Inspection on 09/01/08 for Stambridge Meadows

This inspection was carried out on 9th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stambridge Meadows 01/04/10

Stambridge Meadows 05/10/09

Stambridge Meadows 16/04/09

Stambridge Meadows 09/10/08

Stambridge Meadows 04/05/08

Stambridge Meadows 23/08/07

Stambridge Meadows 15/01/07

Stambridge Meadows 03/05/06

Stambridge Meadows 31/01/06

Stambridge Meadows 28/09/05

Stambridge Meadows 01/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Stambridge Meadows Stambridge Road Great Stambridge Rochford Essex SS4 2AR Lead Inspector Michelle Love Unannounced Inspection 9th January 2008 09:35 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 Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stambridge Meadows Address Stambridge Road Great Stambridge Rochford Essex SS4 2AR 01702 258525 01702 258229 stambridge.meadows@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) vacant post Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Terminally ill (2) of places Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Terminal illness to include persons over the age of 55 Date of last inspection 23rd August 2007 Brief Description of the Service: Stambridge Meadows is a care home with nursing for up to 49 older people. The home is situated approximately three miles from Rochford Town Centre and is set in pleasant country surroundings. The home has 40 single bedrooms, 33 with en-suite facilities and 5 double bedrooms, 2 of which have en-suite facilities. The home has three lounges, one of which has a designated dining area. The home also benefits from a visitors lounge area on the ground floor. The spacious grounds are well maintained, with several paved areas. The home is in good decorative order with high quality accommodation for residents. Inspection reports are readily available for visitors to the care home and are displayed in the main reception area. Upon request, prospective residents and/or their representatives can have a copy of the last report. The range of fees as provided by the home’s administrator are £630.00 for those residents receiving residential care in a bedroom without en-suite facilities, £680.00 for those residents receiving residential care in a bedroom with en-suite facilities, £650.00 to £750.00 for those residents receiving nursing care. A shared bedroom without en-suite facilities is £525.00 per week per person and with en-suite facilities is £550.00 per week per person. A large room is charged at £695.00 per week and a large room with en-suite facilities is charged at £800.00 per week. Respite/Short Term Care is charged at £140.00 per day and after 7 days this reduces to £110.00. Additional charges to residents include chiropody, hairdressing, newspapers and magazines, personal toiletries and telephone charges. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The visit was undertaken over a 10.5 hour period. All but one of the key standards and the manager’s progress against previous requirements from the last key inspection and subsequent additional inspections in October and November 2007 were inspected. For part of the inspection the inspector was accompanied by a specialist pharmacist inspector. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment, detailing what they do well, what could be done better and what needs improving. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the inspection, relatives were contacted so as to seek their views about the services provided and it was positive to note that 9 surveys were returned to the Commission for Social Care Inspection. Additionally 4 staff surveys were also received. The manager, operations manager and other members of the staff team assisted the inspector. Feedback on the inspection findings were summarised at the end of the day with the manager, operations manager and operations director. The opportunity for discussion and/or clarification was given. Due to the number of regulatory requirements and areas of judgements identified as poor at the home’s first key inspection, this necessitated further random inspections on 10th October 2007, 13th November 2007 and a further key inspection so as to examine progress to meet regulatory requirements. A copy of the random inspection reports can be made available on request. As a result of unsatisfactory medication practices and procedures, a Statutory Requirement Notice was issued on 10th December 2007. What the service does well: In general residents were seen to be relaxed. Staff, were observed to be knowledgeable and understanding of individual residents’ needs and to have a good rapport with them. Residents like living at Stambridge Meadows. The management of the home have an appropriate system in place for assessing the needs of prospective people who wish to live at the care home. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 6 Visitors to the home are made to feel welcome. Food provided to residents is of a high quality and comments from residents relating to meals provided, was positive. The home is homely and comfortable for residents and provides a safe place in which to live. Residents spoken with during the inspection were satisfied with the home environment and their personal space. Most relatives felt that the home communicated well with them and kept them informed about relevant issues. What has improved since the last inspection? What they could do better: Care planning at the home, needs to be further developed so that residents’ care needs are clearly identified. This will provide care staff with up to date information so as to ensure proactive and safe delivery of care, which can meet their individual needs. The deployment of staff at the home needs to be reviewed so as to make sure that all residents needs are met at all times. Further development is required to ensure that people who are immobile/bed bound have the opportunity to participate in activities. Complaint records need to be further developed so as to ensure that they include information relating to the investigation and any action taken. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed prior to moving into the care home, so as to ensure that staff working within Stambridge Meadows, are able to meet their needs and provide appropriate care. EVIDENCE: The files of two recently admitted residents were inspected and evidence detailed that the management of the home completed a pre admission assessment prior to admission for both people, so as to ensure that they are able to meet the prospective resident’s needs. As part of the assessment process, formal assessments were completed relating to dependency, moving and handling, pressure area care, nutrition and continence. The Annual Quality Assurance Assessment details that all residents who return from hospital are re-assessed to ensure that the staff at the care home can continue to care for the person’s needs. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 10 In addition to the formal assessment, additional information had been provided, by the individual resident’s placing authority and/or hospital. No information was available to indicate that the resident and/or their representative were given the opportunity to visit the care home prior to admission. The Annual Quality Assurance Assessment confirms that this is an area, which needs to be improved upon. It was positive to note that since the last inspection, written evidence was available to indicate that the management team had formally written to the resident and/or their representative confirming that they could meet the person’s needs. A copy of the Statement of Purpose and Service Users Guide is available in the main reception area of the home and since the last key inspection both documents had been revised and included a copy of the last key inspection report. In addition to the written format, both documents can be provided on a audio cassette and this can be supplied within a reasonable timeframe. Minor changes to the Statement of Purpose and Service Users Guide are required so as to ensure that the documents are accurate and prospective residents and other interested parties have the most up to date information about the services and facilities provided at the care home. This refers specifically to the category of registration, the numbers of people registered at the care home and the range of fees. The manager advised each resident receives a copy of the Service Users Guide and this is placed in their room. Of a random sample of bedrooms visited throughout the day of inspection, not all were noted to have a copy of the document. Relative survey responses received, showed that not all felt that they had sufficient information about the home. The home does not provide intermediate care. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Gaps in the recording of care management means that there may be times where the needs of residents are not always met. EVIDENCE: As part of this inspection three care files were examined. It is evident that the management and staff of the home have spent time and effort on care planning and in general there was a good level of information available about individual residents, to assist staff in providing care. The Annual Quality Assurance Assessment details that all residents have a personalised care plan and that care plans for all residents are audited. The care planning system remains comprehensive and makes reference to individual’s health, social, emotional and social care needs. It was a shame that evidence of resident and relative involvement within the care planning process was still not fully in place. Discussion with individual staff indicated that staff had a good knowledge and understanding of residents care needs, however information detailed within Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 12 individual residents care plans were not always observed to be followed consistently and this could compromise residents’ care. The care file for one person indicated that they were risk assessed as having very poor nutritional care needs and required to be weighed weekly. Records indicated that only one entry had been recorded and staff, were not providing care in line with the person’s care needs and/or risk assessment. The management of nutrition for individual residents continues to require further development and staff need to demonstrate proactive practices and monitoring to ensure positive outcomes for people living at the care home. Records showed that residents identified as being at low risk nutritionally had lost significant amounts of weight and this was not being adequately monitored by staff or referred to a healthcare professional. The Annual Quality Assurance Assessment details “weight charts are in place for all residents, and senior staff inform the GP of any weight loss”. This does not concur fully with the above findings. Although there is a formal assessment/risk assessment process for falls, this needs to be developed further to ensure that this is not solely related to the environment and other areas are also considered e.g. medication, nutrition, diet and other conditions associated with older people. One relative survey recorded that they are not always kept up to date with important issues affecting their member of family and are currently in discussions with the management team of the home. Behavioural charts for individual residents are available so as to record behaviours exhibited, actual care delivery by care staff/outcomes and to detect possible trends and/or common themes. It was disappointing to note that behavioural charts were not completed for all incidents and information detailed within daily care records, were not always transferred or crossreferenced to the behavioural record and/or care plan. Risk assessments were devised for the majority of risk assessed areas, however further development is required to ensure that risks are highlighted for all areas. Information recorded needs to depict how these are to be minimised, with appropriate management strategies devised and in place to ensure residents wellbeing and safety. Some risk assessments were not up to date and not as person centred as they could be. This is disappointing as staff do not have the most up to date information to deliver care that is appropriate or in line with the person’s care needs. The