Inspection on 28/07/08 for Stanbridge House

This inspection was carried out on 28th July 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 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

Stanbridge House 19/01/09

Stanbridge House 13/06/06

Stanbridge House 06/02/06

Stanbridge House 31/08/05

Stanbridge House 14/03/05

Stanbridge House 04/11/04

Stanbridge House 06/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Stanbridge House 56-58 Kings Road Lancing West Sussex BN15 8DY Lead Inspector Val Sevier Unannounced Inspection 10:00 28th July 2008 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 Stanbridge House DS0000014744.V367349.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. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanbridge House Address 56-58 Kings Road Lancing West Sussex BN15 8DY 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) 01903 753059 stanbridgehouse@aol.com Ms Kim Sanders Ms Kim Sanders Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 27. Date of last inspection 13th June 2006 Brief Description of the Service: Stanbridge House is a care home registered to provide accommodation and personal care for twenty- seven elderly (over the age of 65) persons. The establishment is privately owned by Ms Kim Sanders who is also the Registered Manager of the home. Stanbridge House is a large detached property, which has been extensively extended to provide accommodation on two floors. The home has twenty- five single and one double room, which is at present being used for single occupancy. Nine rooms have en-suite facilities. There are two sitting rooms and a dining room available for communal use and three garden areas provide a choice of private and attractive outdoor space for residents to enjoy. Situated in a quiet residential area of Lancing, the establishment is approximately one mile from the town centre and a similar distance from the sea. The fees for the home range between £310 and £550 and are dependent on size of room and assessment of needs by social services. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service 0 star. This means the people that use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assurance Assessment (AQAA) completed by the home, and an unannounced visit to the home, which was carried out on the 228th July 2008, during we were able to have discussions with staff and have interaction with the people who use the service. During the visit we looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and people suing the service, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. We received 12 surveys: 3 from staff, 3 from people who have some relationship to the home for example doctors and district nurses, and 5 from people who live at the home. The registered manager was away on the day of the visit although she did make herself available on the phone if needed. The deputy manager assisted us throughout the visit. What the service does well: The home welcomes people who will use the service and their families or representatives, to visit the home and look at the facilities of the home. The manager seeks information from external healthcare professionals as part of the assessment where necessary, to ensure that the home is able to meet assessed needs. Staff treat people who live at the home with respect; they share their companionship and give support sensitively. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 6 Daily routines in the home were flexible and people who use the service being encouraged to make choices for themselves and exercise personal autonomy as far as was reasonably possible. People who live at the home were mostly positive about the food that the home provided and were pleased with the activities in which they could participate and the condition of the accommodation that they occupied. What has improved since the last inspection? What they could do better: Care plans must detail the care and support needs for individuals where support has been identified so that staff are aware of what they need to do for people who live at the home. Photographs should be signed and dated stating who the individual is. A requirement had been made following our last visit in 2006; that risk assessments should include both environmental and personal risks. We found that there were risk assessments however the action staff should take addressed a need for the individual for example continued mobility and did not address the reduction of the risk that had been identified. Where a risk has been identified, the risk assessment must tell staff what action must take place to minimise the risk for people who live at the home as far as possible. Medication records must be kept of medication received into the home and when administered. Where medication is ‘as required’ a record must be kept of the reasons why, how much and the outcome for the individual. Where there is a choice of dosage of medication to be given a record must be kept of the amount given and why. An assessment for individuals who wish to take medication at time to suit them and the secondary dispensing of that medication, must be in place. The ordering of medication and its availability must meet the prescribed needs of the individual. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 7 The procedure for recruiting staff must ensure that the POVA first and references are in place before employment commences. The maintaining of financial records and monies must be improved. Borrowing money from one individual for another must not happen 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. Stanbridge House DS0000014744.V367349.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 Stanbridge House DS0000014744.V367349.