plans and the information gathered would allow the home sufficient information to judge whether the home could meet that person’s needs. The manager told us that the information gathered is gained from the service user, relatives or if the service user is in hospital, from the records at the St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 11 hospital. Social services also carry out assessment of needs for any service user who is funded by the local authority and share this information with the home. A survey returned by a care manager said: ‘The home always visits the client prior to admission and meet with their relatives’. The majority of service users were unable to remember their admission to the home but those spoken to said they had been involved in the choice of home and this was supported by surveys returned by service users/relative that indicated, in most cases relatives were involved in choosing the home for the resident. Intermediate care is not provided by the home. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 12 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, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service have their health, personal and social care needs assessed which are reflected in an individual personal plan. However the home must ensure personal plans are developed as soon as possible after the person moves in, in order to provide a consistency of care and care plans are reviewed at regular intervals. Service users are not fully protected by the home policies and procedures for dealing with medicines. Procedures are not being followed and this could be detrimental to service users. Service users at the home are treated with dignity and respect and their right to privacy is upheld. EVIDENCE: We viewed a sample of five care plans. One of these being the most recently admitted service user. It was observed that although a pre-admission St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 13 assessment had been carried out there were no care plans written and the person had been a resident for one week. The care planning system is comprehensive and covers all aspects of care. Care plans identified a brief potted social history of the service user and also stated their preferences, likes and choices. One care plan was observed to state the preferred gender of the carer the service user wished to have care for them. Risk assessments were also recorded and risks being identified as “high, medium or low”. Risk assessments were seen for falls and another for a resident who wished to go out of the home. There were no forms of restraint being used at the time of this visit. The assessments were observed to be signed by the service user as evidence of their participation and agreement. Daily notes were documented in detail, but there was also a great deal of information in the ‘staff handover diary’ which contained the working routines of staff for the day, and information about service users that should have been contained in the care plans. The care planning system contained information about the visiting medical professionals and the outcome of any visit. A communication sheet in care plans recorded all communication with family/representative. Service users spoken with at the time of this visit commented that they were very happy living in the home and surveys returned to the CSCI by service users and relatives say; ‘The staff are very caring they do listen to what is asked of them’. ‘The staff are warm and affectionate and my privacy is respected and carers have personal knowledge of every resident’. Comment from a health professional said: ‘I have a patient who is alive many years longer that I thought she would ever be simply because of good care’. There was evidence in the care plans that the primary care team visit the home if requested. Service users are registered with a number of GP’s and are able to keep their own GP if possible and this benefits service users. Dental checks are arranged through a local health centre, although some service users have their own dentist in the local area. Gosport War Memorial Hospital is able to provide hearing tests and foot care with GP referral if treatment is required. A visiting optician service provides eye care and the home has a visiting chiropodist who calls once per month. A senior carer from the home is the co-ordinator for the continence equipment and supplies and she showed us the records she maintains for reviewing the continence assessments for service users who receive this service. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 14 There were records in the care plans of the community psychiatric nurse visiting the home to review some residents. A comment from a visiting professional said: ‘St Vincent and its team use their initiative by deciding if medical care is required and call for it.’ The home has a blister pack system in place for the administration of service users medication. The home has medication policies and procedures in place. The practices in the home are not good. We observed medication being administered from the blister packs to service users and MAR sheets being signed on mass at the end of the medication round. This was discussed with the senior carer observed doing this. She acknowledged this was not the stated procedure, but the home does not have a medicine trolley, because of the lack of room, so the file of blister packs are taken out to the service users and just administered through familiarity rather than using the MAR sheets for guidance, and MAR sheets are then signed in the office afterwards. This was discussed with the manager who said that she has requested a medicine trolley and she also acknowledged this an unacceptable practice. The controlled drugs register was viewed. The AQAA stated that the procedure for dealing with controlled drugs had been updated in the last year. The controlled drug registered was not recorded as per policy and procedure. The records demonstrated that there was not consistently two signatures recorded when any CD had been administered. The records also showed balances of drugs for residents who were no longer living in the home, and whose medication had been returned to