Inspection on 09/06/06 for Stainsbridge House

This inspection was carried out on 9th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 09/01/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stainsbridge House Gloucester Road Malmesbury Wiltshire SN16 0AJ Lead Inspector Mrs Jacqui Burvill Key Unannounced Inspection 9th June 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.V298817.R02.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.V298817.R02.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 Care Home 24 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24) of places Stainsbridge House DS0000028415.V298817.R02.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. As from 19th January 2006 until further notice; no new service users may be admitted to Stainsbridge House. There will be a joint decision made about the Safety issues and completion of building work to the existing rooms in the home. This joint decision will be made by David Gillespie, the Responsible Individual and the CSCI. Once this decision has been reached, the above condition will be removed. 9th January 2006 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. 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 and bathrooms may not be accurate. Fees range from £420 a week to £475 a week for one of the upgraded bedrooms. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 5 Inspection reports are available in the home and two of the four relative surveys said they had access to the inspection reports. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place in June 2006. The inspection consisted of two site visits on 9th and 13th June 2006. A random inspection took place on 24th April 2006. This was because there were three unannounced visits in February, relating to the safety of the building during extensive renovation work. As a result of this, the provider was asked to agree to an improvement plan, which he did. The home had been without a registered manager for two months. During this time, a deputy manager from another home within the organisation provided support as the acting manager. A manager has now been appointed and has begun to make an application to become the registered manager. Service users and relatives views were sought via surveys. 16 surveys were sent to service users and 15 were returned. Of these, six were marked ‘unresponsive’. The inspector was aware that service users would find them difficult and had included a letter to the responsible individual asking relatives to complete them on their behalf if possible. 16 relative surveys were sent to the home for them to distribute. These were left in the home for relatives to pick up. The home was asked to distribute these to relatives by post and four were returned at a later date. It was important to gather the views of relatives, as service users are unable to clearly express their views about living in Stainsbridge due to their needs. The inspection looked at the following; care plans, daily notes, risk assessments, menus and records of meals, medication and accompanying records, fire safety records and other health and safety documentation and staff recruitment, training and supervision records. There was a full tour of the premises. Lunch was sampled. There was a period of observation, where the inspector observed the interaction between staff and service users. Five service users, one relative and four staff were spoken with. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Medication recording and administration has improved greatly since the last inspection. This has included a new medication room and the trolley can now be secured to the wall when not in use. Medication records were up to date, correctly coded and accurate. These now include a photo of the service user, which helps with identifying the right person when giving medication. Staff have been trained in administering medication and a medication round was observed where staff followed safe practice guidance when giving service users their medication and recording this. The two requirements regarding medication set at the last inspection have been met. The quality of the accommodation on the first floor has been much improved, with bedrooms refurbished and decorated including new ensuite bathrooms consisting of a toilet and hand washbasin; a new assisted bathroom on the first floor and the staircase has been enclosed to add extra fire protection in case of a fire. The bedrooms and staircases have been re-carpeted and a hairdressing salon is being added to the ground floor. The kitchen has improved storage facilities and new equipment has been installed. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 8 What they could do better: There are systems in place to ensure that service users’ needs are met and recorded, but these are not used consistently. Care plans, behavioural risk assessments and additional risk assessments, such as nutritional and skin assessments are relevant and easy to follow, however these have not been used by staff unless led by the acting manager, who implemented them. The lack of detail and consistency in care plans has resulted in a continuing requirement. Failure to meet the requirement regarding care plans will result in enforcement action. Some care plans seen had been amended as service users needs had changed. There was insufficient evidence to show that they had been reviewed monthly as required by the National Minimum Standards. This is a continuing recommendation. It is a recommendation that more research and