CARE HOMES FOR OLDER PEOPLE
St Williams Residential Care Home St Williams Cornwall Avenue Darlington Durham DL1 2LJ Lead Inspector
Rachel Dean Unannounced Inspection 25th January 2006 10:00 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 Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 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 Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Williams Residential Care Home Address St Williams Cornwall Avenue Darlington Durham DL1 2LJ 01325 486166 01325 482337 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) BUPA Care Homes (GL) Ltd Mrs Elizabeth Mary Wilson Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th June 2005 Brief Description of the Service: St Williams is a care home providing residential care for up to twenty-two older people. BUPA Care Services purchased the home in 1997. St. Williams, which is a former convent, is a large detached property situated at the top of a cul-de-sac in a residential area of Darlington. Public transport links to the centre of town are good and there are a number of small shops conveniently located. Accommodation is provided on two floors. Seven single rooms are situated on the ground floor and a further thirteen single and one double room are located on the first floor. A passenger lift is provided for ease of access to both floors. There are two lounges on the ground floor and a small quiet lounge on the first floor. The spacious, ground floor dining room is also used for activities and social events. The residents of St. Williams are able to enjoy the benefits of the well-maintained garden to the front of the house, which provides a safe, pleasant environment. St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of St Williams Care Home that took place on 25th January 2006. The manager and deputy manager were on a training course and not available in the home on the inspection day, but the senior carer who was in charge of the home at the time was able to take part in the inspection. This inspection focused on how people are admitted to the home, the care records that are kept by the home, the health and personal care provided, how medication is managed, how people are treated and the daily activities and routines in the home, including the meals provided. During this inspection six residents and two visitors were spoken to about their experiences of living in and visiting the home. The senior carer and other staff, including the cook, were spoken to about working in the home and the service provided to residents. A number of records kept by the home were also inspected and the inspector made observations while she was in the home. What the service does well:
The residents who were consulted during this inspection were very happy with the care and support they were given at St Williams. Comments made about the care staff included ‘if you’re not well they help you out straight away’, ‘if you want them during the night they’re there like a shot’, ‘if you’re poorly they take good care and ring the doctors’, ‘the staff are lovely’, ‘they’re all wonderful’ and ‘excellent’. As well as these comments the inspector observed staff treating residents with dignity, respect and helping people in very considerate ways. The residents were also happy with the activities and choices available to them in the home. The people spoken to felt that there was enough going on, that routines were flexible and that people had the choice of joining in with regular activities if they wanted to. Comments included ‘we have quizzes, keep fit, dominoes, you just please yourself if you want to join in’ and ‘in summer they put chairs put in the garden for us’. The home provides a varied and good quality diet for its residents, with the cook being aware of individual people’s likes and dislikes. Comments made about the food included ‘If you don’t like something you don’t get given it again’, ‘because I’m not well they made me a cheese sandwich today instead of the main meal and it was no trouble to them’ and ‘the food is excellent’, ‘marvellous’ and ‘very, very good’. St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 6 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 Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 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 the following standard(s): 3 New service users have their needs assessed before being admitted to the home, to make sure that their needs can be met at St Williams. EVIDENCE: The home follows the BUPA procedures for the assessment and admission of new residents. The records of three recently admitted people were inspected and these showed that appropriate assessments had been completed before these people were admitted to the home. Records included assessments from local authorities and hospitals where these had been involved in the admissions process. St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 & 10 Each resident has their own care plan that sets out their individual care needs, so that staff are aware of and kept up to date about each resident’s needs. Service users felt that their health care needs were fully met, with the home accessing appropriate services when necessary. Medication is managed and administered in a safe way, by appropriately trained and experienced staff. Service users felt that they were treated with dignity and respect by the home’s staff. EVIDENCE: All residents at St Williams have their own care plan and care records. During this inspection three of these records were inspected. The care plans contained detailed information about each person’s care needs, including regular reviews by the care staff and manager and detailed notes about the care people received on a day-to-day basis. The care plans and reviews included information about what each resident felt about their needs and the care they needed.
