CARE HOMES FOR OLDER PEOPLE
Stainsbridge House Gloucester Road Malmesbury Wiltshire SN16 0AJ Lead Inspector
Malcolm Kippax Unannounced Inspection 8th November 2007 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.V351397.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.V351397.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 Mrs Mary Webb Care Home 24 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24) of places Stainsbridge House DS0000028415.V351397.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. 12th December 2006 Date of last inspection Brief Description of the Service: Stainsbridge House specialises in the care of people who have dementia. The home is situated on a main road 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. Work on a new extension was continuing at the time of this inspection. Other building and refurbishment work has been on-going in the existing accommodation since the last inspection. This is resulting in some major changes and improvements within the home. The majority of the service users had newly refurbished rooms with en-suite facilities at the time of this inspection. Mrs Mary Webb has recently been appointed as the home’s manager. 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 and 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.V351397.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit on 8th November 2007, between 9.20 am and 4.20 pm. A second visit was arranged with the home’s manager, Mrs Webb, in order to complete the inspection. This took place on 21st November 2007 between 9.15 am and 3.40 pm. During the visit on 8th November 2007, a pharmacist inspector from the Commission looked at the home’s arrangements for the handling of medicines Evidence was obtained during the visits through: • • • • Time spent with the service users in the communal areas of the home. This included a period of time spent in the lounge watching how the service users were occupied and being cared for by staff. Meetings with Mrs Webb, Mr Gillespie and with three members of staff. A tour of the home. An examination of records, including the service users’ files. Other information has been taken into account as part of this inspection: • An Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by Mr Gillespie. The AQAA is the provider’s own assessment of how well they are performing. It also provides information about what has happened during the last 12 months. Surveys that were completed by nine relatives and by five staff members. Notifications and reports that the Commission has received about the home since the last key inspection. • • Two shorter inspection visits have been made to the home since the last key inspection. Other visits have also been made in connection with the on-going refurbishment work. Matters arising from these visits have been referred to in this report, where appropriate. 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:
People are given information about the home and have their needs assessed before they move in. They receive confirmation that their needs can be met and have the opportunity to talk about an individual care plan. People’s care needs are then set out in individual plans, so that staff know what support they need to give. Daily records are kept, which help staff to identify changes in people’s health and well being. Procedures have been
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 6 developed so that any concerns, for example about weight loss, can then be followed up and people’s needs more closely monitored. Assessments are being undertaken which help to ensure that people are safe, for example when using bed rails or when they may be at risk because of changes in their health. Relatives generally feel that people’s care needs are met. They think that the staff are caring towards people in the home and are working hard to meet their needs. The relatives commented that staff are ‘very loving and caring’, ‘showed affection’ and were ‘kind and caring’. It was evident from seeing people in the lounge that staff members mostly engage with service users in a friendly and caring manner, and with a sense of humour. The staff members’ contact with service users at this time was important in providing people with some stimulation and activity. People receive support with keeping in contact with their relatives. In their surveys, the relatives confirmed that they are welcome to visit and feel that they can talk to staff about things. There is a varied menu and people benefit from flexible meal arrangements. They are given the time that they need with their meals. There is a choice of dishes for breakfast, including cooked. A number of service users had scrambled egg on the day that the home was first visited. The cooks are aware of the service users’ particular likes and dislikes and provide meals that are known to be popular. People in the home are dependent on others to raise any concerns on their behalf. There are procedures in place that help with this. Relatives are informed of the home’s complaints procedure and staff know what they should do if they have any concerns. The home’s recruitment practices help to protect service users from unsuitable staff. What has improved since the last inspection?
