Inspection on 09/01/06 for Stainsbridge House

This inspection was carried out on 9th January 2006.

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 19/11/08

Stainsbridge House 08/11/07

Stainsbridge House 12/12/06

Stainsbridge House 09/06/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stainsbridge House Gloucester Road Malmesbury Wiltshire SN16 0AJ Lead Inspector Announced Inspection 9th January 2006 09:30 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.V274066.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V274066.R01.S.doc Version 5.1 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 Wendy Margaret Parker Care Home 24 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24) of places Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 2nd June 2005 Date of last inspection Brief Description of the Service: Stainsbridge House is a home providing care and accommodation for service users who have dementia. Stainsbridge House is owned by West Country Care. West Country Care Ltd is a subsidiary company of Treasure Homes Ltd. There is a new manager in place, who was appointed in March and completed the registration process on 4th May 2005. The home is situated on a main road on the outskirts of Malmesbury. The house is Victorian and there are large grounds to the rear. The accommodation is on three floors and there is a passenger lift, as well as a main staircase. There are bedrooms on the ground, first and second floors. There are 4 double or shared rooms and 16 single bedrooms. 3 single rooms have ensuite toilets and 1 double bedroom has an ensuite bathroom with toilet. There are 2 other bathrooms, one of which is an assisted bath and an assisted shower room. There is a large sitting room and a dining room next to each other on the ground floor, overlooking the garden. There is a small smoking room on the ground floor. At the time of the inspection, the premises are being renovated, and some of the descriptions of the bedrooms are not accurate. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days on 9th and 10th January 2006, taking 12 hours. One visitor, four staff members and four service users were spoken with. There was a two hour observation period when interactions between staff and service users were observed and recorded. Discussions also took place with the manager and the responsible individual. There was a complete tour of the building. Care plans, risk assessments, daily notes and other records about service users were seen. Staff recruitment records and some training records were seen. Fire records and risk assessments for the building work and generic risk assessments were looked at. Medication and accompanying records were seen. Menu plans and accompanying records were seen and a midday meal was sampled. There was an additional visit on 6th September 2005, in addition to the last inspection that took place on 2nd June 2005. This was to follow up on the progress of requirements and recommendations from that inspection. There was a meeting to discuss an improvement strategy with the manager and the responsible individual on 13th October 2005. The views of family and service users were sought through the distribution of comment cards. 20 were sent out and 10 were returned. Comments showed the level of concern amongst family about the changes taking place and the possible effect this is having upon the service users. 6 of the 10 responses commented about the change in staff and how caring and capable they seemed, whilst acknowledging the confusing effect this may have on service users. One comment highlighted the apparent lack of staff during the evening, noting that service users were left alone on the ground floor, whilst staff were occupied elsewhere in the building. 6 of the 10 comment cards mentioned this, or ticked the box indicating that they felt there were insufficient staff on duty. The visitor that was spoken with was pleased with the improvements that were being made, and concerns about the effect the work was having on the service users had been discussed with the manager. The visitor felt that Stainsbridge had a homely atmosphere and that staff were friendly and approachable. Some service users find it difficult to comment directly on their care, but one service user when asked what she was going to do for the afternoon described a sense of feeling that she just sitting and waiting for the end of her days. Many service users are unable to hold any conversations, but enjoy the company of staff or others to sit with. Four immediate requirements were made on the first day of inspection. These were to do with safety aspects regarding the building and renovation of the existing building. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Service users would benefit from having the same style care plans and risk assessments, with evidence that every plan has been reviewed monthly. Risk assessments should detail the actual date of the assessment, rather than just the year. Daily notes need to be written in more objective way, that details the care provided, or the response staff have given to service users at times when they were distressed. The storage and safety of medication needs to be improved. This includes all medication and how creams and other topical applications are stored and used within the right date. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 7 The approach to mealtimes needs to be improved. This includes the recording of meals provided as an alternative to the set menu, the timing of the serving of the meals, the recording of additional snacks that are available and the staff approach to assisting service users with their meals. Recruitment of staff needs to be safe and robust. The manager must ensure that all of the relevant documents leading to the safe employment of staff are completed. The renovation work, whilst commendable, must take into account current thinking on how the layout, design and colours of the interiors of the building could further improve the quality of the lives of the service users. This should include guidance from professionals in the field of dementia and occupational health. The new extension to the home would also benefit from this approach, whilst it is currently under construction. Risk assessments regarding the way the work is to be carried out must be done at least on a daily basis, so that service users are protected from harm and that possible risks are identified, reduced and where possible eliminated. 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. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 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.V274066.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 No new service users have been admitted since the last inspection. Standard 6 is not applicable to this home. EVIDENCE: Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, Standards 7, 8, 9, and 10 were assessed at the last inspection. None of these standards were met. In general, service users benefit from care plans and risk assessments that are relevant to their care needs and that are in date. Service users benefit from accurate medication record keeping, but do not benefit from safe storage or handling of medication. EVIDENCE: These standards were re –visited to see what improvements had been made following the requirements set at previous inspections. The care plans were to be put into a new format and to be regularly reviewed and the risk assessments needed to be up to date and describe the range of risks that affect the individual service users. All of the care plans were looked at and 4 were closely examined. 12 care plans are in the new style. Not all of these showed signatures and dates when additions had been recorded and some of these had not been reviewed on a monthly basis, with the last entries being recorded in August 2005. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 11 Four of the old style care plans were in date, with only one being out of date. The old style risk assessments were in date apart from 2 out of 15. The new style behavioural risk assessment had not been completed for 4 service users, but 9 had these in place. It is important to record the actual date of the assessment rather than just the year. One behavioural risk assessment had not been updated following a change in behaviour. Entries in daily notes varied, some recording the care provided, however, when recording behaviour, or mood, a variety of subjective statements were used. These included; ‘ fairly loud today’, ‘ very calm,’ or ‘very happy’. One entry recorded ‘shouting all evening at staff and residents’ but no additional information was provided on how this was managed by the staff team, or how the service user was supported during this time. In one case the emotional needs described in the daily notes were not clearly detailed in the care plan. Medication was looked at. The drugs trolley was in a new room that did not have a secure window in place. An immediate requirement was made and the following day, the window was secure. The drug trolley was not secure inside this room and this was discussed with the owner and the manager. Some medication was held in an unlocked area in a food fridge. Handwritten entries on the medication administration sheet had been signed by two staff. Dates had not been recorded on a box of eye drops when it had been opened. Two boxes of mouth ulcer cream issued to two separate service users had not had the date recorded when they were opened. The home uses a prepared dosette system and staff are going through distance learning medication training. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Standards 12, 14, 15 were assessed with minor shortfalls and standard 13 was assessed as met at the last inspection. Service users would benefit from an improved approach to activities and the way service users need to have positive interactions with staff. Service users would benefit from an improved approach to the assistance required at mealtimes, the timing of serving the meals, as well as clearer records showing what meals have been provided. EVIDENCE: On the first day of inspection the inspector observed a game of bingo taking place in the afternoon, led by a member of the staff team, with a small group of service users. On the morning of the second day the activity on the noticeboard was ‘hairdresser’. It is unusual for this to be recorded as an activity, but in fact, the hairdresser did not arrive that day. No alternative activity was provided, nor did staff seem to know where the hairdresser was when asked by the inspector. At this time, the inspector spent a two hour period observing the level of interactions between staff and service users. The level of interactions was measured using a specific formula. The use of this formula was shared with the manager and owner prior to it being used, but was not shared with the staff on duty. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 13 After selecting a range of 5 different service users, the level of interaction was measured every five minutes, showing whether the service users had interacted with anyone at all, and the nature of this interaction. During the 2 hour period, it was observed that interactions took place every 15 minutes or so. At some points none of the service users were interacted with. The nature of the interactions were mostly task orientated, e.g. at coffee time, or asking service users to go to the toilet. There were only two interactions non task related during the 2 hour period and these were towards service users who appeared to have known interests. One service user was asked if they would like to listen to music and another staff member spoke a service user about the personal possessions in her handbag. One service user had no