CARE HOMES FOR OLDER PEOPLE
Stamford Court Astley Road Stalybridge Tameside SK15 1RA Lead Inspector
Tracey Rasmussen Unannounced Inspection 14th December 2005 09:00 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 Court DS0000060723.V267946.R01.S.doc Version 5.0 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 Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Stamford Court Address Astley Road Stalybridge Tameside SK15 1RA 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) 0161 368 9099 Tameside Care Limited Mrs Christine Evans Care Home 40 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (40), Physical disability (40), of places Physical disability over 65 years of age (5), Terminally ill (2) Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: *up to 40 service users in the category of OP (old age not falling within any other category). *up to 40 service users in the category of PD (Physical disability under 65 years of age). *up to 5 service users in the category of PD(E) (Physical disability over 65 years of age). *up to 10 service users in the category of DE (Dementia under 65 years of age) *up to 2 service users in the category of TI (Terminally ill under 65 years of age). No more than 7 service users must be accommodated between the ages of 60 and 64. The manager must be supernumary at all times. A minimum of two registered nurses must be on duty at all times. A suitably qualified person must be employed by the home to undertake the clinical supervision of nursing staff. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 8th June 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Stamford Court Nursing and Care Centre is a purpose built care home that was first registered with the Commission for Social Care Inspection in May 2004. Tameside Care Limited owns the home which is registered to provide nursing care and personal care to 40 people, primarily to older people with various disabilities. The home is situated in Ashton approximately two miles away from Ashton town centre and the centre of Stalybridge. Local amenities and access to local bus services are readily available. Stamford Park is situated very close to the home. Outside the home, there are car parking facilities and small garden areas.
Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 5 Accommodation is provided over two floors. Each floor accommodates twenty service users. All bedrooms are spacious single rooms providing en-suite facilities. A choice of bathroom or shower is available on each floor. Each floor has lounges and dining areas including kitchen areas to prepare snacks and drinks. Smoking is not allowed in any area of the home. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over almost seven hours on Wednesday 14th December by one inspector. Not all the standards were assessed at this visit. A tour of the home took place and some care and staff training records were seen. Four residents, two visitors, one GP and four staff were spoken to. Twenty comment cards for residents and visitors were provided in the home. Non had been returned at the time of writing this report. Time was spent talking to the manager, residents and staff and observing routines within the home. A short verbal feedback of the findings from the inspection was given to the manager of the home. What the service does well: What has improved since the last inspection?
There have been significant improvements in almost all aspects of the service in the home. A new manager has been in post for six months and she has made great strides in developing the service. She has provided strong leadership, training and support to the staff team and identified the standards of service to be provided. This has resulted in a calm,
Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 7 relaxed home environment where residents were complimentary about living in the home and where staff said they were happy to working there. Residents spoken too said they liked living in the home and they described staff as ‘brilliant’. One resident said “the staff are smashing” and she emphasised that this included the domestic, laundry, cook and maintenance staff. One GP visiting the home stated, he was “very pleased with the care (his) patients received here”. The manager has ensured social activities are provided and motivates the staff team to participate with residents. One resident said she enjoyed the reminiscence group she had recently been in. Photographs were available of other activities undertaken in particular was the Remembrance Sunday and Halloween. A catholic spiritual service where all faiths are welcomed is also provided regularly in the home. Quality assurance systems that have included questionnaires and audits of different aspects of the service have been undertaken. Residents and staff had had opportunities to comment on the home and service through meetings. Staff training in a wide range of care and health and safety issues had been undertaken, including abuse training. Medication practices were safe and regular audit checks were undertaken to ensure good practices were maintained. 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. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 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 Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Residents can visit the home before admission. Residents’ needs are met on admission to the home. EVIDENCE: A sample of resident care files were viewed and these contained detailed information about the resident’s needs. Each file had a community care and or nursing assessment, which detailed clearly the specific care needs of the resident. This was supported by the home’s own assessment. The manager explained that she or the clinical lead nurse assesses all prospective residents and only after this assessment and following review of the community care assessment and nursing assessment is a decision undertaken regarding the offer of a placement. The home also has a contract with Tameside Social Services whereby Stamford Court provides a ‘transitional’ care service. This means that patient’s ready for discharge from hospital but requiring additional care support or services can be accommodated in the home whilst additional services are sought and commissioned. The manager emphasised that the home’s pre-admission
Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 10 assessment process is adhered to and if needs of a prospective ‘transitional’ resident could not be met then they would be refused admission. Resident’s spoken to were satisfied with the service they received. One resident said she visited a number of home’s before deciding to move into Stamford Court. She stated that Stamford Court “..was the most suitable for me”. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents were treated with respect and dignity. The care planning documentation was sufficient to meet personal and health care needs of residents. Some medication practices are safe. EVIDENCE: The home provides nursing, care and support across a range of needs, including a ‘transitional’ care service. A number of residents were spoken to and all provided positive feed back about living in the home. One resident stated that her independence was respected, and ‘she managed what she could for herself’. Another resident said ‘whatever you need, you just ask and you get it’. Residents were presentable and dressed according to preference, clothing co-ordinated, hairs were set and finger nails were manicured. The home was calm and peaceful. Residents in bedrooms or in bed appeared very comfortable. Staff were respectful, attentive and caring in their approaches and interactions with residents. Staff spoken too were cheerful about working in the home and spoke positively about the impact the new manager had had in the home.
Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 12 Care plans viewed contained assessment information based on the activities of daily living, moving and handling, nutritional, falls, skin and Waterlow assessments. Where a risk or need was identified then a care plan was recorded. The resident or their nominated next of kin had signed some of the care plans. Care plans had been reviewed but evaluations’ regarding the effectiveness of the care provided does need more development. The care plan format could be improved. The manager was aware of this and stated that she was in the process of developing and improving all care planning documentation. Records of contact with community health services such as GP, district nursing, tissue viability and optical support were available. One GP visiting in the home stated that, “He was very happy with care his patients received in the home”. Medication practices were safe. Records for the receipt, administration and disposal of medications were maintained and controlled drug records were accurate. Stocks of medications did not appear to be excessive and the medication storage area was clean and tidy. The clinical lead nurse stated that she and her counterpart undertook medication audits to ensure procedures were being followed. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Life style choices are available and resident’s family and friends are welcome in the home at any time. Resident’s social needs are met and the quality of food provided is good. EVIDENCE: The manager for the home has worked hard in the six months she has been in post to ensure social stimulation and activities were provided for residents. At the time of the inspection the main entrance sitting area in the home had been decorated as a scene from the nativity. The manager stated that each month she had tried to decorate the entrance area according to a theme. November’s theme was ‘Remembrance Sunday’ where reminiscence and special spiritual services were held and in October the theme was Halloween. Staff and residents were encouraged to join in. Photographs of these occasions were available. One resident said that there were some activities and she had enjoyed the reminiscence activity the day before the inspection visit. Another resident said she attended the church service, undertaken by a Catholic priest. The resident said all faiths were welcomed at this service. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 14 Work and play care plans had been recorded for the residents but these could be developed further with information about each resident’s personal preferences observed in the home. The manager stated that they were trying to obtain social history profiles from residents and families. Residents were complimentary about the meals provided in the home and said they could request alternatives. Compliments such as ‘the foods very good’ and ‘food is lovely’ were heard frequently. Residents said supper was offered each evening and choc-ices and ice-lollys were offered to each resident in the afternoon. One resident said she looked forward to her afternoon ice cream. The lunchtime meal was sampled and this was tasty. Residents were assisted discreetly to enjoy their meal. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected from abuse. EVIDENCE: All the staff spoken too during this visit had had training in the protection of vulnerable adults and abuse. Records of staff training were available. Staff spoken too demonstrated a good understanding of the different types of abuse and the actions to take if abuse was suspected. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this visit. EVIDENCE: Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Staff are trained to meet resident’s needs and staffing levels are appropriate. EVIDENCE: Staffing levels were maintained in the home at a level appropriate to meet resident’s needs. A detailed and varied training programme had been undertaken since the last inspection. All staff spoken listed various training courses they had undertaken such as fire safety, moving and handling, first aid, abuse, risk assessment, care planning and medication. Records were available of this training. This training has been supported by a drive in the home for care staff to achieve NVQ training. Two care staff both said they had received their NVQ since the home’s last inspection. Approximately 65 of staff had obtained their NVQ and a further four staff had commenced NVQ training at this visit. The manager and another team member had also commenced training as NVQ assessors. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35, 36 and 38 The management of the home promotes the health, safety and wellbeing of the residents. Residents do have a say in how the home is run. Resident’s personal money is safe. EVIDENCE: The manager of the home has been in post approximately six months and during this time she has made significant improvements in almost all aspects of the service. She confirmed that the home has presented a challenge and that she has worked hard to improve the service provided at Stamford Court. Almost all areas of concern identified at previous inspections have been addressed and plans to develop and improve the service further were underway. Resident’s, staff and visitors to the home were complimentary about the home and the atmosphere was calm and relaxed. One resident said, “the manager sorts out any problems you have”. One staff member said, “it was much
Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 19 better with the manager, everything is done as it should be”. Staff confirmed that there was good teamwork in the home. The improvements in the service provided at Stamford Court can be attributed to the strong leadership and management experience of the manager. The manager has a successful background managing a care home service. She has the Registered Manager’s Award and this qualification is supported by numerous other qualifications including training in Community Care Practice, Care Management, Practice Teacher, Dementia Awareness, Moving and Handling trainer and Counselling. The manager had just commenced training for NVQ Assessor. Discussion with the manager identified that she acknowledged the expertise of others and was reliant on the clinical nurse for nursing assessments. The manager had undertaken her own quality assurance survey, recorded the responses and had a resident’s meeting to discuss this. This survey was supported by a corporate quality assurance survey and report. Audits of various aspects of the service had been undertaken in the home. Staff had attended staff meetings and staff formal one to one supervision had commenced. Resident’s personal monies were held securely and records were available which detailed all transactions. Receipts were held for all expenditure undertaken for each resident. Health and safety records were available and these were comprehensive. Fire records were maintained appropriately. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x 3 x 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 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 x 3 3 x 3 Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP7 OP12 Good Practice Recommendations The registered person should ensure that care plan evaluations are recorded and detail the effectiveness of the plan. The registered person should continue developing and improving the care plan documentation to ensure a consistent and concise record of care needs is provided. The registered person should ensure resident’s work and play care plan reflects person centred information. Stamford Court DS0000060723.V267946.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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