One of the main developments has been the appointment of a new manager, whose registration has now been approved. The new manager, Mrs Webb, has previous experience of working in a dementia care service and has relevant qualifications. People can now feel more confident about the management of the home and how the home will be run. In their survey, one staff member commented: ‘Our new manager has not been with us very long but she is very approachable and has already brought new ideas into the home. She listens to us and helps us in any way she can’. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 7 Mrs Webb is reviewing the service users’ assessment and care records in order to ensure that the contents are relevant and sufficiently detailed. This means that some people’s records now include better information about their diverse needs and the things that they like to do. Building work has continued at the home and people are benefiting from the refurbishment that has taken place. The work has produced new bedroom ensuite areas and a higher proportion of single rooms. This makes it easier for personal care to be given in private and better facilities have been provided. The communal areas have improved and a new passenger lift has recently been commissioned. The home has received advice about how to create 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. What they could do better:
The process of reviewing the service users’ assessment and care records needs to be completed as a matter of priority, so that all people can feel confident that the records reflect their interests and other matters that are significant in relation to their dementia. Good information will help ensure that there is a more ‘person centred approach’ in the way that people are supported in the home. There are systems in place for responding to concerns about people’s health and welfare. However these must be followed better, so that people’s conditions are well monitored and their care is appropriately recorded. The way that medicines are administered must also improve, to ensure that people in the home are not at risk from unsafe practices. Care practice in the home should ensure that there is always an individual, rather than institutional, approach to supporting service users. A weighing session was observed in the lounge. This was well intentioned, although it did not take place in an appropriate setting. Action should be taken to help staff members develop their understanding of person centred care and how their interactions can influence this. The way in which staff are deployed should be reviewed in order to ensure that staff can provide support in a consistent way and without interruption. The provision of activities should also be reviewed in order to ensure that service users benefit from a more individual and specialist approach and that their different needs are met. It was evident from the home’s complaints file that people’s concerns and complaints are being discussed in order to resolve issues. However, not all the relevant details are being formally documented. Records should be kept of the different stages of a complaint investigation. This is so
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 8 that the action taken can be clearly identified and people can feel confident that any concerns have been appropriately responded to. At the time of this inspection the main building work was focussed on the new extension. Further benefits for service users will be dependant upon completion of this and other on-site work. This will ensure, for example, that there are more bathrooms and that service users will be able to make full use of the garden. It will also mean that a more normal home environment can be maintained. The work should therefore be completed as soon as possible. Smaller type maintenance and some health and safety type matters must be better monitored and attended to promptly. The maintenance book could include the dates on which items of work have been completed. This would help to identify outstanding items and to ensure that work is carried out without undue delay. Comments made in the some of the relatives’ surveys indicated that they would like to have more information about what the arrangements will be in the home when the extension is completed. They particularly want to be reassured that there will be adequate staffing in the home. Changes in the staff team have meant that some new staff have not yet attended certain courses. There has also been a reduction in the number of staff with a National Vocational Qualification. Mrs Webb is producing a training plan for 2008 and this should ensure that the number of qualified staff increases as soon as possible. The induction booklets that are given to new staff need to be consistently completed. Timescales for the completion of the different parts of the induction programme could be added to the booklets. This is so that priorities can be identified and staff members’ progress with completing their induction can be more easily monitored. 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.V351397.R01.S.doc Version 5.2 Page 9 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.V351397.R01.S.doc Version 5.2 Page 10 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 overall. This judgement has been made using available evidence including the visits to this service. People’s needs are assessed before moving into the home. EVIDENCE: The personal records were looked at for four people who had moved into Stainsbridge House since the last inspection. Each record contained details of a pre-admission assessment that had been carried out. The home had produced its own forms and checklists for recording the preadmission details. These records had been amended and added to during the last year, as different managers have been involved. The main assessment form covered a range of personal needs, including social, communication and psychological. One section of the form was used for recording people’s feelings about the admission. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 11 Mrs Webb said that she would be reviewing the current assessment and care forms. This was particularly to look at how well they provided information about people’s dementia and their individual backgrounds. The files included other information that had been received in connection with the admission, such as hospital transfer letters and local authority care review minutes. People had been sent letters confirming that the home could meet their needs. The letters referred to the home’s terms and conditions. People were advised in the letters that this information was available in larger type. The letters also invited people to talk about the care plan that was being proposed. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 12 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 the visits to this service. People’s main care needs are set out in their individual plans. They would benefit from an approach to their care that is more ‘person centred’. Procedures have been introduced for monitoring people’s health needs, but these are not always effectively implemented. People could be at risk from the medication administration practices in the home. EVIDENCE: Four people’s care records were examined. Other people’s records were also looked at when following up particular aspects of their care. Most of the information about people’s care was being recorded on a computer, using software that had been designed for this purpose. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 13 Each person had an individual care plan. The plans included ‘care evaluations’. These identified different areas of need and the action that should be taken by staff. The evaluations covered areas such as mobility, behaviour and different aspects of people’s personal care. Entries were being made in a ‘general progress’ section of the plan. Risk assessments had been recorded in connection with some areas of need. These included the use of bedrails. The content of the records differed in terms of their detail and the quality of information they provided. Mrs Webb said that she was going through people’s individual records, in order to ensure that the information was relevant and of a good standard. This included looking at how well the records reflected people’s interests and other matters that would be significant in relation to their dementia. It has been recommended at previous inspections that more sections of the care recording system are completed, as a way of providing this information. Entries about people’s care and welfare were being recorded on a daily basis. Records were kept of people’s appointments with GPs and other health care professionals. People’s weight was being recorded each month, as a means of identifying any changes that might be a cause for concern. This provided information for a nutritional risk assessment and for closer monitoring if needed. One person had been assessed on 8th November 2007 to be at moderate risk. According to the guidance, this level of risk should have resulted in weekly monitoring. This had not been started when the assessment was looked at during the visit on 21st November 2007. The delay was brought to Mrs Webb’s attention Fluid intake was also being monitored. One person had been seeing the district nurse because of their need for pressure area care. It was recorded that the nurse had instructed the person to be turned during the night. A ‘Turning, Care and Fluid’ chart had been produced, although information on the chart about recent pressure area care had not been consistently recorded. This gave an incomplete picture of the care that the person had received. Mrs Webb said that this person had responded to treatment and nobody else had any pressure sores. The relatives who completed surveys reported that the home gave people the care that they expected. They commented that staff were ‘very loving and caring’, ‘showed affection’ and were ‘kind and caring’. The refurbishment of the accommodation has produced new bedroom en-suite areas and a higher proportion of single rooms. This has made it easier to give personal care in private and has provided better facilities. It was evident from observations in the lounge that staff mostly engaged with service users in a friendly and caring manner, and with a sense of humour. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 14 On occasions when having a conversation, staff mainly talked with somebody other than the service user who they were attending to at the time. This meant that the interaction was less beneficial and not as personal for the service user as it could have been. While in the lounge, a number of service users had their weight measured and recorded in front of other people, including a visitor. Although, well intentioned, this was not an appropriate setting for the activity. Most service users appeared to accept this practice, although one person questioned the need for it, and staff did not talk to another person. Arrangements for the handling of medicines were looked at by the Pharmacist Inspector, who reported as follows: • The morning medication round was taking place at the time of the inspection. The medication room and trolley were left unlocked and unattended whilst service users were receiving their medication. Some medicines were returned to the trolley after being removed from their packaging as service users were not ready to take them or refused them. The medication administration record was signed at the time of administration and refusals were noted. However, some gaps were seen in the record, which may have related to medicines being out of stock which was not recorded. Where a variable dose (one or two tablets) had been prescribed, the exact dose given was not recorded. Staff showed a good knowledge of the service users and their individual needs for medication. All staff who administer medication are given training and a procedure is available. Records of medication received into the home and returned for destruction were recorded. The controlled drug cupboard does not comply with recent legislation. • Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 15 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 adequate overall. It is good in respect of standard 15. This judgement has been made using available evidence including the visits to this service. People’s diverse needs are being better recognised. A more planned and specialist approach will help to ensure that people’s needs are fully met. People maintain contact with their relatives. They are offered a varied menu and benefit from how the mealtimes are arranged. EVIDENCE: Activities were planned to take place each day and information about these was displayed in the home. A main activity was arranged for the afternoons. The list of activities included musical entertainment, music and movement, art and crafts, reading and bingo. The activity in one of the lounges was observed during the afternoon of 8th November 2007. People mostly spent time by themselves and there was little contact beween service users. One person enjoyed having a visitor’s company. Other people were reading, sleeping, or just sitting. When there were interactions with staff these were mainly good.