interactions apart from a drink offered during the whole two hour period and appeared to be asleep in the chair. Staff attempted interactions with one service user who gave very little response, but these interactions lasted only a few minutes. Staff were observed speaking for a longer period of time to a visitor, although this was not about any care issues, or the condition of the visitor’s relative. When conversation did take place, it was with sensitivity and care and it did appear to have nurturing qualities. This is a definite improvement from previous interactions, but there is still some way to go. During the whole time of the observation, the television was on, although it did not seem as though any service user showed an interest in it. These observations were shared with the owner on the second day. The menu record was looked at and discussed with the chef on duty. The menu is created by the manager, and the chef is responsible for ordering the food. The menu plan is written over a 6 week period and includes a cooked breakfast every day. There is a separate record book, recording changes made to the main menu. When discussing this with the chef, it was clear that some service users were having a different diet to the one described on the menu plan. This was not detailed in the alternatives record book. The range of breakfasts was also not recorded, so it was not possible to see who had eaten a cooked breakfast, or who had not eaten much that day at all. Where service users are having difficulty with meals, this is described in some detail in the care plan. Additional measures, such as Fortisip, or Ensure drinks are provided and some of the alternatives, such as ice cream have been recorded, but this may not be done consistently. Some service users need support from staff when eating their meals. One staff member was observed to stand next to a service user whilst feeding her. The midday meal on the first day was observed and the inspector sampled the meal. Service users were brought to the dining tables at least 20 minutes before the meal was served, this is due to the numbers of service users that need to be toileted before meal times. There was delay of about 10 minutes between the first and second courses and some of the service users were getting restless during this time. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 14 The approach to mealtimes has been mentioned on many previous inspections. These observations were shared with the manager, who was dismayed as she felt there had been an improvement to the approach at mealtimes. The inspector observed very little interaction at mealtimes. Most service users had their heads down, especially when waiting for the second course. Only two or three service users were observed to interact with each other spontaneously. The inspector also gave a member of staff a chair to sit on as assistance with a meal was provided by a staff member standing up, when there were other chairs available. This would help to encourage interaction and eye contact. On the first day of inspection, the meal was cottage pie, with mashed carrot and swede and rice pudding for dessert. Only one choice per meal is prepared. There was a discussion about the evening meal and the time it is served. The inspector asked about the length of time between the evening meal and breakfast the next morning. Staff explained that they provide an additional round of sandwiches, or leftovers from the evening meal, cakes or biscuits with a drink at supper time. None of these choices or meals provided have been recorded. This is important as it provides additional evidence of the nutrition value of food provided in the home. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Standards 16 and 18 were assessed at the last inspection and were not met. Service users benefit from a complaints procedure, that is known and used by relatives. EVIDENCE: There is a complaints record in place in a loose leaf file. The manager has recorded the concern or complaint received from the relative and recorded and dated her response. One of the concerns was described to the inspector by the relative concerned, who felt reassured by the manager’s response, although there were concerns over the amount of building work taking place and the impact this is having on staff and ultimately, the service users. New staff are provided with a pack when they join the home that includes the General Social Care Council code of conduct and the Wiltshire and Swindon ‘No Secrets’ guide. Responses from the comment cards received showed that 7 of the 10 relatives who responded were aware of the complaints procure. Of these 2 had a made a complaint in the past. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 25, 26 Service users are at risk from the changes and improvements to the premises, whilst the work is taking place. Service users are at risk from a lack of sufficient water at appropriate temperatures, a lack of the correct number of baths for the home and lack of sufficient lighting in some parts of the home, including bedrooms. The lack of these facilities is not acceptable, even while building work is taking place. EVIDENCE: One day was spent looking at the changes to the environment and the risks that may occur as a result. The building and renovation work is as a response to the need for the home to be updated. This involves two stages, both of which are taking place at the same time. At the time of the inspection, footings were being dug for a new extension, which will include 22 new bedrooms with ensuite toilets and hand washbasins; two of the bedrooms will have ensuite shower rooms; and there will be three new day rooms. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 17 Some of the new facilities were seen in the existing building. It was noted that the new ensuite bathrooms being installed were not entirely suitable for service users with dementia, as they were beige, with beige tiles behind. It is known that this is a colour that service users with dementia find especially difficult to see. The existing premises are currently being converted from 4 ground floor bedrooms, 9 bedrooms on the first floor and 8 bedrooms on the second floor; to 2 bedrooms on the ground floor, 9 bedrooms on the first floor, 7 bedrooms on the second floor. All of the bedrooms will have ensuite toilets and hand washbasins and two rooms will be shared by two service users. The work involves a major amount of refurbishment and re- positioning of some of the rooms, that had previously opened out onto the main staircase. The lift will be moved and an additional staircase has been added to an existing partial staircase. The bathrooms are being re- positioned on all three floors. At the time of the inspection, there were grave concerns about the state of the building work and the dangers this posed to service users. Four immediate requirements were made, regarding health and safety issues in the home. Risk assessments for the building work were not up to date, nor did they reflect all of the risks that were obvious. See Standard 38. Environmental Health officers were called to the building by the CSCI inspector during the first day of inspection. There was insufficient hot water to all parts of the building. This included the kitchen, where water temperatures were hand hot only, and the second floor where in one bedroom, no hot water was apparent at all, despite running the tap for some considerable time. Staff stated that they had to carry bowls of hot water from the sluice room to rooms where there was no hot water. Situations were described where hot water had run out mid way through running a bath and on at least one occasion, the builders had turned off the water without informing the staff team. Only one bathroom was in use during the inspection. The shower room on the second floor was out of use and the new assisted bath installed on the second floor was broken and had not been used for some time. The lighting in some parts of the home, including bedrooms, was dim, as light bulbs had not been replaced when required in the dining room, and in one service users’ bedroom, a double room, the ceiling light did not provide enough light to see by. In other areas of the home where a double bedroom had been refurbished, the call bell was not in use as it was situated by the light switch and cabling had not been put by each service users’ beds. The position of the beds in these rooms may need to be altered, so that service users can have bedside tables with lights next to them. The laundry has been moved, although it is still on the first floor. The door did not meet fire safety requirements and an immediate requirement was issued to install a new door that fitted correctly. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 18 The medication room was not secure, as a pane of glass had been replaced with plastic sheeting. An immediate requirement was issued and a pane of glass was in place by the next morning. The sitting room and dining room have been redecorated and there are new armchairs. The dining area has benefited from changes made to the position of tables, which are now in small groups of four. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Standards 28 and 30 were assessed at the last inspection. Standard 29 was met and there were shortfalls in standard 30. There are gaps in the recruitment procedure and practice that do not protect service users. EVIDENCE: Standard 29 was assessed again as there have been substantial changes to the staff team since the last inspection. All of the records for the newly recruited staff were seen. New staff had POVA First checks in place and application forms and references. Two staff did not appear to have CRB certificates or letters informing the employer that checks had taken place. In one case, there was a positive result from the CRB check – in this instance the application form had not been completed apart from the first page, so no declaration of previous convictions had been made. There was also only one reference in place. This was discussed with the owner, in the manager’s absence. In a situation where there is a positive CRB result, a risk assessment should be completed by the manager to show why the person is offered employment. Any queries may also be discussed with the CSCI inspector. There was one other applicant where only one reference had been received. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 38 Standards 33 and 35 were assessed at the last inspection. The manager is endeavouring to support service users through a period of major change in the home. Service users, staff and vistors are at risk from serious injury or accident due to the lack of risk assessment whilst building work is taking place. EVIDENCE: The manager has been in post since April 2005 and has at least 2 years previous experience of managing a large service. She has NVQ level 4. This has been a difficult process of managing the changes to the service. It has involved many levels, managing a staff changeover, identifying service users’ needs resulting in reviews for service users, as well as managing the changes to the structure and fabric of the building. During this time, the manager has been very aware of the impact of the staff and the environment’s changes on the service user and has tried to minimise this. On many occasions the Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 21 manager has had to act as a member of the care staff during time of staff shortages. This practice has meant there has been less time to actually ‘manage’ the service and may have meant the manager has no time to gather perspectives of the changes and respond accordingly. Although the fire risk assessment had been amended it did not reflect the changes to the fire safety of