development into service users’ activities and periods of concentration would enhance the quality of life for service users. Service users’ diets and nutritional needs are of serious concern as a number of service users have significantly lost weight. Nutritional risk assessments and accompanying records are not being used consistently to maintain and improve service users’ eating and drinking habits. It is a requirement that more detail about nutritional needs and how they are to be met are written into the care plans and that menu records accurately record what service users have been offered when meals have been refused or not taken. Staff do not display a full working knowledge of the signs and symptoms of abuse, and how some incidents that arise in the home as a result of challenging behaviour can be abusive to other service users on occasion. These incidents have not been reported via Regulation 37 notifications to the CSCI, nor have referrals been made promptly to the Adult Protection Unit. This significantly affects the safety and well being of service users in the home. Requirements have been set to ensure that staff receive training in the adult protection procedure; signs and symptoms of abuse and that regulation 37 notifications are sent when incidents occur. These are continuing requirements and failure to meet these will result in enforcement action being taken. Staff have been assaulted in the line of their work and procedures need to be in place to record these and report when necessary. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 9 Service users do not have lockable spaces nor do they have keys to their rooms. The reason they may not use keys or lockable spaces may be because of their needs in managing this. This should be documented in the Statement of Purpose and in individual risk assessments where appropriate. The recruitment of staff is not robust, as two references were not supplied in all cases seen. This puts service users at risk from staff who may not be suitable to work. It is a requirement that two references are obtained before employment is offered. Criminal Record Bureau certificates are not in place, although the umbrella body provides their own version of the certificate, this is not sufficient. Guidance from CRB and CSCI state that the employer’s copy must be kept in the home as it needs to be seen by a CSCI inspector. It is a requirement that CRB certificates are held in the home. There are requirements set regarding training, as an insufficient number of staff have achieved National Vocational Qualifications and the general training standard and awareness of staff in understanding the needs of service user with dementia and how to meet them is poor. This has a serious impact on the quality of care for service users. Insufficient numbers of staff have training in mandatory courses, such as first aid, infection control and moving and handling. The home has been without a Registered Manger since March 2006. The responsible individual had appointed a new manager, who was due to start in the home the week after the inspection. The responsible individual must ensure there is continuing regular input from in monitoring systems in the home, monthly regulation 26 visits and the use of a robust quality assurance system. 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.V298817.R02.S.doc Version 5.2 Page 10 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.V298817.R02.S.doc Version 5.2 Page 11 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 Quality in this outcome area was not assessed. Standard 6 does not apply. EVIDENCE: The home has a condition that has been in place since 19th January 2006, which does not allow them to admit a service user until aspects of the building work are safe and partially completed. Therefore, no new service users have been admitted to this service since the inspection in January 2006. Stainsbridge House DS0000028415.V298817.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users’ care plans would be enhanced if they were regularly reviewed and consistent with other care documentation. This would ensure their all their needs are fully identified and met. Service users benefit and are protected by a medication procedure that is safe and well documented. For most service users are there are good systems where they are supported by staff in managing their privacy and dignity. EVIDENCE: The records for three service users were looked at. At the time of the first site visit, care plans were not in the files for two of the three service users. These were seen at the second visit, as the acting manager had removed them to be updated. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 13 Accompanying records were looked and these included risk assessments, nutritional risk assessments, additional care notes and daily records. These showed that there are inconsistencies between what staff are doing, what is recorded and what should be recorded. One service user was not eating or drinking very well and had been seen by a GP a few days earlier. In previous months, the deputy manager had set up nutritional record sheets and this had enabled the service user to regain some health. No attempts had been made on this occasion to record this, or devise a plan to improve the intake of food and drink. The inspector raised this with a senior carer, who then kept notes on a blank piece of paper for one day, rather than using the systems in place. One service user has a care chart where staff are asked to document the care