Inspection on 19/11/08 for Stainsbridge House

This inspection was carried out on 19th November 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stainsbridge House 08/11/07

Stainsbridge House 12/12/06

Stainsbridge House 09/06/06

Stainsbridge House 09/01/06

Stainsbridge House 02/06/05

Stainsbridge House 28/02/05

Stainsbridge House 13/10/04

Stainsbridge House 18/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Stainsbridge House Gloucester Road Malmesbury Wiltshire SN16 0AJ Lead Inspector Malcolm Kippax Unannounced Inspection 19th November 2008 9:20 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 Stainsbridge House DS0000028415.V373158.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. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stainsbridge House Address Gloucester Road Malmesbury Wiltshire SN16 0AJ 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) 01666 823757 West Country Care Limited Miss Amanda Pearson (from 27/11/08) Care Home 24 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24) of places Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 24 Only the named female service user with dementia referred to in the application dated 29 November 2004 may be aged between 18 to 64 years. No service users except the one named service user in room 34 are permitted to live on the second floor of Stainsbridge House until the next phase of building work on the second floor is complete and has been passed as safe. 8th November 2007 Date of last inspection Brief Description of the Service: Stainsbridge House specialises in the care of people who have dementia. The home is situated close to the centre of Malmesbury. There are grounds at the rear of the property. Stainsbridge House is a Victorian property that has been extended over the years. A new extension to the home has been built, but it was not in use at the time of this inspection. Miss Amanda Pearson has been appointed as the home’s manager during the last year. Mr D. Gillespie, the managing director of West Country Care Limited, is in the role of ‘Responsible Individual’ for the home. The fees at the time of the inspection were between £450 and £475 a week for a single room, and £425 a week for a place in a double room. An additional charge of £1.25 a week may be made for personal toiletries. The fees do not include dry cleaning, chiropody, hairdressing, phone calls and escorting services. A copy of the last inspection report is available in the home. Inspection reports are also available through the Commission’s website at: www.csci.org.uk Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. Initially, we asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about the home’s plans for the future. Surveys were sent to the home, so that these could be given to the people who live there, to staff, and to other people who know the service. We received surveys back from one person who lives at the home, and from six staff members. We reviewed all the information that we have received about the home since the last key inspection. This helped us to decide what we should look at during an unannounced visit to the home, which took place on 19th November 2008. We made a second visit to the home on 21st November 2008 in order to complete the inspection and give feedback about the outcome. During our visits to the home we met with several of the people who lived there. We talked to staff and to the home’s manager. We looked at some records and went around the home. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: The home encourages relatives to visit and to participate in social events and special occasions. This helps the people who live at Stainsbridge House to feel at home and to keep in contact with their families. People are provided with a varied menu. We observed breakfast on both days that we visited and this was an unhurried meal. People are offered a choice of dishes and a cooked breakfast is available. There is a system of care planning which helps to identify people who need increased support with eating and nutrition. Action is then taken to monitor people’s weight and food intake more closely, so that they are not at risk of poor nutrition, which could result in ill health. People in the home are dependent on others to raise any concerns on their behalf. There are procedures in place that help with this. The home’s Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 6 recruitment procedure helps to ensure that people are protected from unsuitable staff. What has improved since the last inspection? What they could do better: Details of needs in connection with skin care must be consistently recorded in people’s individual plans, to ensure that there is always good information about these needs, and how they are to be met. The requirement for good recording in respect of pressure sore care had also been discussed at the last inspection. We made requirements at the last inspection about the home’s medication procedures. There continue to be shortcomings in the arrangements being made for administering medication, which mean that people at the home are not well protected. The home has made a number of referrals under the procedures for safeguarding adults. However further action needs to be taken to reduce the risk of people in the home being harmed or suffering abuse. This includes ensuring that appropriate risk assessments and behaviour management strategies are in place. A system of staff supervision needs to be established and consistently implemented. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 7 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. Stainsbridge House DS0000028415.V373158.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 Stainsbridge House DS0000028415.V373158.