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): 3 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process which involves others as needed. However the current assessment record would prove more beneficial to the assessment and care plan process for the individual if the record of the information is related to the care plan, and they are signed and dated. EVIDENCE: We received the AQAA for the home, which stated that: All prospective service users and families are provided with a Statement of Purpose. All are invited to visit Stanbridge House at their convenience to see how we work for themselves and questions can be answered as they arise. All prospective service users are visited in their current accommodation and a pre-admission assessment is carried out by the manager or deputy manager to ensure that Stanbridge House can meet their needs. We encourage prospective service users to look Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 10 at recent inspection reports and speak to their G.P.s, District Nurses and Social Workers. Families are involved as much as possible”. This was supported by the evidence we saw at the home and from surveys we received. We sampled four pre admission assessments of individuals who had moved to the home since our last visit. The areas covered in the assessment included: sensory and communication difficulties, mental health, physical health, needs regarding personal care and for those that come for a short stay information on domestic tasks that they carry out whilst at home. The assessment consisted of several sheets with tick boxes in each section with space for any other relevant information. Those we saw were not signed or dated with the day of the assessment or who undertook it. Stanbridge House DS0000014744.V367349.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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records and systems within the home do not always ensure that the personal and healthcare needs of people who use the service are met safely and effectively. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. EVIDENCE: The home’s AQAA told us that: “A comprehensive care plan is started as soon as a service user arrives at Stanbridge House. This document is ongoing and involves the service user, family or family representative, social worker if applicable, G.P. and District Nurse. Service Users are encouraged if at all possible to retain their own G.P.s. G.P.s are requested to visit service users as soon as possible after admission to check medication and general health. Service users who wish to self-medicate are encouraged to do so after a risk assessment is carried out and relevant policies and procedures signed and Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 12 witnessed. Weight is noted on admission and monthly therafter.All service users have access to visiting optician, chiropodist, hairdresser and nail technician”. We sampled four care plans of people who use the service that had moved to the home since our last visit. The care plans sampled were being used in conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals. The care plans are pre typed on several sheets of paper with options that are ticked or offer a yes or no and a line to record individual needs and issues. There was little or no comment on individual issues on these tick sheets. A requirement from the last visit on 2006 stated that there should be a photograph of the individual on their care plan. We saw that there were photographs of individuals however they were not signed and dated to say who they were and when the picture was taken. We saw that action to be taken by staff generally was recorded on a sheet titled ‘Needs and difficulty’. We saw that on three of the four care plans seen there was only one need/difficulty identified, on the fourth there were none. One example of need was: “won’t motivate self in the mornings will always put on same clothes will try not to come down for meals”. Staff action was: ”to give full assistance in the morning and lots of encouragement help to choose own clothes each morning to assist down for meals”. This individual had a risk assessment for falls with action: ”To encourage to walk more and do exercises left by physio, the action for staff to achieve this: ”to walk twice a day along the top of the landing”. Another example we saw on a in ‘needs and difficulties’ was ”gets confused and needs assurance”, action to offer as much support as needed and to steer in the right direction”. There was a risk assessment for moving and handling we were unable to see a care plan relating to the individual needs regarding their confusion. On a third care plan we saw that a risk had been identified regarding falling; we noted that the action by staff was related to the individual’s movement not to how the home would reduce the risk. We discussed the two risk assessments with the deputy manager. We saw a ‘family history sheet’ on the care plans we sampled however they had not been completed. We asked the deputy about these and she commented that they ere left in the individual’s rooms for relatives to complete if this does not happen then they are put on the care plan. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 13 When looking at the care plans we noted that an individual had been discharged from the community mental health team. We could not see any evidence of why this individual had been under their care. When we discussed this with the manager there was written information in another file, which mentioned the difficulties, the individual had with maintaining their mental health. There was no care plan on how the service would support this need. We saw that there were record sheets of visits by doctors, nurses, physiotherapists, opticians, dentist and chiropodists. There was a sheet where staff recorded ‘observations that require action and there were wound assessments weight charts. We noted that there is form for ‘progress reviews’, and another with dates of the reviews. Currently the home records in a diary any significant events for the individuals at the home. We discussed this with the deputy as a social worker had also spoken to the home about this. We discussed the recording of daily or significant events and protection of everyone confidentiality. The deputy undertook to speak with the registered manager about these issues. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in locked and secured medicine trolleys, cupboards and where required in a medical refrigerator. The home uses a monitored dosage system whereby medication is put into blister packs for the times of day when medication is prescribed. The medication had been changed over on the day of the visit so we looked at June 2008 medication records. We found that where an individual is prescribed one or two tablets staff had not recorded what dosage they had given. This was seen for Paracetamol, Co dydramol, Co Codamol and Senna. Where an individual was prescribed medication to be taken as needed, there was a record of when it was given however there was no record of why it had been given and the outcome. In looking at the medication records we saw that there were several occasions when ‘O’ was recorded, this means ‘other’ however there was no record of the reason. We discussed this in more depth and it was described that for one individual Spironolactone had been given for a short period of time only, the home had then to obtain a urine sample for testing, when the GP had the results for this, they had changed the medication for the individual. This was not reflected on the care plans and the medication records were then incorrect. On other medication records where ’O’ had been used, we were told this indicated that a medication was out of stock. We were told that there is sometimes a gap between the GP giving a prescription and the chemist dispensing it. Stock supplied for an individual who had been prescribed two pain relief tablets four times a day was insufficient and the home decided to give half the amount four times a day. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 14 We noted that there were 27 gaps in the medication administration records where it was not clear whether the prescribed medication had been given or not. We saw that there were several individuals who self medicate some or all of their medication, we saw that risk assessment are in place for most people although they were not in the medication file they were seen to be taken out of the managers desk drawer. It was not clear how medication is handed over from the home to the individual. On looking at the medication administration records for one individual we noted that they occasionally self-administer medication, for example Glycerine Tri Nitrate spray. There was no risk assessment for this individual and their care plan did not indicate their needs, choices and risks regarding medication. The deputy manager explained that this individual likes to take their own medication at their own pace. Staff remove the tablets from the blister packs, place the tablets in pots and place the pots in specific places on the table in front of the individual, who then takes the tablets in their own time, which is outside of the medication records and has not been agreed by a multi disciplinary team. We discussed this with the deputy, as there are individuals at the home who walk in and out of other people’s rooms. We also noted that there are individuals who are prescribed lotions and creams, these creams and lotions were not signed for to say that they had been administered. One individual is prescribed Cetraben cream twice a day staff had signed for the nighttime but not for the morning application. Staff were observed speaking and assisting individuals with dignity and respect. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to individuals by the name they wished. People who had returned surveys had high praise for the staff and management saying that nothing was too much for them and that they felt well cared for. Stanbridge House DS0000014744.V367349.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, & 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. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. EVIDENCE: The AQAA sent by the home stated that: “A programme of activities is on the service users notice board for all to see. This includes, outings, card and scrabble afternoons, visits by hairdresser, chiropodist, nail technician, mobile library, clothes parties, outside entertainers and bingo. All meals are home cooked using fresh ingredients and special diets are catered for. Service users are involved with the cook and kitchen staff to agree on menus. Regular service user meetings are now held and all service users ideas and wishes are listened to and incorporated into the social activities programme. On our clients request we now have a quiz afternoon each week which is really well attended and all the clients really look forward to this afternoon” Wht the home feels it could do better is: “Offer more support to service users who do not Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 16 wish to join in any of the activities and to enquire as to what they would enjoy”. The home has several areas where people can choose to sit both inside and out. Some individuals who use the service choose to stay in their rooms to watch television. There is a pubic phone in the hallway. We were able to see from information on the notice board, the homes diary, surveys and speaking with people when we visited that there are activities available. Comments included: “on the whole activities re not geared for people who are totally blind”. “Wednesday we have cards and dominoes, and a magician occasionally; Tuesday music and health, handling tambourines and such like, sitting down and breathing exercises; Friday’s we have an outing twice a month, we have bingo when we can win prizes”. The home has a trolley that staff take around the home so that those people who have not gone out for whatever reason can purchase items such as cards, toiletries and sweets. Two people who use the service commented on the support they had from the home in visiting relatives that were ill. The home operates an open visiting policy and maintains family ties, the home enables regular visits.. People living at the home are encouraged to exercise control over their lives and it is their choice to participate in social activities if they wish. Visitors spoken with said that staff try to help the people living at the home to maintain their rights and for them to be able to make informed choices around daily living. However comments in the surveys were mixed, for example; ”we have to do as they say”, “yes they listen, they got the doctor for me”, “yes they listen but sometimes they forget if they are busy”. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals and diabetics. People who live at the home could choose where to eat and some preferred to eat in their rooms. It was observed that staff asked individuals what they wanted for the next meal and they wanted something different or staff knew they did not like the choice then they were offered an alternative. Of the five surveys returned by people who use the service four said they usually liked the meals and the fifth that they never liked the meals, with one comment that “the food is quite bland”. On the day those people we spoke with said they liked the food. Stanbridge House DS0000014744.V367349.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): 16 & 18 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. People who use the service are protected through the open complaints process and the staff’s knowledge and understanding of safeguarding and protection issues. However the practices and records for individual’s personal monies places people who live at the home at risk. EVIDENCE: The homes complaints procedure was seen to be available in the information given to people who use the service. There have been no complaints received by the commission. The manager advised that the home promotes an open door approach to relatives and people who use the service, to help resolve complaints and issues effectively. The home uses West Sussex safeguarding adult policy and staff were seen to have training in adult protection as well as updates. One safeguarding investigation has taken place in 2008 and was unsubstantiated. The home’s AQAA stated that: “A copy of the complaints policy and procedure is attached to every Service User Guide and all service users and family representatives have one. All staff are encouraged and expected to attent POVA training. Staff are all trained on treating every person as an individual. Detailed recording and reviewing of policies and procedures. Stanbridge Houses policy on abuse is reviewed regularly. All staff have had training on the Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 18 importance of correct communication since Jan 08”. In what they could do better the AQAA stated that: “To ensure staff receive regular updates on abuse and complaints policies and procedures to include whistleblowing policy”. People who use the service who returned surveys had ticked ‘yes’ they knew who speak to and how to make a complaint. Staff surveys we received said that they had had training in safeguarding adults, and that they knew who to speak to if ‘whistle blowing’ was needed. Stanbridge House DS0000014744.V367349.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 & 26 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. People who use the service have a pleasant and homely environment to live in which also has had adaptations to meet individual needs. EVIDENCE: We looked around some of the home and we were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. The garden is accessible with wheelchairs. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures, to make it feel like home. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 20 Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The AQAA for the home stated that” A comprehensive refurbishment programme that is ongoing. Employing 3 domestic staff each day to ensure the cleanliness and hygiene of Stanbridge House. Adequate and sufficient equipement is provided to assisst with mobility and indepence. A gardener is employed for 2 days each week to ensure that the gardens and outside areas are kept in good order and are pleasant to look at as most service users rooms have garden views and so that service users can sit outside if they wish in pleasant surroundings. A handyperson is employed for 4 hours 5 days a weekto keep up with general maintainence. The outside of Stanbridge House has been totally redecorated and a flat roof on the dining room and walkway replaced. maintenance has been carried out on equipment such as the boiler and the lift has been refurbished”. Stanbridge House DS0000014744.V367349.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 & 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have skills and knowledge in mandatory areas which enable them to met the needs of individuals at the home. However the current system of checks in the current recruitment process places people who use the service at risk. EVIDENCE: The AQAA for the home stated that: “We are able to retain excellent care staff who have been at Stanbridge House for many years , some over 20 years,leading to an excellent continuity of care and service users knowing their care staff well. As we have a very strong team of staff we fortunately do not need to use agency staff,again ensuring that service users are confident in knowing their care team. We also ensure that we always have the correct staff ration on duty at all times to meet all service users needs”. The home has told us wehat they have achieved in the last year “Another four members of the care team have achieved NVQ level 2 and 2 more care staff have commenced training for NVQ level 2 using our local training centre at the Bell Memorial Care Home in Lancing. Assisstant manager is actively working as in-house Assessor with NVQ candidates”. The staffing structure at the home consists of: manager, deputy manager, support workers, kitchen staff, housekeeping gardening /maintenance. The Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 22 rota indicated that there are three care staff on duty throughout the day. After 5 pm one of the staff is under 18 years old. There are three housekeeping staff on duty Monday to Friday and one at the weekend. The cook and kitchen assistant prepare and cook breakfast and lunch and prepare tea, care staff finish off tea. Care staff also carry out the laundry. There are two staff on duty throughout the night. Other health care professionals support the team from outside the home as needed. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. There was evidence that staff have received training in mandatory areas such as food hygiene, first aid and manual handling, health and safety and safeguarding adults, in addition to training on communication and dementia. We sampled three staff files for individuals who have been appointed to work at the home since our last visit. Two of the three had application forms, these forms were not signed or dated. All had two references. Staff member number one had a contract which stated they commenced work on 17/3/08 an Email regarding the POVA check was dated 4/4/08 and the CRB was dated 10/4/08. Staff member number two, one of their references was dated 3/3/08 their contract of employment stated that they commenced work on the 3/3/08. There was no separate POVA seen although the POVA check was included on the CRB we saw dated 20/3/08. The third staff member had a contract stating they commenced permanent work on the 5/2/08 there was no separate POVA, the CRB was dated 5/7/07 for Stanbridge. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 23 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 & 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current risk assessments, lack of information in the care plans; current medication administration and recording, individual financial management and recruitment practices may place people who use the service at risk. There are however some systems and procedures in place, which monitor and maintain the quality of the service provided and which, promote the safety and welfare of those living and working in the home. EVIDENCE: The registered manager is also the owner of the home. She stated in the AQAA for the home that:” Comprehensive records kept and regularly updated. The introduction of new care systems when required. The manager has City & Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 24 Guilds Advanced Management in Care Award and both the manager and assisstant manager have the Registered Managers Award. The assisstant manager is now acively working as an A1 Assessor for NVQ. Quality Assurance systems are in place and regularly monitored and updated. Financial planning and budgeting for improvements”. We found that the people who use the service and their relatives or representatives and the staff, are able to discuss all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident, relative and staff meetings the last one was held at the home in June 2008. The home holds individual weekly allowances for many people who live at the home, which are kept in individual bags or wallets. We sampled three records of individual monies held by the home and found that the money available did not match the records in two cases. We also saw post it notes which stated that money had been borrowed from one individual to pay for another’s hairdressing and other items. This was discussed with the deputy manager who had been with us when we looked at the monies. It was noted that the home’s equipment, plant and systems were checked and serviced or implemented at yearly, or six monthly intervals or as manufacturers require for example; passenger lift and hoists; fire safety equipment portable electrical equipment; and hot water system. Records were kept of accidents. There was a fire risk assessment for the premises; tests of equipment and regular risk assessments of the premises and working practices were undertaken regularly with fire alarms set off weekly and monthly checks of fire equipment. It was seen that the fire fighting equipment and emergency lighting was tested every three months by external contractors, who had noted on the last three visits that there were problems with the emergency lights. This was discussed at the time of the visit and the deputy undertook to speak with the manager regarding checks of these items in-between external contractor visits. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 1 X X 2 Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 26 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. 1 Standard OP7 Regulation 15 Sch 3 (1)(b) 13 (4) (b)(c) Requirement People who use the service must have clear individual care plans describing the support that staff give to meet identified needs Where it has been identified that people who use the service are at risk from falls, a risk assessment must be put in place, which describes how the service will lessen those risks. Complete and accurate records must be kept of all medicines given to people, including the actual dosage given when a variable dose is prescribed and all topical creams and lotions. This will show that people get their medicines as prescribed. A clear care plan must be available giving detailed instructions to staff as to what is meant by ‘as required’ for individual people and medicines. This will ensure that medication is administered in a clear and consistent way for the benefit of people who use this service. People must have access to the DS0000014744.V367349.R01.S.doc Timescale for action 28/09/08 2 OP8 28/09/08 3 OP9 13 (2) 12/09/08 4 OP9 13(2) 12/09/08 5 OP9 13(2) 12/09/08 Page 27 Stanbridge House Version 5.2 6 OP9 13(2) 7 OP29 19 Sch 2 (5)(6)(7) 8 OP35 20(3) medication as prescribed to them by their GP. Systems must be in place to ensure that medication is ordered and received at appropriate times so that it is always available to people who use the service. There must be a risk assessment 12/09/08 involving a multi disciplinary approach to enable people who use the service to take their own medicines. The recruitment process of staff 12/09/08 must ensure that the checks, which includes references and POVA FIRST, are in place before employment commences to protect people who use the service. The home must ensure that the 12/09/08 personal monies of people who use the service are kept safely with accurate records. Monies must not be borrowed from one individual for another. The manager must ensure that all individuals have access to their entitlement. 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 OP7 Good Practice Recommendations Photographs of individuals living at the home should be signed and dated. Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Stanbridge House DS0000014744.V367349.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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