staff training matrix details that all staff have completed care planning training. Daily care records, were observed to be written daily however some records were seen to be more detailed and informative than others. This refers specifically to some records not reflecting how residents spent their day and Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 13 purely based information on the personal care provided. Additionally records did not always include staff’s interventions and outcomes. Records showed that residents have access to healthcare professional services such as chiropody, optician, community psychiatric nurse and GP as and when required. Residents spoken with confirmed that they receive appropriate help with their healthcare needs. Deployment of staff on the day of inspection was observed to be inconsistent. On three separate occasions call alarm facilities, were observed to not be answered promptly. One resident was observed to become quite frustrated by the slow response of staff and they demonstrated this by calling out “I’m so frightened, please come and see me”, “nurse, where am I” and “Oh what do I do, please come and help me, I don’t know what to do” and by banging their call alarm cord on their bedside cabinet. Additionally when undertaking a tour of the premises during the morning no staff, were noted to be present within the first floor for a period of time. The majority of resident’s bedrooms had their doors closed. During this time one resident was observed to be calling out for some considerable time, however no staff were available/could be seen. The operations manager was advised and later told the inspector that all four staff, were providing personal care to other residents. The resident’s call alarm facility was observed to not be accessible for them and was placed behind them. This needs to be reviewed to ensure that residents have the means to summon assistance and/or are supported by staff for their health and wellbeing. Interaction between staff and residents was seen and heard to be respectful and friendly. Residents spoken to commented positively on the staff team. As a result of concerns highlighted pertaining to poor medication practices and procedures following the last key inspection, two additional inspections were conducted to the care home in October and November 2007 by a specialist pharmacist inspector. On 10th December 2007 a Statutory requirement notice was served on the home following continued poor practices in the safe use, administration and recording of medication to residents. On this inspection the practices and procedures for handling and recording of medication given to residents was examined by a specialist pharmacist inspector and the requirements of the enforcement notice have been complied with. Residents are now protected by the safe practice in the use of medicines and records show that they receive medicines as prescribed by their GP. There are still some concerns over the storage of medicines that the management are aware of and are working to resolve, but these do not affect the well being of residents. The staff training matrix submitted to the inspector recorded that all staff who administer medication to residents have received training. Under the heading of `what we do well`, the Annual Quality Assurance Assessment details that Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 14 staff who administer medication, “have 3 monthly competency assessments”. This is not strictly accurate as at the time of the inspection 2 staff did not have a completed competence assessment and these assessments have only just been introduced. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the activities programme at the home, means that some residents do not have their social care needs met. Residents at the home are happy with the meals provided. EVIDENCE: Stambridge Meadows employs two people to undertake the role of activities co-ordinator for a total of 30 hours per week, Monday to Friday. The manager advised the inspector that since the last key inspection, the activities coordinator has joined NAPA (National Association for Providers of Activities for Older People) and is currently undertaking a ceramics course for the elderly and completing a distance learning activities course. Both the activity event summary for December 2007 and the diary for 20072008 were examined. Records evidenced that activities provided throughout December included, PAT dog, carol singing, arts and crafts projects, Christmas craft fayre, quiz, sing-a-long, listening to music, bowling, bell ringers, a visiting school choir and hoopla. The activities co-ordinator on duty on the day of Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 16 inspection, advised the inspector that an activity care plan is devised and implemented for all residents. Some residents had an activity care plan in place that gave good detail on their social interests, however this was not available for all people. Of those people case tracked, information recorded for one person was basic and somewhat limited and there was no care plan for another person. A tour of the premises was undertaken at various times of the day. In most cases, there was no evidence that the activities co-ordinator and/or staff had provided stimulation/support to those people who were immobile and spent the day in their bedroom. This is disappointing as this has been highlighted at previous inspections to the home and the outcome is that these people do not have their social care needs met and may become frustrated, bored and their mental capacity may deteriorate over time, if left. The manager advised the inspector that a weekly event sheet is compiled and circulated to advise residents of forthcoming events and enable them to make an informed choice as to whether or not they wish to participate. The event sheet on display in the reception area and some bedrooms was out of date and several resident’s bedrooms were noted to not have an event sheet at all. The manager was advised to consider devising an event summary in larger print/pictorial format so as to enable the majority of residents to make an informed choice. The Annual Quality