CARE HOME ADULTS 18-65
Stagenhoe Park Sue Ryder Care Centre Stagenhoe Park St Pauls Walden Hitchin Hertfordshire SG4 8BY Lead Inspector
Mrs Sheila Knopp Unannounced Inspection 30th January 2006 10:00 Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 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 Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 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 Adults 18-65. 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. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Stagenhoe Park Address 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) Sue Ryder Care Centre Stagenhoe Park St Pauls Walden Hitchin Hertfordshire SG4 8BY 01438 871215 01438 871083 fran.short@suerydercare.org Sue Ryder Care Frances Short Care Home 50 Category(ies) of Physical disability (50), Physical disability over registration, with number 65 years of age (50) of places Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. This home may accommodate 50 people (aged 18 to 65 years and above 65 years) with physical disability who require nursing care. This home may accommodate people with physical disability caused by chronic illnesses such as Huntingtons Disease and other neurological conditions. 9th August 2005 Date of last inspection Brief Description of the Service: Stagenhoe Park is a large Georgian House set in 8 acres of parkland style gardens overlooking the Hertfordshire countryside. The home provides specialist nursing care for younger adults and older people with Huntingtons Disease and other neurological conditions. The home is approximately 15 minutes by car from Hitchin. There is an infrequent bus service however the home has 2 ambulances and a mini bus. The main building is divided into 2 wings. The majority of residents are accommodated in single rooms with access to lounges and assisted showers and bathrooms suitable for people with complex physical needs. Overhead tracking hoists are provided above each bed. There is also a conservatory, library room, smoking room and chapel in the main house. Two passenger lifts provide access to the upper floors. There is a covered walkway from the main house to the Rachel Bowes Lyons Unit, which is a purpose built bungalow with 16 single bedrooms with en suite facilities, an activities room, a sensory room and a physiotherapy treatment area. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second planned unannounced inspection for the year April 2005 – March 2006. Details of key standards not covered by this report can be found in the report dated 9 August 2005. This inspection was carried out by two inspectors who focussed on the social support provided to residents, the environment and the management of health & safety. The Commission has not received any complaints about this service between inspections and no concerns have been raised by health or social care professionals involved with service users at this home. The last report detailed a high level of satisfaction form health & social care professionals involved with residents at the home. The inspectors spent time with 6 residents in the activity area and as well as speaking to the activity staff interviewed a nurse and care assistant. Heads of department were also involved in the inspection. The Home Manager was not present. What the service does well:
The high standard of care and support provided to residents and their relatives creates a positive atmosphere. Stagenhoe has been accredited by the Multiple Sclerosis Society as a preferred provider of respite care. A team of activity co-ordinators promotes the social and emotional well being of the service users by providing a stimulating environment within the home and access into the community. There are very good systems in place for auditing and reviewing the quality of nursing care provided in line with national guidelines. There is an experienced and well trained team of staff who understand the needs of service users with neurological conditions. The skills and on going development of the staff are supported by a training manager. Over 50 of the care staff have qualifications in care at NVQ level 2 and above with a high proportion achieving awards at level 3. Following this inspection the position of Ms Short as the Registered Manager as defined by the Care Standards Act was confirmed by the Commission and a new certificate issued. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 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. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15 & 16 Residents are supported by staff to get involved in a range of activities within the home and further a field in the local community and on holiday. EVIDENCE: There is a team of activity staff who are supported by the nursing and care staff to provide a range of activities within the home and access into the community. There is a large activity room, which residents can spend time in and there is also a sensory room. One resident said they liked spending time in the activity room. Evidence of the art and craftwork involving residents was displayed. Staff confirmed resources for activities and developing independence were available and as an example reported they had obtained a page-turner for one resident so they can now read their newspaper independently. Residents are able to go out and about in the local community and for trips further a field using the home’s transport. Two residents spoke about looking forward to the holiday they had booked.
Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 11 A resident confirmed that the trips were included in their rent and they had visited Southend, Woburn, Duxford and the London Eye. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected. EVIDENCE: Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Stagenhoe provides spacious accommodation in a rural setting. Modifications and equipment required by individuals with neurological conditions are in place. Residents are able to personalise their rooms with their own belongings. EVIDENCE: New flooring has been laid in the main corridors to upgrade these areas. Vinyl style flooring is provided to enable residents with mobility problems and those requiring specialist wheelchairs, seats and beds to be moved easily about. Overhead tracking hoists are provided in bedrooms and bathrooms. Specialist baths and showers are provided. In response to a recommendation from the previous inspection staff are looking into providing an individual call point for a resident unable to take the standard remote call point into the garden. Individuals are assessed for aids to independence. There is a refurbishment programme in place to upgrade the decoration and furnishings within the home and plans to extend the access of residents to the gardens.
Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 34 There are very good systems in place for the training and development of staff. The recruitment policy supports good practice to protect residents but the inspector was not able to verify all aspects of this from the recruitment records checked and information made available. EVIDENCE: The provision of a training officer ensures that staff receive regular training and their on-going development is supported. This has also meant that the level of over 50 of the care staff achieving qualifications in care at NVQ level 2 has been maintained with half that group achieving the award at level 3. There were no records of the checks made with the Nursing and Midwifery Council (NMC) when nursing staff are employed or required to re-register. Copies of the registration cards issued to nurses had been photocopied but these are not deemed to be proof of registration by the NMC. The Head of Clinical Care reported the telephone checks with the NMC verification service had been carried out but not recorded. Criminal Records Bureau checks are in place before staff work in the home. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 16 The 3 personnel records examined did not demonstrate that in all cases a robust review of the references requested or obtained had been carried out in line with legislation or good practice. The application form used by the organisation requests the last 10 years employment history. It is good practice to ask for a full employment history. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Ms Short is a registered nurse experienced in developing and managing services for people with long-term neurological conditions. Shortly after this inspection the Commission confirmed Ms Short’s position as the Registered Manager, as defined under the Care Standards Act. The management and quality assurance systems in the home are subject to continuous development and review to ensure best practice for caring for residents with neurological conditions is followed. The health & safety of residents and staff is promoted through policies and procedures, staff training and servicing of equipment and checks on systems. EVIDENCE: Ms Short is completing the Registered Managers Award and also has a Diploma in Public Service Management.
Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 18 There are quality improvement systems in place throughout the home to monitor the standard of the service provided. For the nursing staff these include standards based on current Department of Health guidelines for nursing practice. The opportunities for residents and relatives to comment on the services at Stagenhoe and receive feedback through meetings and the use of questionnaires has increased. To develop this further it is recommended that the manger provides an annual report on the out come of the quality reviews and views of residents and stakeholders. Staff interviews and a review of training records and the training plan for the home confirmed that the required health & safety training is carried out. The records for reviewing the regular maintenance of equipment and checks on systems were reviewed. A new post, Head of Support, has been created to bring the maintenance, housekeeping and ancillary services together under one manager. Systems in these areas are being reviewed. It was recommended that written confirmation is obtained on the health & safety checks required by legislation on the Calor Gas systems. The Fire Authority are currently carrying out familiarisation visits to the home A copy of any report received and details of action taken by the manager has been requested by the Commission. It was recommended that advice is taken from the Fire Authority regarding how often the fire risk assessment in place under the Fire Precautions (Workplace) Regulations 1997 (as amended) should be reviewed. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 x 4 x 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x x x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 N/A PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x 3 x 3 x x 3 x Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19(1) Requirement Maintain a record of checks with the Nursing and Midwifery Council for all registered nurses as they are recruited and following their periodic reregistration. Ensure two written references are available. It is good practice to: Include a reference from the last employer. Approach other care settings as well as the last employer where there has been a change in working patterns. Send the reference request to the head of the organisation. Timescale for action 31/03/06 2 YA34 19)(1) 31/03/06 Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 21 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. 3. 4. Refer to Standard YA34 YA39 YA42 YA42 Good Practice Recommendations Review application form to include full employment History. Identify a date for providing a report to residents, relatives, stakeholders and the Commission on the outcome of the quality reviews carried out. Regularly review the fire risk assessment in place under the Fire Precautions (Workplace) Regulations 1997 (as amended). Obtain written confirmation on the health & safety checks required by legislation on the Calor Gas Systems. Stagenhoe Park DS0000019549.V286905.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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