CARE HOMES FOR OLDER PEOPLE
St Vincent`s 79 Fore Street Plympton St. Maurice Plymouth Devon PL7 1NE Lead Inspector
Fiona Cartlidge Unannounced Inspection 23rd May 2007 11:15 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`s DS0000003609.V331395.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`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Vincent`s Address 79 Fore Street Plympton St. Maurice Plymouth Devon PL7 1NE 01752 336205 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) Convent of Sisters of Charity Mrs Frances Jane Hanlon Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability over 65 years of age (25) of places St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service Users aged 65 years and over OP Maximum registered 3 service users (both) PD(E) Maximum registered 25 service users (both) One service user under the age of 65 years named elsewhere Date of last inspection 28th February 2006 Brief Description of the Service: St Vincent’s is situated in a conservation area of Plympton St Maurice near the city of Plymouth in Devon. The building was originally a malt house, converted in the 1700s into a private residence and opened as a nursing home in 1944 by the Anglican sisters of charity. The accommodation is provided on 2 floors accessed via a passenger lift or stairs and comprises; 21 single rooms (11 with en suite) and 2 double rooms (1 with en suite) and 4 communal areas, the gardens are attractive, safe and accessible. The home is registered to provide nursing and/or personal care for a maximum of 25 people, over the age of 65 of either gender, with physical disability, frailty and/or illness. The atmosphere within this home is quiet and peaceful. The home benefits from a stable staff team and achieved the investors in people award in 1998, which was renewed in 2002 and 2004 in recognition of their commitment to staff development and training. Information about the home including a copy of the last inspection report can be obtained on request from the administration office. Information given to the Commission by the provider indicates the current range of fees is from £301 to £456/week. Additional charges are made for chiropody, hairdressing, optician, dentist and toiletries. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit took place over 5 hours 45 minutes and was unannounced. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Three residents had their care case tracked - this means their records were examined in detail and two of the three residents were spoken to in depth about the care and services they receive. The other person’s care was observed. Five other residents were spoken with during the visit, as were three visitors/relatives, three members of staff, the manager and responsible person on behalf of the registered provider. Personnel records of 3 members of staff and policies and procedures were also inspected. Two visiting health care Professionals and 12 members of the homes care staff retuned surveys. What the service does well:
People who use this service have sufficient information about the home to enable them to make an informed decision about whether the service is right for them. The pre admission needs assessment means that people’s diverse needs are identified and planned for before they move to the home. People who use this service are provided with a good level of health and personal care; all Residents are registered with a GP and specialist nurses and chiropodists visit. Visits to community and hospital health resources are enabled. Written information was received via survey forms that were returned to the Commission by 2 visiting health care professionals. These indicated that the home communicates clearly and works in partnership with them and that they are satisfied with the overall care provided to Residents within the home. One general practitioner commented ‘ they are very caring, put extra effort in, I cannot fault their care efforts’. The feedback about food was positive, all of the residents spoken with said how good it was. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially.
St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 6 The environment remains clean, warm, safe and comfortable. All of the residents spoken to were satisfied with their private accommodation and there was evidence that they are able to bring personal items with them into the home. Staff at the home are well trained and supported, and employed in sufficient numbers to meet peoples’ needs at all times. The residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from residents included: ‘I am really impressed with the care and support that I am given here at St Vincent’s’, ‘the staff are kind and attentive’, ‘as soon as you ask the staff for something you get it’. What has improved since the last inspection? What they could do better:
Not all of the residents’ plans of care had been regularly reviewed or updated to reflect changing needs; this poses a risk to people who use this service. Staff use these records to inform them about how to meet peoples care needsif they lack up to date information some needs may not be consistently met. To ensure that the social and recreational needs of people who use this service are met, records held about them should contain information about their life experiences their interests and hobbies and they should be offered activities suited to their preferences and capacities. Recruitment processes should be more robust; a requirement has been made: To ensure people are suitable to work at the home two written references must be obtained, references addressed ‘to whom it may concern’ or without signatures should be validated Staff at the home do not currently receive regular formal supervision; a requirement has been made: To ensure staff remain suitable to work with
St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 7 people who use this service they should receive formal supervision to provide them with an individual opportunity to discuss their progress and working practices with their manager at least six times a year. This in turn should improve communication between the management team and the staff team. 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`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 8 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`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 9 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): 1,3,6, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have sufficient information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: The home has a statement of purpose this document sets out the aims and objectives of the home and provides information about the service. This and a simpler guide (brochure) were available for inspection and can be requested from the homes administration office. The personal records of 3 Residents were seen in detail and two of these Residents were then spoken with about their experience of living at St
