Inspection on 11/02/08 for Standon Hall Care Home (The Beeches)

This inspection was carried out on 11th February 2008.

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.

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

CARE HOMES FOR OLDER PEOPLE Standon Hall Care Home (The Beeches) Nr Eccleshall Stafford Staffordshire ST21 6RN Lead Inspector Yvonne Allen Unannounced Inspection 11th February 2008 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 Standon Hall Care Home (The Beeches) DS0000022377.V359778.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. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Standon Hall Care Home (The Beeches) Address Nr Eccleshall Stafford Staffordshire ST21 6RN 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) 01782 791555 01782 791396 Standon Hall Home Limited vacant post Care Home 34 Category(ies) of Dementia (34), Dementia - over 65 years of age registration, with number (34) of places Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. DE over 60 years only Date of last inspection 4th June 2007 Brief Description of the Service: Standon Hall - The Beeches is a care home providing personal care and accommodation for up to 34 older people suffering from enduring mental health problems. The home is owned by a private company called Standon Hall Homes Limited. The company own a number of other nursing and residential homes across the country. The home is located on the outskirts of the small village of Standon near to the town of Eccleshall in Staffordshire and is situated in a rural setting with views over the surrounding countryside. It is not within walking distance of any amenities and transportation would be required to visit the nearest village. The home was opened in 1998 and consists of two single storey buildings, which were built around 1930 as a hospital. A long covered walkway forms a corridor link between the two units - Beeches One and Beeches Two. All the home’s bedrooms are single and have the provision of a sink. Bathing and toilet facilities are located close to bedrooms. The home is situated opposite the Standon Hall Care Home. This was previously a stately home and the two homes share the spacious grounds. The range of fees charged by the home is now included in the Service User Guide. This includes the free nursing care element and the range includes both funded and privately paying residents. Extra charges are made for hairdressing and toiletries. Standon Hall Care Home (The Beeches) DS0000022377.V359778.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 is 1 star. This means that the people who use this service receive adequate quality outcomes. This unannounced inspection was carried out by one inspector and took place over four hours. Prior to the inspection visit the Providers had completed a self-assessment tool known as an Annual Quality Assurance Assessment (AQAA). Information from this AQAA was used to plan the inspection visit. All the Key minimum standards were assessed and judgements were made for each outcome. Each judgement reflects what the home is like for the people who live there. The ways in which we gathered information were as follows – A tour around the home looking at a random selection of bedrooms, all the communal rooms and the laundry. Discussions with the General Manager – Beverley Davies. Examination of relevant records and documentation including a random sample of care plans. Discussions with residents and staff. Observation of care practices. Discussion with a Placement Officer who was reviewing her client at the time of the inspection visit. Prior to this inspection visit the Responsible Individual had informed us that the Registered Manager had recently left the home. The interim arrangements for managing the home were as follows – The General Manager of the two homes (who is also the Registered Manager of Standon Main Hall) is managing the home. She has the support of the Responsible Individual who visits the home at least monthly and usually more often. There are Registered General Nurses (RGN) employed at the home and the Providers are actively recruiting a Registered Mental Nurse. Also, we were informed that the General Manager (who is RGN) is planning to attend dementia and mental health training days to update her knowledge. We had also been informed that Beeches 1 had been temporarily closed and that all the residents were now accommodated in Beeches 2. This move had been carefully carried out and with full communication with individuals and their representatives. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Continuity of management is required for this home in order to ensure that stability is provided. There have been several managers come and go at the home over the last few years and this has not been good for the status quo. The interim arrangements for management of the home are satisfactory, however, with the general manager of the site providing management support. The social and therapeutic needs of the people who live at the home are starting to be addressed but these need developing further. More trips out are recommended, together with in house entertainment in order to ensure that needs are fully met. The environment is in need of total refurbishment and updating in order to provide a good standard of comfort for the people who live there. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 7 We have been informed by the Providers of their intent to replace this home with a new build. However, a timescale for this has not been forthcoming as yet and it is required that the Providers inform the CSCI of their plans for improvement. Care plans could be made more individual and could include more correspondence with either the resident or his or her representative. Evaluations carried out with representatives and more information about the individual resident will help to ensure that autonomy is promoted and choices are upheld. Closer monitoring and documenting of nutritional intake for individuals is needed, where this is indicated. The home recruits a large number of staff directly from overseas and some of these staff members have limited communication. It is essential that, in order to be able to recognise and meet the assessed needs of the people who live in this home, all staff members are trained and “competent”. 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. Standon Hall Care Home (The Beeches) DS0000022377.V359778.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 Standon Hall Care Home (The Beeches) DS0000022377.V359778.