action provided, the incident that may have occurred as a result and the intervention needed to de-escalate the incident. This showed high levels of assaults on staff and on occasion, service users. Corroborating records were then not clear. In one instance the care chart showed that the service user had behaved in a way that caused concern, yet the daily record sheet showed on the same day that he had ‘a good day’. Both entries had been completed by different staff, whose perceptions may have been different. More detail about this can be found in Complaints and Protection. There was insufficient evidence to show that care plans had been reviewed monthly, although occasionally where care needs had changed this had been added in. Not all of these changes had been dated. There is insufficient information in the care plan about service users who need to use additional aids, such as dentures, glasses and hearing aids. Staff need to be aware of how the loss or lack of use of such items can have a serious impact on the lives of service users. Service users are not able to be involved in their own care plans nor take part in reviews as there are challenges about this that face the service about this due to service users needs. There is a care plan review form, but this has not been used consistently for all service users. Daily notes describe the well being of service users and in one case further details of appetite and physical healthcare are recorded objectively. Visits by families are also recorded. Behavioural risk assessments are in place and although not all of these have been dated, they do include some elements of behaviour that may put service users at risk. They focus on areas such as mobility, orientation, daily hygiene, Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 14 toileting and mealtimes, with additional comments of how the need is to be met. Visits from General Practitioners and other health care professionals can be recorded in a separate section on the care plan. However, this is not always used consistently, as notes relating to GP visits were also found in the daily notes section. This could lead to service users’ health care needs being overlooked. Staff views are that they do not receive a good and consistent service from healthcare professionals especially those in specialist fields. They feel they are left to ‘put up with the behaviour.’ This is a specialist home for service users with dementia, however the level of staff knowledge and training could be improved. More confidence in staff’s own abilities and knowledge in managing dementia would improve outcomes for service users. Further details can be found in the Staffing section of this report. The interactions between staff and service users were observed. The level of interaction is caring and more interactions were seen, especially when led by the acting manager. However, staff interactions were predominately limited to task related activities such as providing drinks, or toileting. During a morning observation period, 13 of the 16 service users sat in the lounge. Two were reading magazines and everyone else was sat with their head down or appearing to be asleep. Staff were not sat with them initially at the time of observation and came through slightly later. Staff sat with service users who were alert and more responsive. Medication records and the medication room were seen. A medication round was observed. There is a medication policy and procedure and staff have been trained in administering this. The medication trolley is now secured to the wall and the room is clean and tidy. Each medication administration sheet has a photo of the service user attached. Medication administration sheets were in order, with a log of medication received into the home and the correct codes used when medication is administered. Where staff are handwriting medication onto the MAR sheets, two staff are signing this to verify it is correct. The dates liquids and creams are opened are recorded on the individual boxes. Medication can be stored safely in the fridge in the kitchen in a clear plastic lockable container. No medication is being stored this way at the time of the inspection. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 15 Sheets that contain details about medication in use in the home are kept in a clear plastic folder. More information in the form of a MIMS or BNF book would be useful. Staff who administered medication did so in a safe manner, ensuring that the trolley was not left unsupervised at any stage. Staff gave the medication to the service user and then returned to the MAR sheet to sign it, before administering to the next person. No service user self medicates. Service users who were spoken with were unable to comment directly on whether they are treated with dignity and respect. One visitor when asked felt that staff always treated service users with dignity and respect. Staff were observed to speak politely to service users and in a caring manner. Service users have access to a mobile phone as a public telephone may not be appropriate. Calls may be transferred so that service user can speak to their relative. Staff may need to phone on their behalf due to service users’ communication needs. One service user has their own phone in their room. Service users would need help with their mail and this may be passed to families to deal with. Not all of the double rooms have screening in place. This has been on hold whilst rooms have been refurbished and now needs to be put in place. Staff discussed issues of privacy and dignity that affected service users, in particular where some challenging behaviour is displayed. Staff described how they try to ensure that service users’ privacy and dignity is respected at all times, but that this may sometimes lead to conflict situations arising, that may then result in staff being assaulted, or the service users’ privacy and dignity being affected, although service users may be unaware of this. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 16 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, 13, 14, 15 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users’ lifestyle expections and preferences are not being met as the home does not have an individual approach to meeting these needs. Service users are fully supported to maintain contact with their family and friends. More thought about the way service users could exercise choice and control over aspects of their lives would enhance this for them. Service users would benefit from a more proactive approach to nutrition and the way meals are provided and recorded in order to meet individual needs. EVIDENCE: Service users in this home may not have expectations about their lifestyle or preferences. One visitor explained that living in care would not have been a choice their relative would have made, but as a service user, the relative is unaware that there are in care. All of that person’s previous interests and Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 17 hobbies are seen as no longer possible due to their changing needs as a result of dementia. One service user described how they were waiting for something. When asked what they were waiting for, they described how lonely and isolated it felt without other members of their family around. Staff were observed supporting service users through some of these discussions. Staff are sensitive to the person’s needs. Activities are written onto a wipe board each day. On the first day of inspection this was flower arranging, which did not take place. On the second day of inspection it was colouring and a small group of service users were sat around a table with a member of staff colouring in children’s colouring books. One staff member was supervising the activity and there was some conversation, but when the staff member went away, a service user fell asleep at the table, the other lost interest and one continued. The level of activity is not variable enough or for short enough periods of time to engage service users. More thought and research needs to be given to this to improve the quality of life for service users. Visitors are welcome at any time in the home and two visitors were seen during the inspection. Visitors are made to feel welcome and one visitor explained how staff are very supportive when the visit may be difficult. There is no private space for visitors to meet their family member, apart from their own bedroom. On occasion, a service user may be reluctant to move from one area of the home to another, so the visit takes place in a communal room. Service users do not handle their own financial affairs; this is dealt with by the relatives, or appointed persons, such as solicitors. Some service users are able to bring small items with them to the home; other rooms reflect more of the person’s life before they moved to a care home. The menu of the day is written on a wipe board in the dining room. The meal was sampled on the first site visit; this consisted of fish pie, courgettes and peas, with strawberry cheesecake and ice cream for dessert. The way meals have been organised and served have been assessed by staff as appropriate. Food is plated and two service users are served at a time. One drink is provided at the start of the meal, but no condiments or drinks are left on the table. Staff feel that it may not always be appropriate to have drinks or condiments available, due to service users’ needs. Staff serve tea and coffee at the end of the meal to service users. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 18 Service users appeared to enjoy the meal. Other service users were supported with eating in a caring and sensitive manner. Where service users were refusing meals and unable to say what they wanted, staff explained that it varied from day to day as to what would tempt them. Care plans need to be very detailed in such cases, so that staff know how to promote nutritional needs and not restrict this just to mealtimes. Guidance provided by the CSCI called ‘Highlight of the Day’ which is all about meals in care homes was left with the responsible individual at a previous visit in April. Menu records are an important part of recording service users’ choices and what they are actually eating. A new form has been devised for this purpose, following previous requirements about this. However, staff have been recording that a service user ‘refused’ food, or was ‘asleep’ and have not recorded what happened after this and whether they were given anything else. At the second site visit this was followed up after the inspector described the initial findings to the responsible individual. The format had been changed to make it clear that staff must not record ‘asleep’ and instead staff had drawn a line across the entry for that day, indicating that the service user had not had breakfast. Given that this service user had suffered extreme weight loss in the past few months, staff had not provided an alternative, or provided breakfast in bed, which may have been an appropriate response in the circumstances. This was further discussed with the responsible individual who was dismayed at the findings. There are no special diets required, although some meals do need to be pureed. Staff discussed how even the slightest texture could put a service user off eating a meal. The acting manager has made a weight chart in order to monitor service users. This good practice revealed some alarming weight losses, which have been discussed with GPs. There are good systems in place to aid and monitor this although in the acting manager’s absence staff had not used these. The dining room provides a pleasant environment to eat meals. Service users sit at tables for up to four people. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 19 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, 18 Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this service. Complaints are recorded and relatives know who to complain to. Service users are at risk of abuse as the staff team do not have the skills, knowledge or experience to follow through incidents that must be referred to the Vulnerable Adult Procedure. EVIDENCE: Four of the relative surveys said they had never had to make a complaint and three of the four said they were aware of the complaints procedure. A log is now made of complaints received in the home, which had been started by the previous manager. These showed the response to the complaint, but not if the complainant was satisfied with the response. Pre inspection information showed there had been four complaints to the manager between November 2005 and April 2006. Service users may be unable to make complaints themselves and relatives make complaints on their behalf. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 20 There is a complaints policy and procedure, which refers to the acting manager and one of the senior staff in the home as a point of referral. It includes the contact details for the responsible individual and the CSCI. This does not specify the full procedure, but does detail what to do if unhappy with the response. It does state that complaints will be investigated within 21 days. The acting manager has started a file for compliments. The inspector discussed the adult protection procedure with some of the staff on duty. Staff were unclear about the procedure itself, although they said they would report incidents to the manager. It is of serious concern to find information in records that showed that service users, on occasion, been assaulted by other service users and that staff themselves have also been assaulted. On the first day of inspection, one assault on a service user had not been appropriately handled or recorded. Staff were advised to report this to the Vulnerable Adult Procedure without delay and this was endorsed by a senior healthcare professional who visited that day. However, although the acting manager was completing the referral form during the inspection, it was never sent off and was only referred by the new manager after subsequent phone calls to the home by the inspector. Assaults on service users are not recorded clearly, no body map chart is used nor are all assaults recorded in the accident book for staff and service users. Staff described assaults on them ‘as part of the job’. This de-sensitised approach is worrying, as staff do not appear to have the skills and knowledge to manage aspects of challenging behaviour and record and report safely. Staff are not aware of the reasons when referrals to the Vulnerable Adult Unit should be made and despite discussing this with a CPN, did not receive any further information about referrals in a helpful and constructive manner. Six of the fourteen staff have received training in Adult Protection procedure and signs and symptoms of abuse. There is clear evidence that staff who have received this training are still not able to distinguish what must be reported and how to record such incidents. Further training in this is a requirement. Information on reporting incidents via Regulation 37 notifications to the CSCI is displayed on the notice board; however, none of the above incidents had been reported. Service users’ finances are managed by their relatives. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 21 Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 22 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, 21, 23, 24, 26 Quality in this outcome area was adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a home that is under refurbishment. Risks have been assessed and minimised as far as possible. There are sufficient and suitable bathrooms for service users in the home. Service users own rooms may suit their needs. Consideration needs to be given to the use of call bells and screens where appropriate. Service users benefit from a clean and tidy home. EVIDENCE: Stainsbridge House is undergoing major refurbishment. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 23 There has been some consultation with a specialist organisation who provides advice on suitable environments for service users with dementia. Further discussion about this took place with the responsible individual on the first site visit. The kitchen is almost complete, with a new store room in place. The extractor fan needs to be fitted and fly screens need to be attached more securely to the window frames. There are improved storage facilities in the kitchen and some new equipment. The staircase surround and first floor accommodation is completed and work on the second floor will soon be underway. Refurbishment of the bedrooms on the first floor has taken place, with the installation of ensuite bathrooms with toilets and hand washbasins and total redecoration, new furnishings and furniture. This has greatly improved the quality of the accommodation for service users. Whilst work has been taking place, daily risk assessments have been written, identifying the work about to be done, the hazards involved and how those hazards can be minimised. At this time, service users are restricted to using the lounge and dining room during the daytime. The front door of the home is secure, with a key code and service users are not able to leave the home and use the grounds unless accompanied by staff. The grounds are currently not safe to use because of the building work and new extension. Service users’ bedrooms vary in style during this period of refurbishment. Some are more reflective of personal tastes and choices than others. Where service users share bedrooms, they should have their own chest of drawers and not have to share. This was pointed out to the responsible individual during the tour of the premises as this was seen in one room. Care must be taken to ensure that the call bells are within reach of service users, as in one room, it was a push button situated close to the bedroom door. The inspector was informed that it is possible to have cables that reach to bedsides and these should be installed. Service users are offered safes as lockable spaces. They do not they have keys to their rooms as there is a perceived risk of them being lost or unable to be used. This should be documented in the Statement of Purpose and in individual risk assessments where appropriate. As previously mentioned, consideration should be given to the issues of privacy and dignity for service users who continue to share a room. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 24 The inspector and responsible individual discussed the current use of shared rooms and the future of these rooms, where a new service user may choose not share. In these cases, it may be possible that these rooms will be upgraded singles, as they are large bedrooms. The second floor bathroom will be out of use whilst it is being refurbished. This leaves one bathroom on the ground floor and one on the first floor. This is sufficient for the number of service users in the home at the moment. More bathrooms will be in place once the new extension is completed, as more full ensuites will be included in the newly built rooms on the ground floor. The laundry room has one washer, which meets guidelines for infection control. There is one dyer. An area of the laundry has been sectioned off to provide storage space for service users’ recently laundered clothes. The home was clean and tidy on the days of inspection. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 25 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): 27, 28, 29, 30 Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels are currently sufficient to meet service users’ needs, but will need to be re-evalualted to ensure this remains so. Service users are not protected by robust recruitment procedures. Service users are not fully protected by staff who are appropraitely trained and supervised. EVIDENCE: The rota shows that there were four staff on duty during the morning of the site visits. Three staff are on duty in the afternoon and evening and three waking night staff are on duty. There was one cook, one cleaner and one part time laundry staff member on duty. Comments from relative surveys was that three out of the four felt there were sufficient staff on duty. Service users’ needs have changed since January 2006 and many are considerably frailer and in need of more support. At least five or six service users need two staff to support them at the same time. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 26 Staffing levels will need to be carefully considered during this time and in the future when the home admits new service users. Guidance can be obtained from the Residential Care Forum. There are plans for staff to register to do National Vocational Qualifications at Level 2 in a nearby college. At this time, there are only four out of thirteen staff who have an NVQ. This is well below the expected minimum standard of 50 . One of the chefs has an NVQ level 2 in Nutrition in Care Settings. Recruitment records for four staff were looked at. All four staff had a POVA First check obtained prior to their Criminal Records Bureau disclosure certificate. Staff completed an application form and in two of the four cases two references were obtained. In one case a verbal reference was recorded. This is good practice. Inductions for new staff were incomplete. CRB certificates are obtained using an ‘umbrella’ body. This is an organisation who makes the checks on behalf of the employer. The umbrella body does not provide the actual certificate to the home, but provides their own version of the certificate. The employer must receive its own copy of the CRB check and this is to be held safely in the home until the CSCI inspector can see it. Guidance on this can be found on the CRB website. Information about staff training was provided before the site visit to the home took place. Further records were checked during this visit. Eleven staff have completed training in dementia awareness since the last inspection. Staff were unable to provide a good understanding of dementia when asked and through further questions posed to the inspector disclosed their willingness to learn and understand more. Seven staff attended training in challenging behaviour in March 2006. This is a specialised service for people with dementia. Staff must have the knowledge and expertise to meet the needs of service users and to be able to develop their knowledge and skills in this area, so as to better meet the needs for service users. No system is in place to evaluate staff knowledge. This has begun to be partly addressed through supervision sessions. At least one staff must be on duty each shift with a current first aid certificate. Only four staff have first aid qualifications and the rota shows that there is not at least one person on each shift with a current first aid certificate. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 27 Insufficient numbers of staff have training in mandatory courses. This includes moving and handling, infection control and basic food hygiene. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 28 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, 33, 35, 38 Quality in this outcome area was poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users may have been affected by the changes in management. Lack of quality assurance in the home means that the home may not be run in the best interests of the service users. Irregular fire safety checks may put service users at risk. EVIDENCE: At the time of the first site visit, the acting manager was ending her period of management. This manager was a deputy manager within another home in the same organisation. The staff spoke highly of the acting manager, who acted as Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 29 a mentor to staff and set up new systems of recording and implemented some improved practices in the home. A new manager had been recruited and at the time of writing this report, has started work in the home. An application to be registered has not been received from the new manager, although the CRB check has been processed. It was agreed at the improvement strategy meeting with the responsible individual that an application would be received by 30th June 2006. The responsible individual and the inspector discussed the quality assurance system that will be in use in the home. This has not been implemented, despite the requirement having been issued since 2005, with an extension granted. It is the responsible individual’s aim to have the new manager assess groups of the quality standards every month, so that all of the standards in the organisation’s quality assurance manual are assessed in one year. No surveys have been completed as part of the quality assurance process. It will be important to gather the views of service users, relatives, health and social care professionals. This should be done as a marker before the quality standards are evaluated as no attempts have been made to assess the quality of the service by the provider since the requirement was put in place. The regulation 26 visits are a vital part of the continuing monitoring of the home and the service it provides. Only one regulation 26 visit has been received as only one month has passed since the setting of the improvement plan. This was identified as an action following an improvement strategy meeting. Failure to continue meet this requirement will result in enforcement action. Fire safety records were looked at. The fire alarm is due to be tested weekly. The records show that this has not been done weekly with two weeks between some checks. The last test had taken place on 07/06/06. This was discussed with the responsible individual. Visual checks of fire safety equipment and means of escape are expected to be carried out monthly. The last checks took place on 23.05.06, but no checks had taken place in February or March. A fire drill took place on 09/05/06 and previous drills show that night staff received a fire drill on 27/04/06. The fire risk assessment is undated, but appears to relate to the most recent changes to the home as a result of the building work. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 30 A general risk assessment file is in place and this covers issues relating to the building and to individual service users. These risk assessments would be better placed in the service users’ care plans. There is a file with information on cleaning materials used in the home. Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 31 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 3 X 2 2 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 1 X N/A X X 2 Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 32 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 OP7 Regulation 12 (1) a b 17 Schedule 4.13 Requirement Service users’ nutritional needs must be detailed in their care plan and additional assessments and nutritional records kept up to date in order to maintain levels of good health. Care plans must accurately describe the way in which care is to be given. This must include guidelines for managing challenging behaviour, or management of any mental health issues. COMMENT: This is a repeated requirement. Care plans have been changed, but these have not been consistent. 