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 16 Most people responded positively when a staff member went around the lounge offering to give them a hand massage with cream. Most people appeared to enjoy the experience. One person rejected the offer and they appeared withdrawn. They were left alone until it was their turn to be weighed a few minutes later. The arrangements being made for activities have been discussed at recent inspections. Recommendations have been made about having a more individual and specialist approach to the provision of activities. There have been some positive developments. The home has got better information about activities that are suitable for people with dementia and a staff member has been given responsibility for organising the activities. It was seen in the service users’ records that more information was being recorded about the sort of individual activities that people would benefit from, such as helping in the kitchen (this person used to work in a canteen) or going out for a short walk. However this type of information was not being consistently recorded and put into practice. It was reported in the AQAA that people are able to attend a church if they wish and that an escort can be arranged to take them. People’s spiritual needs were also reported to be met by local ministers who come to the home. In their survey, one staff member commented: ‘It would help if there was more information given when the client comes into the home, for example, what sort of things they did when young, whether they enjoy mixing, music or anything else which might help them settle in’. Other staff commented that service users could be supported with going out more. The garden has been out of use for a considerable time because of the building work. However a new patio area was nearing completion at the time of this inspection. One relative commented in their survey that more variation in routines would be of help. They thought that this could be available as and when the new extension and the gardens were completed. Staff members said that they sometimes had to leave the afternoon activity in the lounge in order to support people with their personal care, such as having a bath. When in the lounge the care staff were seen to be having to deal with a number of different tasks, including being on the telephone. The home’s manager was absent at this time. In their surveys, three people confirmed that the home always helped their relative in the home to keep in touch with them. Two people reported that this usually happened. People commented on the support that they received as relatives, for example ‘They have given me time to talk to them’ and ‘Friendly, always receptive to visitors’. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 17 One relative commented: ‘The food is really good. Its all freshly prepared using fresh ingredients, which I feel is very important’. In the AQAA it was reported that mealtimes were something that the home did well and that efforts were made to ensure that mealtimes were a pleasurable experience’. It was reported at the last inspection that home aimed to have a ‘restaurant style’ approach to meals. This had been reflected in the practical arrangements for the lunch meal, which was seen at that time. The meal arrangements were looked at again on 8 November 2007 and a similar approach was evident. Some people were having their breakfast when the inspection visit started. They were able to choose a cooked dish (scrambled egg). People were taking their time over breakfast and they said that they enjoyed the meal. Staff members said that the breakfast was served at different times, depending on when people wanted to get up. There was a planned menu, which showed a variety of meals. A cook said that the selection of meals was generally popular with all the service users. There was some variation in what was served in order to meet people’s individual preferences. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 18 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 good overall. This judgement has been made using available evidence including the visits to this service. People in the home are dependent on others to raise any concerns on their behalf. There are procedures in place that help with this. EVIDENCE: A complaints procedure has been produced and displayed in the home. It was reported in the AQAA that the home ensured that all people are aware of the procedure. All the relatives who completed surveys confirmed that they knew how to make a complaint. It was reported in the AQAA: ‘We may need to consider the use of independent mental capacity advocates (IMCAs) for residents who lack capacity within the meaning of the Mental Capacity Act and who do not have close family support or other advocates’. The Commission has not received any complaints about the home during the last year. Some concerns had been raised directly with the home. The process for following up complaints was discussed with Mrs Webb. Relevant records were being kept in an office file. It was evident that the home was discussing people’s concerns and complaints in order to resolve issues. However, not all the relevant details were being formally recorded. For example, somebody had not received written confirmation of the outcome of their complaint. Mrs Webb said that this would receive attention and that suitable forms may already exist in the home.
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 19 Staff confirmed in their surveys that they knew what to do if a service user or relative had concerns about the home. One staff member commented: ‘I would take the concerns straight to the manager, higher if necessary’. It ws reported in the AQAA that staff had received training to make them aware of situations that may give rise to abuse. The staff members who were spoken with mentioned the guidance and training that they had received about abuse and protecting people. This included watching a DVD and being given a copy of the ‘No Secrets’ booklet. This booklet gives information about the procedures to follow in Wiltshire if an allegation of abuse has been made. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 20 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 overall, taking into account the improvements that are being made. This judgement has been made using available evidence including the visits to this service. People are benefiting from major refurbishment of the home. EVIDENCE: Stainsbridge House is situated in a residential area close to the centre of Malmesbury. There are grounds at the rear of the home overlooking a river. Building and refurbishment work has been continuing at the home for over two years. This has involved changes to the existing accommodation and the addition of a new extension. Much of the work in the original building has been completed during the last year. Visits have been made to the home in connection with the on-going work and the internal changes.