services being compromised by building work. Fire records showed that the alarm is tested weekly. The last recorded evidence of a drill taking place was on 3/10/05. Fire drills should take place at least every quarter and the record should show that all staff take part in a fire drill at least once every six months. For night staff this should be at least once every three months. The emergency light test had been missed in December 2005. The risk assessment completed by the project manager also did not reflect the constant changes to the home. There needs to be a risk assessment on a day by day basis, identifying the work taking place in the home and actions to be taken to minimise the risks. Some risks were identified during the inspection and immediate requirements were issued. This included rooms currently being worked on, but left unoccupied for some time. Both rooms had floor boards up in varying stages, with power tools and electrical and building equipment in situ. These rooms are to be locked when work is not being carried out and the following day, signs were in place and workmen had been issued with barrel lock keys in order to keep the rooms secure from service users. The fire alarms went off three times on the first day, due to the dust being generated by the work taking place in the home. The response from staff appeared to be slow, although when spoken to they said they had responded appropriately and quickly. All service users are to be encouraged to stay within the sitting room or dining room, unless the fire is in these areas. When alarms go off frequently like this, it can de- sensitise staff’s reaction to the alarms. All of the records of checks to the alarm and other fire safety areas were in order. These ‘false’ alarms should be recorded in the home’s fire safety record. Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 22 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X 2 X 2 2 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 1 Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Where ointments or creams are applied to service users, the date the box was opened and used must be written on the side of the box. Medication that is to be held in a fridge, must be stored safely and securely in a lockable unit. Alternatively, a medication fridge could be purchased. Activities must be arranged to support service users with the variety of needs and interests they may have. Staff must develop positive relationships with residents that reflect current best practice, including understanding the needs of residents with dementia and challenging behaviour. (Carried forward from inspection 2/6/05) Where alternatives to meals have been provided and when meals have been refused, accurate records must be kept. (First set at inspection dated 2.6.05, carried forward 9.9.05 and due to be met by 12.9.05.) DS0000028415.V274066.R01.S.doc Timescale for action 28/02/06 2. OP9 13(2) 28/02/06 3. OP12 16(2) (m) 28/02/06 4. OP12 12(5) (a) (b) 31/03/06 5. OP15 16(2)i 17 Sched 4.13 28/02/06 Stainsbridge House Version 5.1 Page 24 6. OP15 16(2)i 17 Sched 4.13 7. OP19 23(2) (a) (b) 8. OP21 23 (2) (j) 9. 10. OP22 OP25 23 (2) (n) 23 (2) (p) 11. OP25 16 (2)j 23 (2) j p 12. OP38 13 (4) a c 23 (2) b Carried forward from this inspection. The menu must show what meals have been provided for residents and this must include breakfast and supper and any alternatives offered to the main meals. (Carried forward from last inspection on 9.9.05) The design and fittings of the renovations and the new extension must meet the needs of the service users and take into account current guidance about the needs of service users with dementia. More than one communal bath must be available to use for the 18 service users currently in the home. The site of call bells must be within reach of the service users in their bedrooms. The lighting in all of the bedrooms and communal areas must reach acceptable levels. Where bulbs need to be replaced this must happen immediately. Where lighting is too dim, the level of lighting must be raised to reach recognised standards (lux 50) and should include table level lamp lighting where required. The temperatures of hot water to all parts of the building must reach acceptable levels. i.e. 43 degrees Celsius to all bedrooms and bathrooms and at least 60 degrees Celsius to the main kitchen. The building work taking place must be risk assessed on a daily basis with the project manager/ foreman and the manager of the home. These assessments can be recorded in a book, which must contain the date of the DS0000028415.V274066.R01.S.doc 28/02/06 31/03/06 28/02/06 28/02/06 28/02/06 28/02/06 28/02/06 Stainsbridge House Version 5.1 Page 25 Assessment. They need to reflect the work that is due to take place that day, or any changes to the work plan. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP7 OP7 OP19 Good Practice Recommendations All care plans should be in the same format. All service users should have copies of the behavioural risk assessment in place. Daily notes should be objective and record care provided and how staff have responded to behaviour to support the service user. The registered person or responsible individual should make an action plan describing the refurbishment of the home with timescales.( Carried forward from the last inspection) That an assessment of the facilities and premises as a whole is carried out by a suitably qualified person, (Occupational Therapist and Specialist Dementia advisor) and the recommended environmental adaptations are made to meet the needs of the residents. (Carried forward from the last two inspections.) Staff should take part in a fire drill at least once every six months and night staff at least once every three months. 5. OP22 6. OP38 Stainsbridge House DS0000028415.V274066.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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