3. OP7 13 (4) (c) Risk assessments must accurately reflect the risks that may affect other residents, especially where there is challenging behaviour or mental health issues. The guidelines must be clear and staff must be aware of them at all times. Carried forward from the last two Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 33 Timescale for action 31/07/06 2. OP7 15(1) (2) 31/07/06 31/07/06 inspections, due to be met by 06/06/06. Enforcement action will be taken if this requirement is not met. 4. OP15 17 Schedule 4.13 The record of food provided must 31/07/06 show what meals have been provided for residents and this must include breakfast. (Carried forward from the last inspection, due to have been completed by 01/08/05, and 28/02/06) COMMENT: Still not met by 08/05/06, despite changes to the format to ensure that records are maintained. Staff must receive training and awareness in adult abuse and protection. This must include the Wiltshire and Swindon No Secrets guidance. This is a repeated requirement. An extension was provided to allow the provider to find suitable training. Failure to meet this requirement will result in enforcement action. Due to be met by 01/08/06 set at the last inspection. 6. OP18 37 Regulation 37 notifications must be made where there have been assaults on service users and staff, as this is an event which effects the well being of service users; or any incident required to be reported under this notification. (Carried forward from the last inspection) The kitchen windows fly screens must be fully secured to the sides of the windows. Staffing levels must be reviewed DS0000028415.V298817.R02.S.doc 5. OP18 13 (6) 01/08/06 31/07/06 7. OP19 13 4 (c) 23 (2) (b) 18 (1) (a) 31/07/06 8. OP27 31/07/06 Page 34 Stainsbridge House Version 5.2 to ensure that there are sufficient staff on duty at any time to meet the current assessed needs of service users. 9. OP28 18 (1) (a) The provider must provide 31/07/06 evidence of how at least 50 of the staff team will attain National Vocational Qualifications at Level 2. Two references must be obtained 31/07/06 for all staff who are employed in the home. The employer’s copy of staff Criminal Record Bureau certificates must obtained from the umbrella body and be held in the home until seen by the CSCI inspector. 31/07/06 10. OP29 11. OP29 17, 19, (b) (c) Schedule 2.5 17, 19 (1) (b) (i) Schedule 2.7 (a) (b) 12. OP30 13 (4) (c ) There must be at least one 18 (1) (a) person on duty at all times who has a current first aid certificate. 18 (1) (a) (c) (i) (ii) 29/09/06 13. OP30 Staff must be trained and 29/09/06 competent to carry out the duties they are to perform. This includes specialised knowledge in the field of dementia, challenging behaviour, communication and provision of activities. Staff must receive training in infection control and the moving and handling of service users. A quality assurance system must be introduced in the home and a report sent to the CSCI on conclusion of the first audit. (Carried forward from the last inspection.) This was due to be concluded by 31/07/05 with further extensions to 01/12/05 and 30/05/06 DS0000028415.V298817.R02.S.doc 14. OP30 13 (3) 13 (5) 24 (1) (a) (b) (2) (3) 29/09/06 15. OP33 29/12/06 Stainsbridge House Version 5.2 Page 35 16. OP33 24 (1) (a) (b) (2) (3) Surveys of the views of service users, relatives, health and social care professionals must be obtained in order to form a view about the quality of the service. A report must be sent to the CSCI on completion. Regulation 26 visits must take place at least once a month and be unannounced. Copies of the report produced must be sent to the local CSCI office. COMMENT: Only one had been received by 30/05/06 Failure to meet this requirement will result in enforcement action. Fire safety checks must take place as prescribed in the fire safety log book. 31/08/06 17. OP33 26 (1) (3) (4) (5) 31/07/06 18. OP38 23 (4) (a) (b) (c) (i) (ii) (iii) (iv) (v) 31/07/06 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 OP10 OP10 OP12 Good Practice Recommendations Care plans should be reviewed monthly. (Carried forward from the last inspection) Screening in double bedrooms should be considered to improve the privacy and dignity of service users. Daily records should be consistent with other records kept daily about service users’ behaviour of special needs. The activities co ordinator should produce a plan of activities over the week, ensuring that the range of activities are suitable for all service users. There should be consultation with organisations who have specialist knowledge in this area. (Carried forward from the last DS0000028415.V298817.R02.S.doc Version 5.2 Page 36 Stainsbridge House four inspections.) 5. 6. 7. OP18 OP19 OP24 Procedures should be in place that ensure staff know what to do when they have been assaulted by service users. An extractor fan should be installed in the kitchen. (Carried forward from the last inspection) Information about lockable spaces and keys to bedrooms should be included in the statement of purpose and service user guide and individual risk assessments, especially where this is not provided. Call bells should be accessible to service users from their bedside. Service users who share bedrooms should have individual chest of drawers in their room and should not have to share one. All staff should receive an induction within one month of appointment and an in depth induction within six months of appointment. Staff should receive training in basic food hygiene. As part of the monthly regulation 26 monitoring visits, the responsible individual should spend time observing the interactions between staff and service users. 8. 9. OP24 OP24 9. OP30 10. 11. OP30 OP33 Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 37 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. Extracts may not be used or reproduced without the express permission of CSCI Stainsbridge House DS0000028415.V298817.R02.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!