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who come into this home are given information about the home and can be assured that their assessed needs will be met. EVIDENCE: We looked at standards 1,3 and 4 The home has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format and now contains the range of fees charged. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 10 We had been supplied with copies of the new Statement of Purpose and Service User Guide and these were seen to be more specific to the home. The nurses consult the assessment information to see if they can meet the prospective resident’s needs before they make the decision to accept the application for admission and offer a place. Evidence suggests that prospective residents should have a needs assessment before they go to live at the home. For most of the residents the home has received copies of the summary and care plans from the assessments carried out through care management arrangements. For residents who are self-funding staff were able to demonstrate how they have undertaken the assessment. They are generally undertaken satisfactorily. Staff have the necessary specialist skills and ability to care for individuals who are admitted. Four care plans were examined at random. These all included a pre admission assessment of needs. The previous manager of the home had carried out three of these assessments. One contained only a social services’ assessment as the individual had been admitted as an emergency. The named nurse had then carried out a thorough assessment of this individual’s needs within 24 hours of his arrival at the home. Usually other healthcare professionals have carried out an assessment of needs. There was evidence contained in care plans of assessments undertaken by psycho geriatricians and psychiatrists. The General Manager of the home confirmed that she goes out to assess individuals in their home/hospital surroundings. She stated that she would often take along one of the Registered Mental Nurses to these assessments. She also confirmed that she would only offer placements to individuals where she is confident that the home can meet the needs of the individual. The manager confirmed that there is a trail period of six weeks in place during which the individual can decide whether this is the home for them and/or to ensure that their needs can be met there. Standon Hall Care Home (The Beeches) DS0000022377.V359778.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of individuals are set out in a plan of care and individuals can be assured that care is delivered according to their plan. Greater attention to the monitoring of individual nutritional intake, where this is advocated, would help ensure that adequate nutrition is maintained. Psychological healthcare needs are monitored and involvement of healthcare professionals helps to ensure that these needs are met. EVIDENCE: We looked at standards 7,8,9 and 10 Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 12 People have access to health care services both within the home and in the local community. Most people are unable to access local services and are supported by visits to the home by health care professionals. Health needs are monitored and appropriate action and intervention taken. The home is generally able to provide the aids and equipment recommended, but more attention could be given to the changing needs of residents. There is evidence in the care plans of health care treatment and intervention, and a record of general health care information. There are some gaps in information but staff are able to think in a person centred way and are able to give a verbal update. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. The views of residents are sought about the way personal care is delivered. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. The home generally respects the rights of people using the service in the area of health care and medication. With refusal of treatment or medication being managed in a way that recognises choice and independence. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs. Medication systems do not always follow good practice or safe practice guidelines and has needed action. The registered person has responded and staff generally think in a person centred way when considering an individual’s personal care needs. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care. People who use the service are able to demonstrate their understanding of working towards improvement. The home has a training plan and intends to train its staff in health care to achieve accreditation. People receiving services are happy with the way that most staff deliver their care and respect their dignity and rights. However, decisions on how personal care is delivered might not be consistently recorded. The home has policies and procedures, which provide guidance for staff on how to support a person and their family when faced with a terminal illness. Staff are not consistently trained in terminal care but are able to give a verbal account of good practice that includes the religious and cultural needs of the people they support. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 13 A sample of four care plans were randomly chosen and examined. Concerns had been raised by Social Services, the week prior to the inspection visit, in relation to significant weight loss of a resident whose care they were funding. Examination of this lady’s care plan confirmed that the staff at the home had assessed her nutritional needs and problems and developed a care plan to address these. Also, on the day of the visit, the GP had ordered blood tests and a comprehensive health review to be carried out. The lady was observed to be very active –walking around the home. The manager and named nurse were working on a suitable diet and menu for the lady, based around food “on the go” as it was very difficult for her to sit and eat a meal. Through direct observation and examination of care records it was identified that staff at the home were endeavouring to help this lady as much as possible. It is recommended, however, that help and advice be sought from a dietician, who may come up with other suggestions for meals. It is recommended that records of food and fluid intake be maintained in respect of this lady in order to monitor her nutritional intake daily. The nurse in charge told us that the home is well supported by