Assurance Assessment details that record keeping of social activity participation has improved and that the activity co-ordinator is good at ensuring an activity programme is displayed and made available for residents. It is hoped that within the next 12 months a year planner for bigger social events will be developed and implemented. One resident confirmed to the inspector that they go out each day for a walk and join in activities as and when they so choose. The resident confirmed that they are usually provided with an event sheet as described above, however this had been taken down as it related to December 07. Other residents spoken with also confirmed that they spend the majority of the time in their bedroom, however if there is an activity, which interests them, then they attend. There is an open visiting policy whereby visitors to the home can visit at any reasonable time. One visitor advised that he is always made to feel welcome by staff and can visit at any time. A four week rolling menu is in operation at the care home. The menu for the day was displayed within the main dining room, however some residents when asked, were unable to say what was on offer for lunch/tea. The manager should consider devising a larger/simple print and/or pictorial menu so that the majority of residents are enabled to make an informed choice. The menu indicated there were two choices of main course available and three choices for dessert, however alternatives to the menu are always available. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 17 Dining tables were laid with tablecloths and condiments and a choice of drinks were readily available. The dining experience for residents was observed to be positive and appropriate. Where residents required assistance from staff to support them to have their meal, this was done with respect and sensitivity. It was positive to note that many residents choose to have the majority of their meals in the privacy of their own room. Comments relating to food from residents were noted to be positive, “its lovely, I have no complaints” and “oh yes, it is always good”. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the management of safeguarding in the home is good, shortfalls were noted with regard to complaint management that could lead to residents and other interested parties not feeling that concerns expressed will be listened to or acted upon. EVIDENCE: A satisfactory complaints procedure and policy is available within the home. The complaints procedure is clearly displayed and residents spoken to confirmed that if they had any areas of concern/complaint, then they would discuss this with either the deputy manager or manager. Relative surveys forwarded to the Commission for Social Care Inspection, recorded that they all knew how to make a complaint and were aware of the complaint procedure. The home has a formal system for the logging of complaints, however this was observed to be disorganised. Since the last key inspection, the management team at the home have received 11 complaints relating to a variety of issues pertaining to care, lack of activities, maintenance and monetary issues. It was of concern that out of 11 complaints logged, records were only available for 4 complaints. Both the manager and operations manager concurred with the inspector’s findings and assurances were given to ensure that records were located and evidence of actions taken were recorded. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 19 The Annual Quality Assurance Assessment recorded that complaints are dealt with promptly, appropriately and recorded and followed through to completion/outcome, however this is not evident from the findings on the day of inspection. No safeguarding issues have been highlighted since the last key inspection. Policies and procedures relating to safeguarding are readily available within the home. Staff spoken with demonstrated an awareness and understanding of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge of the shift. The staff training matrix evidenced that 91 of staff have attained safeguarding training and 85 of staff have received training relating to challenging behaviour. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Stambridge Meadows provides a comfortable, safe and homely environment for residents which meets their needs. EVIDENCE: A partial tour of the premises was undertaken. On the day of inspection the home was observed to be clean, odour free and no health and safety issues were highlighted. A random sample of resident’s bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display e.g. ornaments, photographs etc. The Annual Quality Assurance Assessment details that residents are actively encouraged and supported to personalise their rooms. Stambridge Meadows provides residents with a comfortable and safe living environment. The ambience in the home is homely and residents spoken with were all complimentary regarding the home environment and their own personal space. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 21 The manager advised the inspector that plans are currently being discussed to divide the main lounge/dining area and to redecorate another lounge on the ground floor so as to make it more inviting to residents and to encourage more use. The manager also advised that there are plans to turn the first floor lounge into a library for residents use. The Annual Quality Assurance Assessment details that within the next 12 months it is hoped that the grounds that surround the home will be further developed to include raised flowerbeds so as to enable residents who have a physical disability to also enjoy the gardens. Within the home it was noted that there was sufficient items of equipment e.g. hoists, wheelchairs, grab rails etc so as to ensure residents safety and wellbeing. The manager/staff within the home must ensure that where items of equipment are specifically purchased for an individual person these are used solely by them. A maintenance person is employed for 40 hours per week and there is a rolling programme of maintenance and decoration. In addition to this person a window cleaner and gardener are also employed. The training