Inspection on 19/04/07 for Stamford Bridge Care Home

This inspection was carried out on 19th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stamford Bridge Care Home 16/09/08

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Stamford Bridge Care Home Buttercrambe Road Stamford Bridge Near York Yorkshire YO41 1AJ Lead Inspector Eileen Engelmann Key Unannounced Inspection 19th April 2007 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 Stamford Bridge Care Home DS0000069334.V337081.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. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stamford Bridge Care Home Address Buttercrambe Road Stamford Bridge Near York Yorkshire YO41 1AJ 01759 371418 01759 371682 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) Barchester Healthcare Homes Ltd Mrs Helen Lewis Care Home 107 Category(ies) of Dementia - over 65 years of age (107), Old age, registration, with number not falling within any other category (107), of places Physical disability over 65 years of age (107), Terminally ill over 65 years of age (5) Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Stamford Bridge Care Home is a Care Home with nursing that provides a service for residents who meet the following criteria of need: - Dementia, Old age, Physical disability and Terminal illness for those over the age of 65. The home is situated in the village of Stamford Bridge and enables easy access to the local shops and public transport routes. Accommodation consists of one hundred and seven placements within single and double rooms on three floors with lift access. Residents have the choice of six lounges and dining rooms in which they can relax and enjoy the company of others, although the staff do recognise that individuals need time to themselves. An activities organiser is employed, who will see each individual to discuss their interests and hobbies and arrange outings on the home’s minibus. Residents also have access to the grounds of the home, which are designed to be accessible to those in wheelchairs and with mobility problems. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager within the Pre-Inspection Questionnaire indicates the home charges fees from £450.00 to £800.00 per week depending on the type of room required and the nursing input needed. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the manager, staff and residents of Stamford Bridge Care Home. The visit took place over 2 days and included a tour of the premises, examination of staff and resident files and records relating to the service. Four staff and six residents were spoken to during this visit; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of staff, relatives and residents and their written response to these was good. The inspector received 18 back from relatives (90 ), 5 from staff (25 ) and 6 from residents (30 ). The manager completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last visit to the home the service has been re-registered and on this basis is classified by the Commission for Social Care Inspection as a NEW service. What the service does well: The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. All of the people spoken to are positive about the home and like living there. Five individuals said they love living at the home and the care is very good. People living in the home and relatives expressed their satisfaction during this visit regarding the care given, service received and the living environment of the home. Staff are hard working and do their best to meet the needs of those living in the home. People being cared for have good access to professional medical staff and are able to access external services such as dentists and opticians. People in the home are provided with a warm, safe and comfortable environment that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. People said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 7 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 Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 8 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, 2, 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. All residents undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The statement of purpose and service user guide is on display in the entrance hall and copies are available from the manager. It was recommended that the manager give each new resident a copy on admission. Each of the packs is produced in a clear print version, and these are very in-depth and informative. Given the wealth of information in the documents the inspector queried how many of the residents are able to take in and use the information provided. The manager does have a welcome pack, which is written in plain English and provides information in a more simple way. It is recommended that the home consider producing more appropriate formats that use innovative methods to make the information they give meaningful and interesting, for example using photographs, leaflets, visual or audio versions. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 9 Information from the surveys shows that the majority of residents received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. A significant number of residents within the home are self-funding and their files show that information about fees and fee increases is sent out to the person responsible for each individuals finances and sufficient notice of changes to the prices is given in writing. Each resident has their own individual file and four of those looked had a need assessment completed by the funding authority or the home before a placement is offered to the resident. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the resident and family. Discussion with the manager indicated there is no formal, written process of offering placements to prospective residents and it is recommended that this is implemented. Those residents at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. It is recommended that the manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. This will help the manager to assess if the home and staff are achieving the aims and objectives for the service. Residents and relatives are very pleased with the care and support given by the staff, one person said ‘I cannot speak highly enough of the care my relative receives. It is very individual to their needs and personality. The staff are professional and calm, and this is the norm every day as I visit on a regular basis’. Survey responses show that everyone using the service is confident about the care and satisfied that the individual needs of the residents are being met. One relative said ‘ my family member is deeply Christian and the staff ensure their religious needs are met’, another said ‘all the residents are treated equally and with respect’. The home employs ten staff from overseas including South Africa, Romania, Bulgaria and the Philippines. Residents are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has five male care staff as well as the female members. The manager said that she would discuss this with prospective residents during the assessment process. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 10 staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of the residents, including dementia care. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of the residents. Information from the Pre-Inspection Questionnaire and discussion with the residents indicates that all of the residents are of white/British nationality. The home does accept residents with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Stamford Bridge Care Home DS0000069334.V337081.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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The health, personal and social care needs of the residents are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. EVIDENCE: Since the last visit the home has changed the format of its care plans, all documents have been up dated and reviewed and information transferred onto the new paperwork. The care plans are very detailed and contain a lot of nursing information. This could make them difficult for the residents to read and understand without staff support and guidance. The manager should look at how the plans can become more ‘resident friendly’. Individual care plans are in place for all residents and the four examined set out the health, personal and social care needs identified for each person. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Risk Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 12 assessments were seen to cover pressure sores, nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. The funding authorities are carrying out yearly reviews of the care plans and the minutes of these meetings show that residents have input to this process (where possible), and family/representatives are also invited to the reviews with the resident’s permission. However, discussion with the manager indicated that where the residents are self-funding the review process is not always being carried out. One relative said that ‘ we did ask for a yearly review as our relative pays for their own care, and so far nothing has happened’. It is recommended that the manager ensure that all residents have the opportunity to have a care review, where family/friends or representatives are invited with the consent of the resident. Residents or their representative have signed the care plans at the point of their being written to show they agree with the content, however there is little evidence that residents are consulted on a regular basis about their care, especially when staff are completing the monthly evaluations. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Information from the surveys indicates that residents and relatives feel that the home gives the support and care that individuals require. One relative said ‘My relative sits in the lounge and the staff are very friendly and caring towards them and our family who visit’, another individual commented that ‘my mother has blossomed since coming into the home, the difference in care and her wellbeing is so marked. The nurses and carers talk to her, hold her hand and she has put on weight and says how happy she is’. Six residents said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that the residents and relatives are satisfied with the level of medical support given to the people living at the home. Relatives commented that ‘the care provided for my aunt is extremely good, I do not think she would be alive today without the support from the staff’, another said ‘the home has made such a difference to my mother’s life. Her care is excellent and way beyond anything I could have expected’. Entries in the care plan specify where individuals have dietary needs, including supplement drinks and pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. One area of good practice noted during this visit was the monthly nutritional reports for the manager detailing Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 13 which residents have lost or gained weight, their risk assessment outcomes and any input from outside professionals. The nurses within the home carry out specialist tasks such wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and specialist beds, mattresses and seat cushions. Information from the pre-inspection questionnaire and discussion with the manager indicates that currently there are four residents who have with pressure sores, their wounds are documented in their care plans and wound care is given as appropriate. Checks of the wound care records showed these were detailed around the type of dressings used and the progress of the wound. The staff ask the tissue viability nurse for advice, where required, and documented any changes as necessary. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (where appropriate) on their care and feel involved in their lives. Overall there is a good level of satisfaction with the care being given to the residents. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the residents spoken to prefer to have staff administer their medication. Checks of the medication records showed that overall these are well maintained and kept up to date, however there was one area which they could improve •It was noted that medication already held in the home when a new medication sheet is started is not added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. Resident and relative comments show they are very satisfied with the care and support offered by the staff. Chats with the residents revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were ‘the staff treat residents with dignity and respect, providing a warm, calm and person centred atmosphere. We feel safe here’, ‘staff constantly check on us to see that we are okay, this is done in a positive way without being intrusive’. One relative said ‘ the people with dementia are treated with respect and professionalism. I am always made welcome and kept up to date with my relative’s well being’. Observation of the service showed there is good interaction between the staff and resident, with friendly and supportive care being given to assist residents in their daily lives. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: There are two activity co-ordinators within the home, who together provide a programme of events from Monday to Friday each week. During this visit it was observed that residents enjoyed a church service on Thursday morning and Friday morning a baking activity was undertaken, where individuals made flapjack. The home has a mobile shop for residents to purchase sweets and other essentials, there is a library area with ‘large print’ books and residents can take part in a literary appreciation group. Discussion with the residents indicated that they have access to a minibus each week and can go out on regular trips; they also take part in Quizzes and other group activities. In the dementia unit the residents have made and displayed posters, Easter bonnets and pictures and have access to a range of memorabilia from days gone by. Individuals spoken to are satisfied with the activities and social events that Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 15 take place and comments were made that ‘the interaction between the residents and carers is good. There is a plentiful provision of activities and we cannot praise the staff highly enough. They do their jobs well and are extremely kind and loving towards the residents’. Resident/relative meetings are held every 3-4 months; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Good records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that residents are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. There are weekly in-house church services, one week it is Methodist and the next it is Church of England, and the catholic priest will visit anyone, wishing to take communion, on request. Discussion with the residents indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the local village. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly is a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. Individuals said that the home helped their relatives/friends stay in touch with them. One person said ‘I am phoned when important things affecting my relative take place’ another commented that ‘ the staff make time for me, answer my questions and help me through what is a difficult time’. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service, although these have been accessed in the past. Six residents spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Residents spoken to are satisfied that they can access their personal allowances when needed. All the residents said that the home encouraged them to bring in small items of furniture and personal possessions to decorate their bedrooms. There are three-monthly resident meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. Since the last visit the home has updated its menus and offers residents a wide choice of food. Discussion with the chef indicates that Barchester provides a very good food budget to ensure individuals are given high quality foodstuff, which promotes a healthy and well balanced diet. Discussion with the Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 16 residents and relatives indicated they are satisfied with the food available and enjoy the meals and choices presented to them. One person said ‘the food is varied and looks nice, it is available when I want it and I can have snacks and drinks throughout the day’. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft/pureed diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to residents who need help with eating and drinking. Some of the staff felt that there are some problems with getting food out on time, so that it is always hot and fresh. This was discussed with the manager and she assured the inspector that she would talk to the staff to see in what way the service could be improved. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 17 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): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home has a good complaints system with some evidence that residents’ views are listened to and acted upon. Visitors and residents are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: The home has a complaints policy and procedure that is included in the statement of purpose and service user guide; it is also on display within the home. Four out of the six resident survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those residents spoken to said ‘we would talk to our key worker or the nurse on duty if we have a problem’. Fourteen out of the eighteen relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. One relative said ‘the staff are very helpful if you raise concerns. They take the time to talk to you and explain things, and take the necessary action to resolve your issues’. The home has received eleven complaints since the last visit; these related to food, gardening, care, care plans, loss of property, staff and access to the home. All have been investigated and resolved. The complaints record documents each issue and the subsequent action taken by the manager or staff. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 18 The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that they all have received Safeguarding of Adults training. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 19 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, 22, 24 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The standard of environment within the home is good, providing residents with an attractive and homely place to live. EVIDENCE: The manager has a record of the ongoing maintenance and renewal programme and this indicates that the provider is committed to improving the facilities and environment within the home. Since the last visit the dementia unit has had new carpets fitted to all its communal areas, one bathroom has been refurbished including a new bath, carpet replacement is ongoing throughout the home, new curtains have been provided to the lounges and vinyl flooring covering fitted to all dining areas. Comments from the residents and relatives are very positive about the changes. One person said ‘ the environment is clean, well maintained and the lounge is light and spacious. The home is beautifully clean and my relative’s room is immaculate’. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 20 The home comprises of five different units titled The Terrace (ground floor), Manor Lodge (ground floor) this is the dementia unit, The Circle (first floor), The Croft (second floor) this is a high dependency unit, and the original Manor House. The Manor House is the oldest part of the building and although the environment in this section is acceptable, there is one area that could be improved. •The floor covering in the bathroom is uneven and could present a trip hazard. It is recommended that this should be replaced. All areas seen by the inspector were found to be clean and tidy and there were no malodours within the building. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious and have enough room for people in wheelchairs or with walking frames to pass by comfortably. The home is built on three floors with flat walkways inside and out, providing safe and secure footing for people with limited mobility. Access to the upper floor is by use of staircases or the passenger lift. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of the residents and to encourage their independence within the home. This includes mobile hoists, stand aids and handrails. Specialist nursing beds and hospital beds are provided throughout the home to aid staff in caring for the residents and make life more comfortable for individuals who spend a lot of time in bed. Five residents spoken to were very pleased with their individual rooms and said that they had ‘brought in a number of personal possessions to make them feel more at home’. The rooms are decorated to a high standard and supplied with sufficient furnishings to meet the needs of the residents. All bedrooms are supplied with door locks and lockable storage space to ensure resident’s valuables are kept safe. Staff have a master key, which can be used to gain access in an emergency. The environment is clean, warm and comfortable and no malodours were present. Comments from the surveys indicate that the residents find the home to be spotlessly clean and the majority of people are satisfied with the laundry service provided by the home. Three individuals spoken to on the day of this visit said that ‘ the domestic staff come round regularly to clean our rooms, they tidy up as they clean and do a good job’. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 21 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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Improvements to the team working system must be made within the home to raise staff morale and produce better communication between the units. This would ensure that residents’ care continues to be provided to a high standard by motivated and enthusiastic staff. EVIDENCE: Comments from the residents and relatives are on the whole very positive about the staffing levels within the home, and individuals feel that there is a high standard of care being given to the people living in the home. Survey responses said ‘the staff create a good atmosphere; it is caring, comfortable and safe. Staff are supportive, friendly and professional’. Some individuals feel that staffing could be better in a morning and two relatives commented that ‘we find it difficult to find staff on an evening’. Inspection of the duty rota and discussion with the manager indicated that due to reduced numbers of residents the staffing levels have been lowered accordingly. At present there are 76 residents living in the home and staffing is provided as follows From 07.30am to 2.30pm there are 4 nurses and 15 care staff on duty, 2.30 pm to 8.30pm there are 4 nurses and 13 care staff, and from 8.30pm to 07.30 am there are 3 nurses and 6 care staff. Observation of the staff showed that the home is busy, but well organised. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 22 Information from the pre-inspection questionnaire about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. Information from the staff indicates that there are some concerns around the staffing levels and the effectiveness of communication within the team. Since the home became part of the Barchester Healthcare group the staff feel that they are not being treated fairly, with little regard given to them as individuals and increasing pressure to perform to high standards with a reduced workforce. Staff say they feel rushed and under pressure at times and commented that not all the staff work as a team, which creates problems and an unfair distribution in the workload. Poor communication and time management issues were also factors that resulted in staff feeling frustrated and misunderstood. Staff say they have not received contracts, staff morale is low and staff meetings are not being held. Discussion with the manager indicates that she has been waiting for new Barchester contracts for the staff. These have arrived in the week of this visit and will be given out to staff within the next few days. Staffing numbers have been reduced because the numbers of residents are also less. Given the layout of the home this is not always easy to manage, but the home is still staffed with sufficient numbers to meet the needs of the residents. The manager said she would meet with the heads of units to discuss staff issues and see what could be done about improving staff morale and create a better working environment. Staff meetings are being held in smaller groups with the Head of unit taking the lead for their part of the home. This may mean that information sharing is not as good as it could be and the manager assured the inspector that she would look at how this could be improved. There is an induction and foundation course for new members of staff, and 29 of the care staff have achieved an NVQ 2 or 3. The home provides a mandatory staff-training programme and is beginning to add some more specialised training to help staff develop their skills and knowledge around mental health, dementia, customer care and care planning. Discussion with the manager indicated that the new training officer for the home is hoping to improve access to specialist subjects and this should be more evident over the next 12 months. Staff do have access to training around equality, diversity and disability rights and this will be included in the rolling programme of staff training and development. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 23 The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The manager said that she has employed more male carers in the past as she is aware that the majority of staff are female, but as people move on the numbers of male to female staff have reduced. She is aware that this may affect resident’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Comments from the manager indicate that all of the current residents are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police/Criminal Records Bureau checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Stamford Bridge Care Home DS0000069334.V337081.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, 35, 36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of residents, staff and relatives. EVIDENCE: Mrs Helen Lewis is the registered manager of Stamford Bridge Care Home; she has been in post since 2002 and is a Registered Nurse and has an active registration with the Nursing and Midwifery Council. She is applying for the Registered Managers Award training, and although there has been some delay due to changes of ownership of the service she is hoping to complete this by the end of 2008. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 25 Since the home became part of the Barchester Healthcare group there has been a system of Quality assurance and monitoring put into place. The manager and heads of units are responsible for completing monthly audits of staff practice and records within the home and the registered individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is sent to the commission. Meetings for the staff and residents are taking place; minutes are kept and are available for any interested parties to read. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Feedback is sought from the residents and relatives through regular meetings and satisfaction questionnaires, and the manager is working on producing an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The results of the resident surveys must be published and made available to current and prospective users, their representatives and other interested parties. The manager must look at how the views of stakeholders in the community (e.g. GP’s, chiropodist, community nurses) can be sought on how the home is achieving goals for residents. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Evidence was seen that the Barchester Company has produced its own crisis plan for the Flu Pandemic that may affect the country in or around 2009, this is detailed and sets out what each home must do to ensure the residents and staff receive the care and support needed in the event of a flu outbreak. It was not possible to look at the financial records relating to the personal allowances of the residents at this visit, as the administrator was away on sick leave. This standard will be looked at in full at the next inspection. Discussion with the residents and relatives indicated they were satisfied with the service and had no concerns about being able to access their monies. Individuals receive regular supervision, both formal and informal and feel that this aspect of support is useful and offers them an opportunity to discuss their views and get feedback on their performance. Yearly appraisals are completed and staff receive advice and constructive criticism on their work performance. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? New service. 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 OP33 Regulation 24(1)(a)( b)(2)(3) Requirement The manager must ensure that the results of resident surveys are published and made available to current and prospective users, their representatives and other interested parties, including the Commission for Social Care Inspection. The manager must look at how the views of stakeholders in the community (e.g. GP’s, chiropodist, community nurses) can be sought on how the home is achieving goals for residents. Timescale for action 01/10/07 12(1)(a) 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 The manager should give each new resident a copy of the service user guide on admission to the home. DS0000069334.V337081.R01.S.doc Version 5.2 Page 28 Stamford Bridge Care Home 2. OP1 3. 4. OP3 OP3 5. 6. OP7 OP7 7. 8. OP7 OP9 9. 10. 11. 12. OP19 OP28 OP31 OP33 The home should consider producing the statement of purpose and service user guide in more appropriate formats, which make the information within them meaningful and interesting for the residents. The manager should implement a formal, written process of offering placements to prospective residents. The manager should make sure that the admission process is looked at as part of the quality assurance audits to determine the level of resident satisfaction with their experiences of these processes within the home. The manager should look at how the care plans can become more ‘resident friendly’ and easy for individual to read. The manager should ensure that all residents have the opportunity to have a care review, where family/friends or representatives are invited with the consent of the resident. The manager should consider how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. Staff should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. The floor covering in the bathroom in the Old Manor House is uneven and could present a trip hazard to staff or residents. This should be replaced. 50 of care staff should have achieved a NVQ 2 in care by June 2008. The manager should achieve the Registered Managers Award by December 2008. The manager should ensure the annual development plan for 2006/7 is completed and published by the end of July 07. Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Stamford Bridge Care Home DS0000069334.V337081.R01.S.doc Version 5.2 Page 30 - 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. 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