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 21 The main improvements have been to the bedrooms (which have been refurbished and had en-suites installed) and in the provision of new communal areas. A new passenger lift has recently been commissioned. At the time of this inspection the main work was focussed on the extension. Further benefits for service users will be dependant upon completion of this and other on-site work. This will ensure, for example, that there are more bathrooms and that service users will be able to make full use of the garden. It will also mean that a more normal home environment can be maintained. People expressed a range of views in their surveys about the impact of the work. There was concern about the length of time it was taking, but people were generally looking forward to the end result and the full benefits that this would bring. Mr Gillespie said that he was in discussion with the Commission’s registration team about a completion date for the extension. Some parts of the accommodation have been looked at in detail during visits made to the home since the last key inspection. The communal areas were looked at again during the visits made as part of this inspection. The impact of the building work around the main accommodation had much reduced although work was still being undertaken in the vicinity of the new extension. The accommodation was generally clean, with several areas having been redecorated recently. In their survey, one relative commented that the service users’ rooms were maintained ‘in good, clean and comfortable condition’. A new position had been found for the clinical waste bins that were being kept outside the home. These are now located away from the pavement. Some items were found to be in need of attention when going around the home. A bottle of toilet cleaner was being kept on a shelf in the bathroom. This was later removed to a safer area. A join in the carpet outside the bathroom was not secured and the carpet was lifting up. The door to a maintenance room was not locked. Mr Gillespie was informed of these items and he attended to them. A maintenance book was kept in the kitchen where staff could write in jobs that needed to be done. There was no record being kept to show when a job had been completed, although it appeared that some jobs had been mentioned more that once. Mr Gillespie has received advice about creating environments that meet 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. From the observation in the lounge it was seen that consideration should be given to ways in which people can manage their drinks and put them down safely. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 22 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 adequate overall. This judgement has been made using available evidence including the visits to this service. Improvements are being made in the provision of training for staff. Further developments are needed in order to ensure that service users benefit from an effective staff team. The home’s recruitment practices help to protect service users from unsuitable staff. EVIDENCE: The rotas showed that there were usually three care staff on duty throughout the day. Ancillary staff were deployed to cover the cooking, laundry and domestic work. There had been rare occasions in recent months when a carer had also covered duties in the kitchen because the cook was absent. This was discussed with Mrs Webb and Mr Gillespie, who confirmed that it was no longer happening. Staff members and relatives gave mixed feedback about how well the current arrangements were meeting people’s needs. Relatives commented positively about the work that the carers did. One person commented that staffing was ‘perfectly adequate’, but others expressed concerns, particularly in view of a proposed increase in the number of service users. One person commented: ‘We would like reassurance that once the building work is completed and the new rooms let that the staffing will be increased to
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 23 provide the correct ratio to provide the care and increase the activities available to interest the residents’. Other commented: ‘I do so hope that as the resident numbers increase following the extension opening that they will have adequate staff as the residents will pick up on the unconscious communication if the staff are stressed and overworked and will become unsettled in themselves’ and ‘They must improve the staffing levels in this home especially as it is being doubled in size. The present staff levels are inadequate which must affect staff health and morale due to the long hours they have to work’. One of the staff members commented in their survey: ‘I personally wish we could have a few more staff so we could do a bit more, for example if we wanted to take somebody into town for a walk we would not have enough staff left’. The deployment of staff was discussed with Mr Gillespie and with Mrs Webb. Mr Gillespie reported that the number of staff hours being provided were meeting the Residential Forum’s guidelines. It was confirmed that there would need to be agreement about the staffing arrangements when the home increased in size. Mrs Webb said that another carer would shortly be starting, which would increase the level of staffing during the day. Changes in the staff team meant that some new staff had not yet attended certain courses. There had been a reduction in the number of staff members who hold a National Vocational Qualification (NVQ). It was reported in the AQAA that four staff have achieved a NVQ at level 2 or above and three other staff members were working towards their NVQ. The three staff members who were met with on 21st November 2007 had all been employed since the last inspection. A new induction programme has been introduced during the last year. The new staff members had their own induction booklets. These had not been consistently completed to confirm the induction that they had received. The booklets did not identify timescales for completing the different areas to be covered. Staff training has been discussed at recent inspections. Progress has been made in providing the training that staff need. Recommendations have been made about the recording of training, and the need to complete an assessment of staff training needs and a plan of how these are to be met. Mrs Webb confirmed that a training matrix was to be completed for 2008. Staff were due to attend Introduction to Dementia and Abuse Awareness courses in December 2007. As reported under the section ‘Health and Personal Care’, there were matters that should be followed up with staff in connection with how care is practiced. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 24 Three staff employment files were looked at. The recruitment procedure included Criminal Record Bureau (CRB) and protection of vulnerable adults list (POVA) checks. Written references were being obtained. Mr Gillespie said that evidence of proof of identity was obtained when the CRB checks were made. Copies of these records were not being kept in the home and Mr Gillespie confirmed that these would be added to the staff members’ files. In their surveys, the staff members confirmed the checks that had been carried out when they were recruited. It had been recommended at the last inspection that notes are kept of the interviews with job applicants. This was in order to ensure that there was a record showing how issues arising from the application form and the interview had been followed up. The previous manager had recorded some notes, although further details would have been beneficial for the new manager. Mr Gillespie was advised to take advice about how one section of the application form could be amended, with the aim of getting additional information from applicants. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is good overall. This judgement has been made using available evidence including the visits to this service. People can now feel more confident about the management of the home and how the home will be run. EVIDENCE: Mrs Webb was appointed as the home’s manager in September 2007. Her application to be the registered manager was being dealt with by the Commission at the time of this inspection. The application has since been approved. 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.V351397.R01.S.doc Version 5.2 Page 26 The applicant will also have demonstrated that they have the qualifications, skills and experience that are necessary for managing the care home. Mrs Webb has previous experience of working in a dementia care service. She has obtained a certificate in basic dementia care mapping and person centred care. In their survey, a staff member commented: ‘Our new manager has not been with us very long but she is very approachable and has already brought new ideas into the home. She listens to us and helps us in any way she can’. The Commission has been receiving reports from Mr Gillespie, which include comments arising from his monthly monitoring visits. Mr Gillespie has also had an operational role in the home, particularly in relation to the arrangements being made for the building work and other developments affecting the home. Mr Gillespie has taken the lead in developing the home’s systems for quality assurance. This has included gaining people’s views about the home through the use of surveys and holding meetings with the service users’ relatives. Since the last inspection, the Commission has received a report of the findings and an action plan. New surveys were due to be sent out again in December 2007. Mr Gillespie provided a lot of detail in the AQAA about how the home is performing and has developed during the last year. It identified various areas for further improvement. These included providing more staff training, completing the refurbishment and extension of the accommodation, and making the care more person centred. Mrs Webb confirmed that the home was not managing or looking after money on behalf of service users. Service users received support with their financial affairs from people outside the home. Information was provided in the AQAA about the arrangements being made for health and safety. Aspects of health and safety have also been looked at during the visits that have been made to the home in the last year. The home has sent notifications to the Commission in connection with certain events and accidents that have occurred in the home. Some health and safety records were looked at during this inspection. The home’s fire risk assessment had been reviewed in October 2007. Regular assessments were being made in respect of the on-going building works, and guidance has been produced for staff about safety within the property. As reported under, Standard 19, there are some day to day maintenance items that need to be more closely monitored and responded to. A member of staff confirmed that they tested the temperature of the hot water when preparing a bath.
Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 17(1)(a) Requirement A record must be kept of the treatment provided to service users in connection with the incidence of pressure sores. Medication must be administered safely and kept securely at all times. Medication administration records must be completed with a signature or code for nonadministration. The amount of variable doses given must be recorded. All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. Suitable arrangements must be made to ensure that the home is conducted in a way which respects the privacy and dignity of service users. This requirement is made in respect of the arrangements being made for weighing service users. Ensure that any unnecessary risks to the health or safety of
DS0000028415.V351397.R01.S.doc Timescale for action 22/11/07 2 OP9 13(2) 14/12/07 3 OP9 13(2) 14/12/07 4 OP9 13(2) 31/03/08 5 OP10 12(4) 22/11/07 6 OP19 13(4)(c) 22/11/07 Stainsbridge House Version 5.2 Page 29 service users are identified and as far as possible eliminated. This includes ensuring that hazards and items in need of repair are promptly and appropriately responded to. This requirement was made at the last inspection. 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 OP7 Good Practice Recommendations That the process of reviewing the service users’ assessment and care records is completed as a matter of priority. This is so that people can feel confident that their records reflect their interests and other matters that are significant in relation to their dementia. That action is taken to develop staff members’ understanding of person centred care and how their interactions can influence this. That the way in which activities are provided for service users is reviewed in order to ensure that service users benefit from a more individual and specialist approach and that their different needs are met. That records are kept of the different stages of a complaint investigation. This is so that the action taken can be clearly identified and people can feel confident that any concerns have been appropriately responded to. That the maintenance book includes the dates on which items of work have been completed. This will help to identify outstanding items and to ensure that work is carried out without undue delay. That the way in which staff are deployed is reviewed in order to ensure that staff can provide support in a
DS0000028415.V351397.R01.S.doc Version 5.2 Page 30 2 OP10 3 OP12 4 OP16 5 OP19 6 OP27 Stainsbridge House consistent way and without interruption. 7 OP30 That the induction booklets include timescales for the completion of the different parts of the induction programme. This is so that priorities can be identified and staff members’ progress with completing their induction can be more easily monitored. Stainsbridge House DS0000028415.V351397.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 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
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