pharmacy. Records of the medication returned are maintained. Medication that needed to be stored at stipulated temperatures was being stored in the domestic fridge in a separate box in the kitchen. This was seen as unsatisfactory and was discussed with the manager. She said that she has requested a medication fridge for storage, and that she is bringing one in from home that she no longer needs. We recommended to the manager to download from the Internet the guidance on the management of medicines in a care setting, issued by the Royal Pharmaceutical Society. Staff say they have received medication training, but this may highlight a need for further training or re-education in the management of medicines. The interaction between the staff and service users was observed to be good and staff were obviously very familiar with the residents routines of the day and were demonstrating respect and being courteous towards them. Staff St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 15 were seen to use service users preferred form of address when talking to them. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a range of activities for service users, which meets their expectations and meets their religious and recreational needs. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives and are provided with a wholesome and balanced diet in pleasant surroundings at a time convenient to them EVIDENCE: The home does have an activities programme. The activities provided include musical movement, games, scrabble, trips out. The craft lady visits the home three times a week and the service users, who were able to communicate, told us they do enjoy this. There was evidence displayed around the home of the crafts they had work recently. The residents also are offered the opportunity of having reflexology or a massage from a trained therapist who visits the home, which is reported to be well received. The home does record a short social history of each service user. There was no evidence that the social activities are tailored around the individuals’ need of specific mental St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 17 stimulation, however, the activities provided are well attended and from work displayed around the home, has good outcomes for the service users. The home has an activities file, which gives details of what activities have been provided and who took part. Service users spoken to were happy with the activities provided. Comments noted on the surveys from service users say: ‘There are lots of activities going on’. There is always an activity arranged for us’. ‘Regular craft sessions, sometimes musical entertainers although my mother is beyond taking advantage of this’. The home has a visiting policy and there are no restrictions on visitors. Service users can see their relatives in the privacy of their rooms or there are pleasant sitting communal areas. The visitor’s book demonstrated that the home does have daily visitors. One visiting relative told us they are always made most welcome to the home. Other visitors to the home include outside entertainers such as musicians, and one even brings his dog, which we were told, the service users thoroughly enjoy. The local clergy also visit the home regularly and one person has communion in their room. Service users go out with their relatives on outings and coach trips are arranged if possible. On the day of this visit, the outing had been cancelled because the bus was no longer available. This had disappointed one or two service users who chose to mentioned this to us. The service user’s assessment documents the service users preferences about food and how they like to undertake the activities of their daily living. It was observed that service users were able to wander about the home as they please. Another service user told us he liked to stay in his room and look out onto the garden. Service users spoken to said they could do as they wish throughout the day. We observed that the interaction between service users and care staff was good and the staff were very responsive to the service users wishes and choices. We visited the kitchen and spoke to the cook. The kitchen was clean and well organised. The cook for the day was usually a carer and she explained that the home is in the process of recruiting a new chef and until then, people who work at the home are volunteering to do extra hours to fulfil the cooking duties. It was noted that 90 of staff have received the food handling and hygiene training. This arrangement has been in place since the middle of April and the consequence of this was that the cleaning schedules and records of fridge temperatures and food temperatures had not been recorded. This was discussed with the senior person assisting the inspection and the cook and will be addressed in standard 38. The home operates a four-week rolling menu. The meals are served in a pleasant dining room and those choosing to, can eat in the lounge area St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 18 adjoining the dining room. The lunchtime meal was a roast dinner and this was well presented and service users said it was ‘very good’. Service users spoken with said the food was generally ‘good’. Pureed and diabetic diets are provided for a number of service users and the cook said she has the knowledge to provide these diets, with pureed food being kept separate to enable service users to enjoy the colour and textures of the food. The AQAA stated that the home has improved the meal times by serving the meals at two sittings. This provides a better service for residents, especially for those who need assistance with their meals, of which there are a number. Surveys received from service users indicate a high level of satisfaction with the food. Comments made were: ‘The food is always presented well and a good selection’. ‘The meals are usually good’. ‘There are always choices and most importantly a record of what actually is eaten is recorded in the resident’s records. Service user’s weights are recorded monthly in the care plans to identify any risks. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place and service users and their relatives are confident that their complaints will be listened to and acted upon. The policies, procedures and training of staff ensure that service users are safe. EVIDENCE: The home has a complaints procedure in place. The AQAA identified that the home could improve by having a dedicated complaints log. This is now in place. Surveys returned by the service users indicate that they would know who to talk to if they had any concerns: ‘Yes I always know who to see of I am not happy’. ‘The manager and her deputy would follow up any concerns and if necessary would be dealt with by a director’. The policies and procedures for safeguarding vulnerable people are in place. Staff receive training on abuse and adult protection and this is commenced as part of the induction programme. Staff surveys returned to CSCI indicated that the staff are aware of what to do should they wish to report any witnessed or suspicion of abuse to service users. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 20 The home has had one adult protection issues in the past year and this was dealt with by social services and resolved. A survey from a care manager commented that: ‘The home has been very responsive when adult protection issues were raised and attended the strategy planning and review meetings. They have acted on our recommendations and change practice following one event’. The policies and procedures for Safeguarding and Whistle Blowing were discussed with the manager who demonstrated sound knowledge of her role in dealing with any issues concerning ‘safeguarding’. All checks on CRB and POVA are in place before a person can commence their employment St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally live in a safe and well-maintained environment and have access to comfortable indoor and outdoor facilities. The home is clean and hygienic and free from offensive odours. EVIDENCE: We toured the home. The house is a very grand Georgian building and has retained many of the original features and is over four floors, the top floor being the administration offices. The requirements made from the last inspection with regards to making arrangements for the grills covering drops to the basement to be inspected St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 22 and repaired. These grill are now covered with a fine mesh covering and would not present any danger to the service users. The home was clean throughout with no offensive odours. The AQAA states that the home has made improvement since the last inspection and new wood effect safety flooring has been laid in some of the communal areas. The AQAA states that as part of the maintenance plan for the next twelve months, further new flooring will be put down in the remaining communal areas and flooring replaced in some bedrooms. The home has also purchased some new hospital type beds to give access to the hoist if this is needed. These were viewed whilst looking round and they were observed not to be adjustable beds The furniture and fixtures and fittings were in a satisfactory state of repairs. The bedrooms were pleasantly decorated and the home has an ongoing maintenance programme. The home now employs two maintenance men one of whom was present at the time of this visit and was undertaking general outside maintenance of the home and repairing a door lock. The home has 12 single and 6 double rooms and it was observed that service users are able to bring their own belongings to the home and have personalised their rooms, many displaying collages of old family photographs that stimulated conversation when talking to service users in their rooms. Privacy screens were observed in the double rooms. Whilst visiting the rooms we observed that one bedroom was very dark and dingy caused by the undergrowth and foliage outside the window being so overgrown, which shut out the light completely. This necessitated the need for artificial light to be used at all times. This was discussed with the manager who agreed that some action must be taken to clear the outside and make this room more pleasant for the service user to sit in. The kitchen is in the basement along with the laundry room, both of which are fit for purpose and were clean and well equipped. Dedicated laundry staff operates the laundry at the home. There are also three bedrooms in this basement area, one double and two single rooms. All look out onto a brick wall, that albeit are painted white, but are very dirty and in need of repainting to allow a more pleasant outlook for the service users who occupy these rooms. The two rooms at the back of the house in particular are very dark. This was discussed with the manager and they have suggested to the provider that flowerpots be attached to the walls to brighten the area. The house has a large enclosed garden, which is well kept and is over looked by the conservatory and the lounge. The AQAA states that in the next year the garden is being redesigned, for which the home has been awarded a grant. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 23 The home employs a team of housekeepers who attend the home every day of the week. The home was very clean and hygienic and hand-washing facilities were observed to be in place in bathrooms and toilets. We observed that toiletries were stored in some bathrooms and the carer accompanying us said that they would be removed to the appropriate service user’s room following their baths. We reminded one of the housekeepers the dangers of leaving her cleaning materials unattended, she acknowledged she should not have done so but it had been unattended for a very short time whilst she went in search of the maintenance man. Staff do attend infection control training and are aware of the principles of how to prevent spread of infection. Protective clothing was observed to being worn by staff. We observed that staff were wearing gloves for all duties including serving out tea/ biscuits and food. This was discussed with one staff member who said that gloves are worn for all duties and that they were changed between assisting each service user. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has mix of staff that has a range of skills and there were sufficient numbers of staff on duty to meet the needs of service users. Service users benefit from a staff team that has had sufficient training to meet the needs of service users, however there are areas of client specific training identified by staff that they consider they need. The homes recruitment policy and practice supports and protects service users. EVIDENCE: The homes staff rota was examined, this showed that the home provides 6 care staff on duty between 0800 – 1400, 5 care staff on duty between 1400 – 2000 and 3 care staff on duty between 2000 – 0800. In addition there is the homes manager and her deputy, who were attending a training course on the day of this visit and attended the home later in the day. Staff are contracted to do set hours each week and contracts state the days and hours to work, therefore the rotas on display were not for specific weeks but showed who was rostered for duty and when. The staff diary showed any changes to the rota if staff had changed duties or were doing extras. The senior carer said that staff are very good at covering hours that are needed in St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 25 times of sickness or annual leave. On the day of this visit the home had one carer off sick and there were 5 carers, 3 domestic, I cook and 1 laundry person on duty. Three waking staff are on duty throughout the night. Agency staff do attend the home to cover staff shortages. From observation, and taking into account the senior carer was accompanying us on this visit, the staff were very busy and were aware of the staff shortage, but this did not appear to affect the service users unduly and staff were observed to be giving time to service user to assist them and talk to them whilst carrying out their duties. The home does employ a mixed gender and race staff group and service users are asked at assessment if they have objections to being cared for by the opposite sex. Some of the service users have voiced their preferences and these are recorded in their care plans. The home has14 staff that have already obtained their NVQ qualification or equivalent, with 3 staff members currently undertaking this qualification. This represents nearly 60 of the workforce to have achieved an NVQ qualification. The AQAA states that the home has pledged a Statement of Intent with Train to Gain to ensure that all staff are aware of the organisations commitment to help staff develop their skills. The home has policies and procedures in place with regard to staff recruitment. A sample of three recruitment files was viewed for the most recently recruited staff. The home retains its staff well and the turnover of staff is low. The files demonstrated that all the required information of CRB and POVA check and two references had been received before the person commenced employment. The AQAA states that the home has arranged a contract with a training company to provide all essential training needs for staff. The AQAA also states that the plan for improvement over the next year is to manage budgets in such a way to enable the home to arrange more client specific training events. Staff training records were available but were difficult to view as they were in one folder and not filed in individual staff files. The person responsible for maintaining the records was in the process of putting the information on the computer to create a database for information and a training matrix and at the time of this visit she had to leave the home and was unable to go through the large envelope of training certificates to identify individual training. However, staff spoken with said they do have training opportunities given to them and confirmed that they had received training and they were confident that they could meet the needs of service users. 10 staff surveys were returned and 9 said they felt they received training appropriate to their roles but with two stating that there was a need for staff to be trained in Challenging St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 26 Behaviours as this was occurring more in the client group. This was discussed with the manager and the director and she told us that this has been acknowledged and that she was in the process of booking this course for all staff to attend. Induction records were seen in the staff recruitment files. The home has a new induction and foundation training booklet, which covers care practice and principles of care and is linked to NVQ. The AQAA states the home has greatly improved the methods of induction in the last year. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 27 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, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the home is run in the best interests of service users and the home’s manager is experienced. The home obtains the views of service users, relatives and visitors and this benefits both the home and its service users. The home accounting and financial procedures safeguard service users and service users financial interests are protected and they control their own money wherever possible. Staff at the home do not receive supervision on a formal basis and this could be detrimental to staff and service users. The health, safety and welfare of service users and staff are not consistently protected. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager is experienced and has been at the home for some 12 years and she has completed NVQ4 and the registered managers award, she also has a deputy who has considerable experience and has a dedicated management role. A comment received from a relative was ‘A superb’ hands on’ manager and deputy and any concerns are followed up if necessary’. The home does not have a formal quality assurance system in place. We could not access records of any audits or quality assurance systems currently in place. The company have developed a questionnaire that is distributed to service users and relatives. The home also holds relative and service user meetings and records of these meetings were seen by us. It is at these meetings that feedback is given on any issues or suggestions raised in the returned questionnaires. The AQAA states the improvements that have been made as a consequence of listening to what people have said and