matrix provided to the inspector details that the maintenance person, housekeeper, laundry person, domestics and gardener have up to date training relating to fire safety, fire drills, moving and handling, COSHH (Control of Substances Hazardous to Health), health and safety, safeguarding and infection control. Records for safety checks that are weekly, monthly, 6 monthly and annually are maintained by the maintenance person and these were seen to be satisfactory. Cleanliness of the home is maintained to a high standard and there is a rolling programme for carpet cleaning and deep cleaning of individual resident’s bedrooms. A random sample of safety and maintenance certificates showed that equipment and services in the home were kept in good order. The manager and operations manager were advised that further evidence is required, where shortfalls are highlighted so as to show remedial work that has taken place. This relates specifically to the electrical installation for the home. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst recruitment practices are good the level of staffing/staff deployment on occasions restricts the ability of the service to deliver person centred care and to ensure that residents needs, can be met and that they are safe. EVIDENCE: The registered manager advised that staffing levels at the care home remain at 7 staff (includes 1 RGN and 1 Senior) between 08.00 a.m. and 14.00 p.m., 6 staff (includes 1 RGN and 1 Senior) between 14.00 p.m. and 20.00 p.m. and 4 waking night staff (includes 1 RGN) between 20.00 p.m. and 08.00 a.m. each day. The manager advised the inspector that she is looking to review the waking night staffing ratio to 1 RGN, 1 Senior and 2 members of care staff. At the additional inspections undertaken in October and November 2007, it was evident that staffing levels were not being regularly maintained and that we had not been notified and there was no rationale recorded as to what steps had been undertaken by the management team to address the deficit. It was positive to note at this inspection that staff rosters examined indicated that staffing levels, as detailed above, had on most occasions been maintained. The rosters show on occasions that some shifts have run short, however we have been advised via Regulation 37 notifications. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 23 The staffing levels in relation to the numbers of residents and dependency levels need to be kept under regular review to ensure that those people who are immobile and are cared for in bed receive appropriate support. As stated previously there were occasions during this inspection when the deployment of staff was observed to be poor and call alarm facilities were not answered promptly, which could affect resident’s wellbeing and safety. Additionally one relative survey stated that on occasions their relative has not received a bath as the home has been short staffed. A random sample of staff files, were inspected for those staff newly appointed since the last key inspection. These were seen to contain all the correct checks in line with Regulation and were maintained in good order. Evidence of inductions in line with Skills for Care, was also available. At the additional inspections undertaken in October and November 2007, it was evident that records relating to agency staff (profiles/inductions) were not available for some staff utilised at the care home. It was positive at this inspection to note that profiles and inductions had been completed and were readily available. Several relatives’ surveys made reference to quality/permanent staff being retained at the care home and for less usage of agency staff. The training matrix provided to the inspector showed that at the time of the key inspection 55 of staff had training relating to fire safety, 73 fire drills, 85 food hygiene, 79 moving and handling, 85 COSHH, 88 health and safety, 91 safeguarding, 82 infection control, 90 nutrition, 100 care planning, 85 challenging behaviour, 18 dementia awareness, 7 had received training relating to safe use of bed rails and 25 members of staff have up to date first aid training. The above is seen as an improvement and evidences the organisations commitment to ensuring that staff, are receiving regular training to enable them to provide appropriate care to residents and to meet their needs. The manager was advised that the newly employed chef’s food hygiene certificates need to be updated, as they are several years out of date. Further development is required pertaining to staff training for those conditions associated with the needs of older people. The Annual Quality Assurance Assessment details that 12 members of staff had attained NVQ Level 2 or above. It is hoped within the next 12 months to purchase an overhead projector and teaching materials to enable in house training of staff. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements are generally sound, shortfalls identified during this inspection, could adversely affect outcomes for residents. EVIDENCE: The manager has been in post at Stambridge Meadows since November 2007. The manager is a qualified RGN (Registered General Nurse) and has experience in care provision and managing a care home. She has achieved the Registered Managers Award qualification. The manager advised the inspector that she will shortly submit her application so as to be formally registered with the Commission for Social Care Inspection. Staff and residents spoke positively about her and staff spoken with advised that staff morale has improved. The Annual Quality Assurance Assessment Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 25 recorded that “staff morale is beginning to improve and team members are beginning to feel valued in their job role” and “a sense of management presence and leadership is being instilled back into the home”. One staff survey recorded “since management has changed it is getting better and the atmosphere has definitely improved”. At this inspection it was positive to note that progress has been made by the management team at the home to address previous identified shortfalls and requirements. It is hoped that future inspections to the home