Inspection on 09/08/05 for Stagenhoe Park

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stagenhoe Park 19/04/07

Stagenhoe Park 30/01/06

Stagenhoe Park 04/01/05

Stagenhoe Park 15/07/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Stagenhoe Park Sue Ryder Care Centre Stagenhoe Park St Pauls Walden, Hitchin SG4 8BY Lead Inspector Sheila Knopp Unannounced 9 August 2005 10:10 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Stagenhoe Park Address Sue Ryder Care Centre Stagenhoe Park St Pauls Walden Hitchin Hertfordshire, SG4 8BY 01438 871215 01438 871083 fran.short@suerydercare.org Sue Ryder Care Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Application to CSCI in progress Care home with nursing 50 Category(ies) of PD Physical Disability - 50 registration, with number PD(E) Physical Disability - 50 of places Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate people with physical disability caused by chronic illnesses such as Huntingtons disease and other neurological conditions. This home may accommodate 50 people (aged 18 to 65 years and above 65 years) with physical disability who require nursing care. Date of last inspection 4 January 2005 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 neuological 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 accomodated 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 bungelow with 16 single bedrooms with en suite facilities, an activities room, a sensory room and a physiotherapy treatment area. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors who spent the majority of their time talking with residents and staff about their experiences at Stagenhoe Park. The focus of the inspection was to look at how the nursing and care needs of the residents were being met. The information in this report is based on what was observed on the day of inspection and interviews with 8 residents, 2 visitors and 7 staff. The inspectors also had informal contact with 16 residents involved in group activities and as lunch was being served. Six care plans were reviewed to provide details of how the needs of residents were being followed up and how residents were being involved in decisions being made. Sixteen hours of inspector time has been allocated to this inspection. This was a positive inspection that found the residents to be relaxed and comfortable. There was a lively good humoured atmosphere among residents taking part in planned activities during the morning. Residents who needed to rest or who remained in bed were also comfortable and received regular attention from staff. Co-ordination between the nurses, care staff and the activities staff ensured the needs of residents were individually supported as they moved about the building between activities. What the service does well: Residents and visitors report that they are made to feel that Stagenhoe is their home and nothing is too much trouble. A relative commented that the ‘residents come first’. The residents and their relatives were very positive about their relationships with staff and the care received. Two residents said ‘ The staff are angels, nothing is too much bother’, ‘If we are upset for any reason they want to know why’. Residents are supported by an experienced, well-trained and committed staff team who are responsive to their changing needs. The staffing levels provided are maintaining good levels of nursing care as evidenced by the absence of pressure sores and maintenance of body weight in residents for whom these are high-risk areas. A comment card the Commission received from a health care professional said that the service was ‘excellent’. Over 50 of care staff have National Vocational Qualifications (NVQ) in care. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 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 I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 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 standard(s) 2 Residents and their representatives confirmed that they had received detailed information about the services provided at Stagenhoe Park enabling them to make an informed choice. Discussion with residents and a review of care plans confirmed that detailed assessments of need are carried out to ensure the home is able to provide appropriate support. EVIDENCE: Detailed information about the home and support services available to individuals with neurological disorders are available in the front hall and around the home. Discussions with residents, their representatives and a review of care records confirmed that they were involved in setting out how their needs were to be met. Information about services in the home including the last inspection report are sent to residents enquiring about a place in the home. The information in the Statement of Purpose and Service User Guide have been updated following a requirement made at the last inspection. Some further changes to the Statement of Purpose were discussed with the manager following the inspection in order to clarify some points. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 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 standard(s) 6, 7 & 9 The individual needs of residents are set out in detailed care plans which have been discussed and agreed with the resident and their representatives. As changes occur or further assessments are required to support informed risk taking staff have involved residents and their representatives and the decisions reached are clearly recorded in the care records. EVIDENCE: The 6 care plans examined provided detailed information about how each residents wished to be cared for based on assessments of nursing, personal, social and healthcare needs. The records provided confirmation of what the residents, their relatives and staff discussed with the inspector. Regular reviews of care needs were being carried out and records had been updated to reflect changes. Records were available of the formal reviews taking place between the home, resident, relatives and the placing authority. The care records indicate consideration is given to the wishes of the resident in relation to the gender of the person providing personal care. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 10 Detailed information was available in relation to risk taking and specifically in relation to residents with Huntington’s Disease, negotiation around food selection and the consistency of diet to provide a diet requested by the resident but also to minimise the risk of choking. Risk assessments were in place to support residents requiring the use of specialist aids and adaptations in relation to seating, mobility, safe moving and handling, provision of bed rails and pressure relieving equipment. The manager reported that a resident forum is being started in September to increase participation and involvement in running the home. One resident told the inspectors that they had no complaints but they would like to be involved in the decisions being made. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 11 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 standard(s) 17 The specialist dietary needs of residents with Huntington’s disease and other neurological conditions are well managed providing individual residents with the nutrition they need and the opportunity for meal times to be a positive experience. EVIDENCE: Maintaining body weight and a good nutritional balance is one of the complications of Huntington’s disease and the inspectors were impressed with how well this is managed. The care plans showed that residents were maintaining their body weight. Detailed risk assessments for the prevention of choking included input from a dietician and negotiation with the resident on the best way of managing the risk, were in place. A high level of staffing is provided at meal times as a large number of residents require one to one support from staff who are familiar with their individual responses when eating and drinking. Overall residents were very positive about the meals being served. Choices are offered but a small number of residents did not seem to be aware of this. The Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 12 manager agreed to look into this and ensure service users were made aware of the options available to them. Examples of how individual likes and dislikes are supported were given to the inspectors. This included having curries available for one person. Special occasions are celebrated with cakes and meals. Visitors are able to order a meal if they wish. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 13 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 standard(s) 18, 19, 20 & 21 Staff respond to the wishes of residents in relation to the personal care they need to support their individuality and dignity. Residents have access to a range of health care professionals and specialist to support their physical and emotional health needs. There are safe systems in place to manage the medicines that the residents require. A sensitive approach by experienced and knowledgeable staff provides support to residents and their families as changes in health occur. EVIDENCE: All the residents observed had received a high standard of personal care with individual attention to clothing, hair care, mouth care, nail care, shaving, make up and jewellery to support their dignity and individual preferences and choices. The residents looked relaxed and very comfortable. The provision of specialist seating and the skills of staff in positioning residents was reducing much of the movement and spasm associated with the specific neurological conditions. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 14 The systems for managing and auditing the medication systems within the home were checked. The care plans demonstrated that there is a high level of input from the General Practice linked to the home and support from other community specialists. A dentist was visiting on the day of inspection and the home employ their own physiotherapist and physiotherapy assistants. Two of the care plans examined had very detailed information related to individual wishes in relation to illness and the end stage of life. Recording daily information on the psychological and social well-being of residents to provide a picture of their response to the nursing and personal care delivered was discussed with the manager. A number of records examined just reflected the physical tasks carried out which are already recorded in the care plan. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 15 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 standard(s) 22 & 23 There is an open atmosphere in which residents and relatives can raise their concerns. The staff interviewed during the inspection had a good understanding of their responsibility to report any concerns under the home’s Whistle Blowing procedure so that residents are protected. EVIDENCE: A relative confirmed they are happy to speak to any of the staff is there is a problem. Staff confirmed there was an open culture in the home in which practices can be challenged and suggestions for changes made. No formal complaints had been recorded by the home. In discussion with staff and the manager informal issues are managed through the named nurse and key working systems with staff acting as advocates for individuals were required. Staff demonstrated they had received training and understood the issues in relation to the protection of vulnerable adults. The address for the CSCI area office has been added to the information given to residents and their relatives in relation to making a complaint. The manager is putting in place a comment box for use by residents, visitors and staff to provide an additional avenue for suggestions to be made. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 16 Resident financial records were not reviewed on this occasion but assessed as being met on 4.1.05 Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 17 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 standard(s) 30 A high standard of housekeeping provides residents with a fresh, clean odour free environment in which to live. There are good systems in place for auditing and monitoring staff practices within the home to prevent the spread of infection. EVIDENCE: All the areas visited by the inspectors were found to be fresh and clean. Residents are able to individualise their rooms and a wide variety of individual furnishings and tastes were observed. There is a development plan in place for the home which was put in place following an assessment by the Sue Ryder estates department and health & safety department. The manager has been requested to keep the Commission informed on the progress being made as there are a number of public rooms which require refurbishment as the funds become available. The recent focus has been on redecorating resident rooms. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 18 Following a discussion with 2 residents on the patio it has been recommended that a suitable remote call pad be made available for use outside. When asked how they attracted the attention of staff one resident said they had to shout. There is a system for monitoring and auditing infection control practices within the home to ensure current practice is being followed. One of the nurses provides a link to the Community Infection Control team. This includes an annual Personal Protective Risk Assessment to ensure appropriate gloves and equipment are provided to protect staff. Staff confirmed they have received recent training. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 & 36 Residents are supported by an experienced well trained group of staff who responded sensitively to the needs of the service users. The level of staff provided on the day of inspection was meeting the needs of the service users. There is an annual training and development plan in place to support the professional development of the staff and the clinical competencies of the nurses. The training is linked to the specialist needs of residents at Stagenhoe Park. EVIDENCE: The information provided by the manager indicates that over 50 of care staff have achieved NVQ qualifications in care at level 2 or 3. Skills for Care (formerly TOPSS) induction and foundation training is in place for new staff. New staff are allocated a mentor to help them settle in and provide support. Staff are very positive about the level of training provided and feel supported and valued. They were aware of, and had access to, the home’s policies and procedures. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 20 Staff confirmed they received regular supervision and there are staff meetings on each unit. The registered nurses take part in clinical supervision. Staff were very knowledgeable regarding the specialist area of care being provided within the home particularly in their sensitivity to listening to and counselling residents and their families. Residents confirmed staff had time to talk to them and spent time finding out what the problem was if they were worried. The staffing levels provide a mix of nursing, care and therapy staff to support residents. Core staffing is provided on the basis of 3 registered nurses and 12 care assistants during the day and 3 registered nurses and 8 care assistants at night. There are also housekeeping, administrative, educational, management and maintenance staff. There is a low staff turnover and minimal staff vacancies were reported. Stagenhoe Park has been audited by Hertfordshire University as a training area for student nurses. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: While there are extensive quality assurance and clinical governance programmes in place to ensure that a high standard of service and nursing care are provided, developing an annual report on the outcome of the monitoring systems and the views of the residents and others involved with the home was discussed with the manager (standard 39). Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stagenhoe Park Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 23 No 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 Regulation Requirement No further requirments were made. 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. 2. 3. Refer to Standard 24 24 39 Good Practice Recommendations Continue to update CSCI on the progress of the maintanence and renewal programme including the upgrading of the ground floor lounge areas. Make suitable remote emergency call points available to residents using the garden. Provide feedback to residents and CSCI on the results of service users surveys and the outcome of the homes quality assurance systems. Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Stagenhoe Park I52 s19549 stagenhoe v242723 090805 stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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