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. EVIDENCE: A number of people had moved into the home since the last inspection. We talked to Miss Pearson about the admission process. Miss Pearson said that, as manager, she normally carried out the initial assessment of a person’s needs. This included visiting the person, and talking with them and with their relatives. The home had produced its own assessment forms and checklists for recording the pre-admission details. Miss Pearson said that she had reviewed the assessment forms since coming into post, and had added some additional sections. The aim was to have obtained sufficient information in order to have a care plan in place at the time of admission. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 10 We looked at the assessments for two people who had moved into Stainsbridge House since the last inspection. The assessment forms had been completed with details of people’s needs in a range of areas, including physical support, social, communication and psychological. There was information about people’s personal backgrounds, such as their religion. One section of the assessment form was used for recording people’s feelings about the admission. One person’s needs had been assessed in August 2008 and they had not been able to move into the home until October 2008. A second assessment had been carried out in October 2008, to ensure that the information about the person’s needs was up to date. We thought that it was good practice to complete a second assessment in these circumstances. Stainsbridge House DS0000028415.V373158.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of people’s needs are set out in their individual plans. Details of needs in connection with skin care must be consistently recorded in people’s plans, to ensure that there is always good information about these needs, and how they are to be met. There are procedures in place which help to ensure that people’s health needs are met in most areas. The support that a small number of people require with their mental health needs should be considered further. This is in order to reduce the impact that the behaviours associated with these needs are having on people. People are protected by most of the home’s medication procedures and practices. The practical arrangements need to be reviewed and changes made, to ensure that the correct procedures are always followed. People’s right to respect and privacy is upheld. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 12 EVIDENCE: We looked at four people’s care records. Other records were seen when following up particular aspects of people’s care. Most of the information about people’s care was being recorded on computer, using a software programme that had been designed for this purpose. The programme had been updated since the last inspection, which we thought had improved the presentation of the information. Each person had an individual care plan. The care plans included a section for recording people’s needs (under the heading of ‘Problems’) and another section for recording the action to be taken to meet these needs. These sections reflected people’s individual circumstances, so that staff would be aware of the areas in which people required support. They highlighted matters such as relationships, communication, and how people expressed their emotions. They also covered people’s physical care needs, such as assistance with washing, dressing, and toileting. There were ‘progress of care’ sections for recording on-going information which was relevant to the care plans. We saw that entries in these sections were being made at least monthly. They showed that people’s weight was being monitored, which helped to identify any changes that might be a cause for concern. This provided information for a nutritional risk assessment and for closer monitoring of food and fluid intake if needed. Records were kept of people’s appointments with GPs, district nurses, and other health care professionals. Entries about people’s care and welfare were being recorded on a daily basis. One person had a skin condition, which was being treated by the district nurse. This was identified in the ‘Problem’ section of their care plan. We looked at the records for two other people who were seeing the district nurse for pressure sore care. This area of their care had not been recorded in the ‘Problem’ sections, which meant that their care plans did not fully cover all their needs and the support that they required with these. ‘Problems’ had been recorded in connection with people’s mental health and certain behaviours. As reported under the ‘Complaints and Protection’ section of this report, we thought that more details needed to be recorded about how people’s needs were to be met in these areas. This was with the aim of reducing the risk to people arising from inappropriate behaviour. Following refurbishment of the home, most of the accommodation was provided in single rooms, which had en-suite facilities. This made it easier for staff to provide personal care in private. When in the communal rooms we observed staff supporting people in a friendly and caring manner, and with a sense of humour. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 13 We looked at the arrangements for the handling of medicines, and followed up three requirements about medication that we had made at the last inspection. One requirement concerned the need for controlled drugs to be stored in a cupboard that meets the current storage regulations. We saw that a new cupboard had been obtained, although we were told that no controlled drugs were being administered at the time of our visits. The other two requirements concerned the need for medication to be administered safely, kept securely at all times, and for the medication administration records to be completed with a signature, or with a code for non-administration. The amount of variable doses, e.g. one or two tablets, also needed to be recorded on the administration records. We looked at the medication records during our visit on 21st November 2008. The procedure for administering medication was discussed with Miss Pearson and with a staff member. The amount of variable doses (one or two tablets) was being recorded. We saw that there had been a change in the record keeping, with the introduction of a ‘bland cream’ chart. The chart was being completed, but it lacked the detail that needs to be included in an administration record for prescribed medication. For example, the chart did not specify the type of cream that had been administered. We also saw that some hand written entries on the medication records had not been initialled by the person who made the entry. We were told that the ‘bland cream’ chart had been started on the recommendation of the dispensing pharmacist, who had recently inspected the arrangements in the home. A staff meeting had taken place in October 2008 when the pharmacist’s findings had been discussed. Staff members had been reminded at the meeting of the need to sign the records on all occasions when medication was administered. We looked at the main medication administration records. Some people’s medication was recorded as having been administered during the morning. We queried why the record of one person’s morning medication had not been completed. A staff member told us that this person had received their medication, but that they (the staff member) had then been distracted and intended to sign the record at a later time. We discussed this with Miss Pearson and confirmed the need for the records to be completed at the time that medication was administered. This was so that there could be no misunderstanding about whether, or when, the medication had been administered, and there were no deviations from the usual procedure. The medication was stored and recorded in a room that was off one of the main halls and was close to the communal rooms. This could be a busy location, with background noise, which we thought could be a factor in a staff member not being able to concentrate on completing the medication tasks without distraction or interruption. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are benefiting from the developments that are taking place in the home. These are helping to ensure that the lifestyle which people experience in the home meets their expectations and diverse needs. People maintain contact with their relatives. They are offered a varied menu and generally benefit from the way in which mealtimes are arranged. EVIDENCE: Information was displayed on notice boards about the regular activities and one-off events that took place. Group activites were being held during the week using one of the communal rooms. The activities included musical entertainment, music and movement, art and crafts, reading and bingo. A minster came to the home to take a religious service on the afternoon of our first visit. It was reported in the AQAA that spiritual needs were met by the local vicar and Catholic minister who attended the home regularly. It was also reported that if somebody moved into the home who was from a different denomination, then the home would endeavour to support them so that they Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 15 ccould continue to practice their religious beliefs. We heard about birthdays being celebrated, and arrangements were being made for entertainments to be held over the Christmas period. Relatives were invited to join in with the entertainments and to stay for a meal. We had recommended at the last inspection that the way in which activities are provided is reviewed. This was with the aim of ensuring that people at the home benefit from a more individual and specialist approach. We talked to Miss Pearson about this, and heard about the developments that were taking place. The staff member who was co-ordinating activities at the time of the last inspection had since left. Other staff had come forward to be involved and had met to discuss the planning of activities. We were told that there was no dedicated activities organiser. Miss Pearson said that an increase in staffing levels during the afternoons meant that a member of staff could be deployed primarily on activities, without the need for them to combine this with other tasks. Miss Pearson also said that it was likely that an activities person would be appointed when the home increased in size following occupation of the new extension. Relatives had been requested to complete life history questionnaires, in order to provide the home with more personal information about people’s interests and diverse needs. Memory books were being completed, which could be used during reminiscence sessions with the people who lived at the home. We had asked staff members in their surveys whether they felt that they had the right support, experience and knowledge to meet people’s different needs (for example in relation to race, ethnicity, sexual orientation and faith). Four staff members reported that this was always the case, and two staff members that they usually felt this way. Details of people’s family backgrounds were recorded in their personal records. It was reported in the AQAA that the home offered a welcoming approach to families and friends, who were able to visit at any time and stay for meals if they wished. We saw information displayed in the home, which would be of interest to people’s relatives and visitors. This included for example a copy of the last inspection report, the home’s complaints procedure, and details of forthcoming events in the home. Some people were having breakfast in the dining room when we arrived at the home on both days. People were able to take their time over the meal. Staff said that breakfast was served at different times, depending on when people wanted to get up. A cooked breakfast was available. There was a planned menu for the week, which showed a variety of meals. There was some variation in what was served in order to meet people’s individual preferences. People’s likes and dislikes had been recorded. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people in the home are dependent on others to raise any concerns on their behalf. There are procedures in place which help with this. There are matters affecting people’s well being and safety, which need to be further followed up to help reduce the risk of people being harmed. EVIDENCE: A complaints procedure had been produced and a copy of this was displayed in the home. Staff members confirmed in their surveys that they knew what to do if a resident or a relative had concerns about the home. We received one survey back from somebody who lived at the home. This person confirmed that they knew how to make a complaint. They also mentioned the home’s manager as somebody who they could speak to if not happy with something. We were told in the AQAA that the home had received five complaints during the last 12 months and that 80 of these had been resolved within 28 days. We discussed these with Miss Pearson, and looked at the records. Some of the matters raised had been dealt with informally at the time and were not recorded as formal complaints. It was agreed with Miss Pearson that it would be useful to distinguish between those issues that are raised and dealt with satisfactory at the time, and other matters that somebody has raised as a formal complaint and was expecting it to be investigated and recorded as such. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 17 It was reported in the AQQA that the home, may need to consider the use of independent mental capacity advocates (IMCAs) for people who lacked capacity within the meaning of the Mental Capacity Act, and who do not have close family support or other advocates. There was a whistle blowing policy and staff received training in abuse awareness. The home had copies of the local authority’s procedures for safeguarding vulnerable adults, and the ‘No Secrets’ booklet, which summarises the procedures. There were also a procedure for the reporting of notifications and incidents that needed to be referred to other agencies. Since the last inspection we have been notified of a number of incidents that the home has referred for investigation under the local procedures for safeguarding vulnerable adults. Details of these referrals were confirmed in the AQAA and in discussion with Miss Pearson. The incidents have involved concerns about people’s well-being and allegations about incidents of both a verbal and a physical nature. Miss Pearson confirmed the action that had been taken in respect of these referrals. We were told that the home had not received an acknowledgment for two of the referrals that had been made, and where the referrals had been followed up, the outcome of these had not always been confirmed. It was agreed with Miss Pearson that further questions needed to be asked about the referrals that had been made, to ensure that the concerns raised were appropriately followed up and acted on. Information had been recorded in people’s care records about their behaviour and the risk that this posed to other people. The ‘Problem’ sections of the care plans had been completed in respect of particular behaviours, and some outcomes had been reported in the ‘progress of care’ and other sections. The ‘Problem’ recorded in one person’s care plan referred to a risk assessment. We thought that the record of this assessment lacked detail and did not provide staff with appropriate guidance about the action that they needed to take in response to this person’s behaviour. We brought this to Miss Pearson’s attention, and she changed some of the wording at the time. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are benefiting from the changes that are being made to the home. These are providing people with a more pleasant environment, and with accommodation which better meets their needs. EVIDENCE: Stainsbridge House is situated in a residential area close to the centre of Malmesbury. There were grounds at the rear of the home, and a parking area close to the front door. We have reported at previous inspections about the building and refurbishment work that has been taking place over the last few years. This has involved changes to the existing accommodation and the addition of a new extension. People have benefited from improved facilities, such as new en-suites areas in their bedrooms and changes to the communal areas, including a new lift. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 19 Externally, a new patio area has been built and the grounds have been replanted and reinstated, following completion of the building works. An extension to the home has been built, with the aim of increasing the size of the home to 45 places. We have received an application for the increase in places, although the approval process had not been completed at the time of our visits. In addition to new bedrooms, the extension will also provide more communal areas, for the benefit of all the people who live at the home. The current provision of shower and bathrooms was less than would normally be expected for the number of places in the home. This was due to be rectified when the new facilities in the extension became available. We went around the home and were shown some of the bedrooms. The accommodation that we saw looked well decorated, clean, and there were no unpleasant odours. There was a system in place for the disposal of clinical waste into bins that were located outside the home. We noticed that some of the joins in the landing carpet were not secured. The carpet edges were not raised, but we advised Miss Pearson to ensure that they received attention to ensure that they did not become a tripping hazard. Fastenings had been fitted to the windows in the bedrooms that we saw. These restricted the amount that the window could open, which reduced the risk to the people who lived at the home. We have been told that restrictors are fitted to all windows. There were staff call alarm points throughout the accommodation. We also saw pressure floor pads in people’s rooms, which would alert staff if people left their beds and they needed assistance during the night. The call system was tested from one of the bedrooms. It worked appropriately and there was a quick response from a staff member who came to the room. Mr Gillespie (responsible individual) has been overseeing the development of the home and the new extension. Mr Gillespie has received advice about creating an environment that meets the needs of people with dementia. Initial work has included painting the toilet doors in a contrasting colour, so that they can be more easily identified. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are being met by the staff team. The support that people receive will be enhanced by further training and guidance for staff. There is a recruitment procedure which helps to ensure that people are protected from unsuitable staff. EVIDENCE: There was a staff rota, which showed the deployment of staff throughout the day. We talked to Miss Pearson about current staffing levels and how these were being kept under review. Staffing levels had increased during the last year. There were four care staff working between 7.30 am and 5.00 pm, when the staffing level reduced to three carers. Miss Pearson confirmed that she was supernumerary. Ancillary staff were deployed to cover the cooking, laundry and domestic work. We have discussed future staffing levels with Mr Gillespie, in relation to the new extension and the additional people who will be accommodated. It has been agreed that staffing levels will increase in a phased way, in line with increases in the number of people being supported. We asked staff members in their surveys whether there were enough staff to meet the individual needs of all the people who used the service. Three staff Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 21 members reported that there always were, and two people that there usually were. One staff member reported ‘sometimes’ and commented, ‘It’s been better of late, but there are still times when more staff are needed’. It was reported in the AQAA that there was a staff team of 17 permanent carers, of whom nine had achieved a National Vocational Qualification (NVQ) at level 2 or above. Miss Pearson said that the number of qualified staff had reduced during the last year as people had left. Three staff members were currently undertaking their NVQ and another six staff members were shortly to enrol for the qualification. In their surveys, the staff members confirmed that they were being given training which was relevant to their role, helped them to understand and meet people’s individual needs, and kept them up to date with new ways of working. One staff member commented, ‘the new manager is hot on training staff, which is good for the morale of staff and residents’. We met with staff members who confirmed that they had received mandatory training. One staff member had just received their certificate for completing a course on medication and they were very happy with this achievement. Miss Pearson confirmed the training that had been planned in order to ensure that staff training was up to date. Some staff were booked to go on a first aid course and two staff were due to attend a course that would enable them to train other people in moving and handling. The training records were being updated at the time of our visits, although there was no overall training plan for the coming year. Staff had undertaken basic dementia awareness training. Miss Pearson had held in-house training events with staff members, which were geared to increasing their understanding of dementia and how people should be supported. We discussed the need for more training about how staff interacted with the people who lived at the home. We gave examples of what we had heard, such as staff talking across the hall about individual residents, when a more discreet discussion would have been appropriate. There were also a lot of occasions when staff showed affection and a very caring approach towards the people they supported. We reported at the last inspection that a new induction programme had been introduced during the last year. We had recommended that the induction booklets included timescales for the completion of the different parts of the induction programme. This was so that priorities could be identified and staff members’ progress with completing their induction could be more easily monitored. Miss Pearson showed us a new induction booklet that was being used, which did include timescales. It was not clear whether the induction programme was consistent with the common induction standards, and this should be followed up. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 22 We looked at the recruitment records for three staff members who had been employed since the last inspection. The recruitment procedure included Criminal Record Bureau (CRB) and protection of vulnerable adults list (POVA) checks. Written references, proof of the applicants’ identifies, and their authority to work, had been obtained. The staff members had completed application forms, which included questions about their health and employment history. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is good overall. This judgement has been made using available evidence including a visit to this service. People are benefiting from the current management arrangements. However, there are systems that need to become established, to ensure a consistent approach and so that the home is always run in people’s best interests. EVIDENCE: Miss Pearson was appointed as the home’s manager in July 2008. We then received an application for Miss Pearson’s registration as manager. The application process was completed shortly after we visited the home as part of this inspection. Miss Pearson has now been approved as the home’s manager. As part of the registration process, the applicant is required to show that they are a ‘fit person’ to manage the home. ‘Fitness’ refers to a number of personal attributes, such as having integrity and being of good character. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 24 The applicant will also have demonstrated that they have the qualifications, skills and experience that are necessary for managing the care home. Miss Pearson has a range of qualifications, which include NVQ at level 4 in Health and Social Care, and the Diploma in Person Centred Dementia Care. Miss Pearson has enrolled on the Leadership and Management Award and is currently studying for the Diploma in Dementia Studies with the Bradford Dementia Group. We received one survey back from somebody who lived at the home. This person described Miss Pearson as ‘very helpful’. One staff member commented, ‘Our manager is new and has a lot on her plate, she has done an excellent job in fitting in’. Another staff member commented that Miss Pearson had been ‘most supportive’. We asked staff members in their surveys whether their manager met with them to give support and discuss how they were working. Five staff members responded that this happened ‘regularly’, and one staff member responded ‘often’. We talked to Miss Pearson about the arrangements being made for staff supervision. A record had been kept of supervision meetings during the last year. It was agreed with Miss Pearson that there had been some shortfalls in the expected frequency of meetings, and a more planned and consistent approach was needed. There was no deputy manager in post to support the manager with undertaking the supervision of staff. Miss Pearson said that this position had been advertised, which we thought was a positive development. Miss Pearson described processes that she has used to gain feedback from people about the service. This has included the use of surveys with relatives. Mr Gillespie, as the responsible individual, was taking the lead in producing an annual development plan for the home, based on the feedback obtained and on the business objectives. We received an AQAA that included a lot of information about how the home is performing and how it might further develop. The home has obtained an audit based system for quality assurance although this was not being formally implemented. We advised Miss Pearson that a comprehensive policy is needed for quality assurance, which shows how the different elements are connected. Miss Pearson confirmed that the home did not normally manage or look after money on behalf of the people who lived there. The exception to this was when money, for example from a relative, was left for safekeeping for a while. People received support with their financial affairs from people outside the home. The home then invoiced these people for certain expenditures, such as hairdressing and chiropody. Information was provided in the AQAA about the arrangements being made for health and safety. The home has sent notifications to the Commission in connection with certain events and accidents that have occurred in the home. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 25 Some health and safety records were looked at. The home’s fire risk assessment had been reviewed in relation to the development of the new extension. Guidance had been produced for staff about safety within the property. The temperature of the hot water at different locations was being checked weekly and records kept. Miss Pearson said that staff also checked and recorded the temperature of the hot water when preparing a bath. A thermometer was kept by the bath for this purpose. Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 26 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes, in part 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 Requirement The incidence of pressure sores must be recorded in a person’s individual care plan and reviewed on a continuing basis. Medication records must be appropriately completed. This includes ensuring that: • Medication is recorded at the time that it is administered. • The recording of creams includes full details of the cream that has been administered, and by whom. • Hand written entries on the medication administration records are signed by the person who has made the entry. Arrangements must be made to prevent people being harmed or suffering abuse, or being placed at risk of harm or abuse. This includes ensuring that all allegations and concerns are appropriately followed up. Timescale for action 22/11/08 2. OP9 13(2) 22/11/08 3. OP18 13(6) 22/11/08 Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 28 4. OP18 13(6) Arrangements must be made to prevent people being harmed or suffering abuse, or being placed at risk of harm or abuse. This includes ensuring that appropriate risk assessments and behaviour management strategies are in place and are being kept under review. An appropriate system of staff supervision must be in place. 31/12/08 5. OP36 18(2) 31/12/08 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 OP10 Good Practice Recommendations That action is taken to develop staff members’ understanding of person centred care and how their interactions can influence this. That the condition of the carpets is checked and action taken where necessary to ensure that the joins cannot become a tripping hazard. That action continues to be taken to develop an environment which reflects the needs of people with dementia. That a training plan is produced based on a training needs assessment for the staff team. That a policy for quality assurance is produced. 2. OP19 3. OP19 4. 5. OP30 OP33 Stainsbridge House DS0000028415.V373158.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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