will continue to evidence progress. Staff meetings are held at the care home and evidence showed that these cover care provision and practices, training etc. The last staff meeting was held at the beginning of January 2008, however it was disappointing to note that only 3 members of staff attended, despite being advertised for the previous two weeks. Records showed that a relatives meeting was held at the care home in October 2007. Concerns were raised in relation to the numbers of staff who had left the employment of the home, inadequate staff cover when training provided, high turnover of staff very unsettling, some resident’s missing activities as a result of staff shortages and one relative was noted to state “feel there is no community spirit”. Records detailed that the manager/operations manager have tried to provide explanations as to why some of the above have occurred and steps being taken to address the issues, however some interpretations are misleading as they lay blame with the Commission for Social Care Inspection e.g. staffing levels. This is incorrect as it remains the registered providers responsibility to ensure there are sufficient staff on duty at all times for the numbers and needs of residents living at the care home. A quality assurance system is in operation at the home. A questionnaire was sent out to resident’s relatives and/or representatives since the last key inspection and 14 were completed and returned. Comments in the main were positive and some of these recorded, “My relative is loved and well looked after. The food is excellent and nothing seems to be any trouble for anyone”, “We are very happy with the care and attention our relative receives. The atmosphere of Stambridge Meadows is a very happy one now, after a brief interim of unrest amongst the staff reflecting upon the residents” and “The staff do this very difficult job extremely well and the catering is excellent”. Southern Cross Healthcare, have a comprehensive auditing system in place at the care home and these are conducted regularly by both the manager and operations manager. The organisation hold monies of behalf of residents and records are maintained. It was not possible to ascertain as to whether or not records are accurate and well maintained as these are held on computer and at the time of the site visit, access was not possible. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 26 The manager advised the inspector that up until her appointment, formal staff supervision had not been happening. The manager is aware of the recommendation highlighted within the National Minimum Standards for staff to receive 6 supervisions annually. Currently the manager is undertaking the role of conducting all supervisions for staff, as there is a need to provide training to senior/nursing staff so that they can undertake this role for the future. The supervision tracker evidenced that 2 staff received supervision in January 2008 and others are planned for February 2008. A health and safety policy was observed within the home. Accident records were inspected and these evidence that these mainly relate to people experiencing falls. Records were well maintained and included all necessary information. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 X 3 Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Ensure that care plans are detailed and comprehensive and clearly reflect how the needs of residents are to be met and residents supported. This will ensure that the delivery of care is appropriate to meet the needs of the individual person. Previous timescale of 1.5.06, 21.10.06, 1.7.06, 1.7.07 and 1.11.07 not fully met. Ensure that risk assessments are devised for all of assessed risk, that these are person centred and clearly depict how risks are to be minimised to ensure individuals wellbeing and safety. Previous timescale of 1.10.07 not fully met. Ensure that those people who are immobile have their social care needs. Previous timescale of 1.6.06, 1.12.06, 1.7.07 and 1.11.07 not fully met. Timescale for action 09/01/08 2. OP7 13(4) 09/01/08 3. OP12 16(2)(m) and (n) 01/03/08 Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 29 4. OP16 22 5. OP27 17(2), Sch 4(7) Ensure that there is a clear audit 09/01/08 trail/records depicting complaints received, investigation, action taken and outcomes. Ensure that there are sufficient 09/01/08 staff, on duty at all times, and that the deployment of staff is appropriate to meet the needs of residents and to ensure their safety and wellbeing. Previous timescale of 21.6.07, 1.10.07, 31.10.07 and 13.11.07 not fully met. Ensure that staff receive appropriate training to the work they perform. This refers specifically to those conditions associated with the needs of older people. This will ensure that staff, have the competence, confidence and ability to meet resident’s care needs. Ensure that staff, receive regular supervision so that they feel supported and residents know that staff are appropriately managed. Previous timescale of 1.1.06, 1.7.07 and 1.11.07 not fully met. 6. OP30 18(1)(c)& (i) 01/05/08 7. OP36 18(2) 09/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Consider that all residents and other interested parties have information about the services and facilities provided at the care home so as to make an informed choice. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. OP1 OP3 OP7 OP8 OP12 Make sure that minor amendments as highlighted within the text of the report are undertaken in relation to the Statement of Purpose and Service Users Guide. Evidence should clearly depict where residents and their representatives are invited to visit the care home prior to admission. Daily care records should record how residents spend their day, staff interventions and outcomes for residents. Turn charts should be completed consistently and in line with individual resident’s care plans/needs. The activity/event sheet should be up to date so as to enable people to make an informed choice. Consider devising this in larger print/pictorial format. Stambridge Meadows DS0000015554.V356774.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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