have introduced cooked breakfasts on Saturdays and now have two sittings at meal times. The AQAA states that the home receives positive comments from clients, visitors and professionals that confirm that the service users are well cared for. Comments from service users surveys retuned to CSCI were: ‘The staff are very caring and they do listen to what I ask them’. ‘I do receive the support I need’. ‘I truly cannot fault St. Vincent and never have any doubt about mother’s care in my absence’. ‘’Carers are cheerful and smile when you enter the home’. ‘They let clients wander and the home is kept safe to allow them to do so’. The home does allow service users to control their own finances as much as possible with the help of relatives and friends. The home does not currently keep money for service users; any items that are required are purchased by the home and then invoiced to service users or relatives. All transactions were recorded. The last inspection identified that staff supervision was not taking place and a requirement was made. There was no evidence at this inspection that the manager or deputy are undertaking staff supervision and maintaining records. This was discussed with the manager and the director, who said that they acknowledge that this is not taking place and that the director said she is trying to allocate training for herself, the manager and deputy on the skills for supervision and appraisal. A further requirement will be made and the registered persons must ensure that this is complied with. Any failure to comply will result in the Commission taking enforcement action . St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 29 The AQAA identifies that the home could improve by having a structure supervision development plan for staff and it is anticipated this will happen in the next twelve months. The current annual service certificates were seen for the fire system, gas installation and the general wiring certificate showed expiry date of 2012. The AQAA stated that the home has had a complete overhaul of the central heating and hot water system and now have a contract with a company for maintenance and repairs. The fire log was viewed and identified that the testing of fire alarms had not been recorded since April 2008 and the emergency lights having not been tested since July 2007, and although the servicing certificate showed that the fire alarm system had been serviced in December 2007, the records did not reflect this. During this visit the fire alarm went off. The senior carer attended the fireboard as procedure but no other staff attended. Two carers came out of the kitchenette and reported that the toast had burnt and had set the alarm off but they did not think it necessary to carry out the drill as per procedures. The fire training log recorded that staff have attended fire training but staff did not follow the procedures on that day and response to the fire alarm was lacking. The kitchen was visited and was clean and well organised. We viewed the cleaning records in the Making Food Safely manual and these had not been recorded since August 2007. The Environmental Health Officer visited the home recently and had found traces of bacteria around the taps. Without evidence of cleaning records it could demonstrate that the kitchen is not being cleaned appropriately and as often as it should be. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 30 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 31 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 Reg 15(1) Requirement The registered person must ensure that all the people who use the service must have personal care plans in place as soon as possible after they are admitted to ensure staff can provide a consistency of care, especially if their needs are complex and challenging. The registered person must ensure service users safety by ensuring that all staff that administers medications follows the policies and procedures of the home. Administration, storage and recording of medicines must be written in policy and be in line with the Royal Pharmaceutical Society guidelines. The registered person must make arrangement to have the undergrowth and foliage cut back from outside Room 26 to allow light into the room and negate the need to use artificial light throughout the day. The registered person must ensure that effective quality DS0000011868.V363737.R01.S.doc Timescale for action 30/06/08 2. OP9 Reg 13(2) Reg 13(4) (c) 30/06/08 3. OP19 Reg 23(2) 31/07/08 4. OP33 Reg 24(1) 30/09/08 St Vincent House Version 5.2 Page 32 5. OP36 18 (2) assurance and monitoring systems are in place, to include seeking the views of service users/stakeholders, to measure the success of the service in meeting the aims and objectives and statement of purpose. The registered person must 31/07/08 make arrangement for all staff at the home to receive formal supervision at lease 6 times per year. This was a requirement from the last inspection report with a timescale for action of 30/08/06. The registered person must ensure that all staff are familiar with the fire alarm response procedures and respond accordingly to the procedures. The registered person must ensure that the fire alarm and emergency lighting is tested at the appropriate intervals and records of these be recorded in the fire log. The registered person must ensure that all cleaning records for the kitchen be completed appropriately to evidence the kitchen has been cleaned thoroughly at stated intervals. The registered person must ensure that the cook is recording the appropriate temperatures for cooling and freezing equipment at the appropriate intervals. 30/06/08 6. OP38 Reg. 23(4)(c) (e) Reg 16(2)(j) St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP26 Good Practice Recommendations It is recommended that the brick walls that the rooms in the basement look out on be painted and decorated with plant baskets. It is recommended that all service users’ personal toiletries be taken out of communal bathrooms and returned to their bedrooms to prevent toiletries being used communally. St Vincent House DS0000011868.V363737.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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