St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 10 Vincent’s these Residents confirmed that the home was meeting the expectations they had when they were admitted. One Service User said that their family had visited and chosen the home because they themselves had been too poorly. This resident’s son confirmed they had chosen the home for two main reasons; Its calm atmosphere and Christian ethos. Another residents told us they chose St Vincent’s because of its good reputation in the local community and because of its proximity. Both confirmed that the home had done an excellent job in meeting their needs. An assessment of care needs of prospective Residents takes place prior to admission to the home. Documents seen provided evidence that the home uses a standard assessment form; this assesses prospective Residents needs in depth and allows the homes personnel to make a clear decision about whether or not these needs can be met. Other records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. People who use this service are provided with a good level of health and personal care and, they are protected by the homes policies and procedures for medicines. EVIDENCE: Residents spoken with confirmed they receive a good level of care. Personal records held on behalf of 3 Residents were examined; in all of those seen there were documented assessments which provided information about skin integrity, moving and handling, safety - including risk of falls, nutritional screening and social needs. The information generates the plans of care, which provide the basis for the care to be delivered. The plans of care are held in the nurses office, resident’s spoken to in detail were aware of the documentation held on their behalf. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 12 Not all of the plans had been regularly reviewed or updated to reflect changing needs, this poses a risk to people who use this service. Staff use these records to inform them about how to meet peoples care needs if they lack up to date information some needs may not be consistently met. Records are maintained for all visits to the home by social or health care professionals, all Residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, specialist nurses and chiropodists visit. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Written information was received via survey forms that were returned to the Commission by 2 visiting health care professionals. These indicated that the home communicates clearly and works in partnership with them and that they are satisfied with the overall care provided to Residents within the home. One general practitioner commented ‘ they are very caring, put extra effort in, I cannot add to their care efforts’. The medication system is generally well managed, we looked at storage and recording and checked balances against records of controlled medication stored in the home these were accurate. The medication administration records did have some gaps and it was not clear therefore whether medication had been administered or not. The home does however use the Monitored dosage system so that in most cases the number of tablets left in the cassette could be cross referenced against the records. Not all medication is able to be blister packed and therefore gaps in these administration records would cause a risk to residents, as there is no clear record that they have or have not received their treatment, which may lead to under or over administration. Staff were seen and heard knocking on doors before entering rooms and were carrying out personal tasks in private. Staff observed in conversation with residents were heard to be courteous and respectful. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 13 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. People who use this service enjoy a peaceful, pleasant yet varied life, with family and local community links maintained and encouraged. Various formal and informal impromptu activities are made available on a regular basis. Good quality meals are provided. EVIDENCE: During the site visit, some residents were seen sitting in the lounges and garden. Other residents were seen spending time in their rooms, reading, listening to music, or watching television. Staff were seen encouraging and enabling residents to engage in meaningful conversation. The records seen did not contain information about people’s life experiences their interests or hobbies. Organised activities are advertised on a notice board
St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 14 in the nurses’ office and these are communicated verbally by the staff to the residents. There were no organised activities on the day of our visit. At the time of our visit all the residents living in the home were of British origin and white. They were predominantly of a Christian faith; People told us that they are able to attend church services both within the home and in the local parish. The feedback about food was positive all of the residents spoken with said how good it was; some residents ate lunch in the lounge/dining rooms others ate their lunch in their own accommodation. The food served at lunchtime looked and smelt appealing. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 15 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. Arrangements for protecting people who use this service and responding to their concerns are satisfactory. EVIDENCE: This service has a complaints procedure it is clearly written and easy to understand and was seen advertised in the guide about services. Residents and visitors confirmed that they felt comfortable discussing issues with the staff and manager. One complaint had been received within the home this had been investigated fully and action taken to minimise the risk of a reoccurrence of the issue. There have been no complaints referred to the Commission about this service. A complaints/concern book is kept in the entrance hallway there were no entries. Records seen show that the Staff are made aware of and attend training on the recognition and reporting of incidents or allegations of abuse or neglect, all 12 staff who returned surveys to us indicated they are aware of adult protection procedures. The homes policy and procedures for safeguarding adults gives clear specific guidance about referring to external agencies. Residents said they feel safe living in the home. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 16 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. The environment remains clean, warm, safe and comfortable. EVIDENCE: A tour of the building showed that some areas of the building have been redecorated since the last inspection. Evidence that improvements are on going included several bedrooms that had been painted as well as the kitchen, 1st floor lounge, landing and downstairs hallway. Two offices have been redecorated and refurbished. Other major works have included a new roof and windows throughout the home. A buggy and oxygen store has been built and one fire escape has been rebuilt. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 17 All of the Residents spoken to were satisfied with their private accommodation and there was evidence that they are able to bring personal items with them into the home. The home benefits from 4 communal rooms as well as attractive and accessible gardens. There is a range of equipment around the home, available to assist staff in moving and handling residents, as well as a disinfecting sluice, hand washing facilities and disposable gloves and alcohol rubs for use when/if in contact with body fluids. The environment was clean and odour free at the time of the visit. Records show that all equipment and systems are regularly serviced. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff at the home are generally well trained and supported, and employed in sufficient numbers to meet the service users’ needs at all times. Tighter recruitment checks are required to ensure staff are suitable. EVIDENCE: Three Personnel files were examined, these records generally showed a commitment to safe recruitment practises, files contained detailed application forms, one file contained only 1 reference and the other 2 contained 2 written references but in each of these only one was signed. There was evidence of Criminal Record Bureaux checks, and each file held proof of the person’s identity. Training and development records provided evidence that training is provided and ongoing. 12 Staff who returned surveys to us indicated they receive sufficient training to enable them to meet the needs of those living in the home. All new members of staff have to work through the ‘working in care’ induction standards from the Skills for Care Scheme. Five of the 12 staff that returned surveys to us indicated that they are sometimes asked to care for people outside of their expertise. Comments from
St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 19 staff included ‘mentally ill patients are admitted, staff are unable to cope as no one has had training about caring for elderly people with mental illness’. Information provided in the pre-inspection questionnaire suggests that 10 care staff (55 ) have obtained a National Vocational Qualification (NVQ) in care at level 2 or above. The residents were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘I am really impressed with the care and support that I am given here at St Vincent’s’, ‘the staff are kind and attentive’, ‘as soon as you ask the staff for something you get it’. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. St Vincent’s continues to be managed well and run in a safe way, which also takes into account the best interests of service users. EVIDENCE: The home’s manager became registered with the Commission in October 2006. Mrs Hanlon is a registered nurse, has obtained the Registered Managers Award (RMA), has a Diploma in older persons Nursing, currently working towards Degree, post registration courses in care of the elderly, and Continuing Care of the dying patient and family.
St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 21 Mrs Hanlon has worked at the home for over a decade and as Matron Since 2003 she demonstrates a commitment to constant updating of knowledge and skills, which has benefited the home and those who live and work there. Staff at the home do not currently receive regular formal supervision and the term ‘supervision’ is not well understood by the staff team. Comments received on returned staff surveys included: ‘I don’t need supervision I have worked with the elderly for 30years’, ‘ I don’t know if I get supervision’. Supervision means that that staff have an individual opportunity to discuss their progress and working practices with their manager at least six times a year. Staff meetings are not held regularly and comments from some staff indicate there is a need for greater communication; ‘it would be good if staff received more recognition’ ‘there needs to be better communication between staff’ ‘we only have 1 staff meeting per year’, ‘we only have meetings when something is wrong’. During this inspection examination was made of the arrangements for dealing with service users independent finances. The home has a robust system, which ensures that service users’ monies, are safeguarded and protected. Purchases are receipted, and examination of the system demonstrated that references could be cross-referenced with purchased items. A quality management system has been in place for a number of years the home has achieved the Investors in people award twice and is currently gathering evidence for its 3rd quality assessment for this purpose. We were shown satisfaction questionnaires that were ready to be circulated to residents and or their representatives. Safety notices were displayed throughout the home including action to be taken in case of fire and how to Control of Substances hazardous to health. Written information provided to the inspector by the provider before the inspection indicates that all equipment is regularly maintained and tested. The administrator has attended an intermediate course on health and safety and has responsibility for reviewing and developing environmental risk assessments. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 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 Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15.1 Requirement Timescale for action 01/07/07 2 OP9 13.2 2 OP29 19 3 OP36 18(2) All people using the service must have an up to date, detailed care plan. This will ensure they receive person centred support that meets their needs. When medication is administered 01/07/07 to people who use this service it must be clearly recorded. This will ensure that people receive the correct levels of medication. To ensure people are suitable to 01/07/07 work at the home two written references must be obtained, references addressed ‘to whom it may concern’ or without signatures should be validated To ensure staff remain suitable 01/09/07 to work with people who use the service they should receive formal supervision to provide them with an individual opportunity to discuss their progress and working practices with their manager at least six times a year. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 24 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 OP12 Good Practice Recommendations People’s interests should be recorded and they should be given opportunities for stimulation through leisure and recreational activities, which suit their needs preferences and capacities. St Vincent`s DS0000003609.V331395.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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