St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 10 Discussions with residents during the inspection showed that they all felt that their personal and health care needs were very well met at St Williams. Comments included ‘if you’re not well they help you out straight away’, ‘if you want them during the night they’re there like a shot’ and ‘if you’re poorly they take good care and ring the doctors’. Care plans included things like nutritional and skin care assessments and information about maintaining people’s continence. Special equipment, such as pressure relieving mattresses and cushions were observed to be in use around the home. The home also has close links to a number of local doctors practices, a local pharmacy and a regular chiropody service. During this inspection the senior carer was observed doing the morning medication round. The carer gave out the medication appropriately and showed a good understanding of the importance and responsibility of this role. The drugs trolley was neat and tidy and the medication administration records were also neatly written up and maintained. The only thing that would benefit from being improved is the recording of stock balances when ‘as required’ (PRN) medication is carried over from one month to the next. There should always be a clear audit trail of medication in the home, allowing stock balances to be checked against the records. Residents at the home felt that staff were kind, considerate and polite. Comments made by residents to the inspector included, ‘the staff are lovely’, ‘they’re all wonderful’ and ‘excellent’. Observations made during the inspection included staff being very friendly and polite to residents and offering help and assistance in respectful ways. For example, some residents were called by their first names while others were called ‘Mrs’, according to their preferences. St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 & 15 Routines in the home are kept as flexible as possible and activities are provided on a regular basis so that residents can join in if they wish to. Visitors are made to feel very welcome when visiting the home and were able to have meals with their relative or friend if they wished to. The home’s staff are flexible and try to accommodate each person’s preferences where this is possible. Residents felt that a very good standard of food and drink was provided in the home. EVIDENCE: The home’s deputy manager is responsible for coordinating regular activities for the residents to participate in. Discussions with residents confirmed that regular activities and events take place, including quizzes, bingo, dominoes, visiting entertainers, craft projects and helping with small domestic tasks, such as folding napkins and setting tables where residents wanted to help with such things. Comments made by service users included ‘we have quizzes, keep fit, dominoes, you just please yourself if you want to join in’ and ‘in summer they put chairs put in the garden for us’.
St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 12 Discussion with residents and observations made during this inspection showed that people had a choice about their daily routines and that their wishes were accommodated where ever this was possible. For example, residents confirmed that their preferences about food and drink were catered for, that they could choose when to get up and go to bed and that they could choose what activities they wished to join in with and where they wanted to spend their time. Two regular visitors to the home confirmed that they were always made to feel very welcome, always offered refreshments and that there were no unreasonable restrictions on visiting. One visitor described how she was invited to stay and have lunch with her friends when she visited and how this was never any bother to the staff. During this inspection service users were asked about the food and drink provided in the home, discussions were held with the cook and the lunchtime meal was observed. Service users were very complimentary about the cook and the food provided. Comments made to the inspector included ‘the food is excellent, you couldn’t afford to eat like this at home’, ‘if you don’t like something you don’t get given it again’, ‘because I’m not well they made me a cheese sandwich today instead of the main meal and it was no trouble to them’ and ‘the food is excellent’, ‘marvellous’ and ‘very, very good’. Varied menu’s are in place and residents confirmed that they can choose to have different things if they wish. The dining room was very pleasantly decorated, with nice tablecloths and flowers on the tables. Staff were observed to assist people with eating in a very sensitive and pleasant way, for example, chatting nicely to the person they were helping and explaining what they were doing. St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 13 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 the following standard(s): These key standards were not assessed during this inspection. They were assessed during the last inspection. EVIDENCE: St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 14 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 the following standard(s): These key standards were not assessed during this inspection. They were assessed during the last inspection. EVIDENCE: St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These key standards were not assessed during this inspection. They were assessed during the last inspection. EVIDENCE: St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These key standards were not assessed during this inspection. They were assessed during the last inspection. EVIDENCE: St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME 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 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations There should always be a clear audit trail of medication in the home, allowing stock balances to be checked against the records. St Williams Residential Care Home DS0000000825.V269458.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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