healthcare professionals such as Tissue Viability Nurse Specialist – who will visit and assess individuals with pressure sores. We were told that there were no individuals with pressure sores at the time of the inspection visit. Other healthcare professional support includes – Chiropody, Optician, Community Psychiatric Nurses, District Nurses, Psychiatrists General Practitioners and nurses from the Surgery. There was a Placement Officer visiting at the time of the inspection visit. She had come to review an individual who is funded by her department. Discussions with her identified that; overall she did not have any concerns about the care provided for her client other than she felt that the care plans could be more individual and documentation more up to date. Other care plans were examined and found to be comprehensive and needs specific. There was little evidence that evaluations are done with representatives and this will need to be developed. A care plan was examined in respect of a gentleman whom we had observed, on a recent visit to the home opposite, as trying to climb out of his bedroom window. A risk assessment in respect of this had been developed in his care plan and he had moved to another bedroom where the window was more secure. Meanwhile the maintenance person was replacing all the window restrictors with ones that were more secure. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 14 We were informed that individuals are offered a key to their bedroom following a suitable risk assessment. The lunchtime medication round was observed and discussions were held with the nurse in charge. We were informed that there were no individuals who were self-medicating at the time of the visit. There is a policy in place in relation to this and individuals are able to self medicate following a suitable risk assessment. All the previous requirements left at the last key inspection had been addressed. The staff were observed to be attentive to the needs of individuals and spoke with dignity and respect. Individual residents were dressed appropriately and were able to move around the home freely whilst being observed by the staff. At the time of this unannounced visit, most of the residents were seated in the lounge in small informal groups – each group was supervised by a carer and involved in a different activity. Standon Hall Care Home (The Beeches) DS0000022377.V359778.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a planned programme of activities in the home and the addition of dedicated hours for an activity co-ordinator has improved this outcome for residents. However further improvements are required in order to ensure that individual social and therapeutic needs are fully met and autonomy is promoted. The meals served offer choice and variety and help to ensure that nutritional needs are met. EVIDENCE: We looked at all the standards for this outcome. Discussions with staff and examination of records identified that generally staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Some Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 16 residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. The home has a basic understanding of human rights and how this impacts on people using the service. There is some commitment being shown in the areas of respect, dignity and fairness, although this commitment might be difficult to evidence, or the home might view human rights as a concept rather than something to be followed in practice. Policies, procedures and guidance promote individual independence and the right to live in a flexible environment where their choice of routines and activities are met when possible. Systems for checking practice are not always evident. The home tries to be flexible and attempts to provide a service that is as individual as possible, using its staff and resources effectively. Not all residents are consulted on how the home can work to provide them with a flexible lifestyle, the home recognises this and plans to make some changes. The food in the home is of satisfactory quality, well presented and meets the dietary and cultural needs of people who use the service. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. It was pleasing to note that, on entry to the home, we found social and therapeutic needs of the residents were being taken into account. Residents were arranged in small groups of no more than five or six. There was a member of the care staff with each group and they were all doing different activities. One was playing Bingo, another dominos, another chatting and a small group watching TV. We were informed that the activities co-ordinator, who worked over on the main hall, had increased her hours and now provided 2 hours per day over on The Beeches. She plans and organises activities and the carers help to deliver these. Examination of records identified that individual activities were documented regularly and that all residents were encouraged to join in with activities. Discussions with staff members identified that visits from entertainers was limited and it is recommended that the Provider supplies more in the way of outside entertainers to visit the home. This will help ensure that residents enjoy a varied and stimulating entertainment programme. Also it was identified that trips out to local venues hardly ever happen and that most of the residents never leave the home. It is recommended that Provider arrange some trips out for the residents, so that individuals can enjoy different scenery and can benefit from observing different settings Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 17 Also recommended is – development of the sensory gardens including provision of new garden furniture so that people can enjoy the garden areas. During a recent Random Inspection held at the home we met with a visitor – who suggested that someone just sit and read to his relative as she used to “enjoy reading so much”. The mobile library visits the main hall and it is recommended that books be borrowed for staff to read to individuals, once reading preferences have been confirmed by residents or their representatives. The general manager confirmed that she would be arranging for herself and the activities person to attend a course on the provision of social and therapeutic activities for individuals with mental health related illnesses. Discussions with the general manager identified that church services are held on a regular basis and that individual are encouraged to attend as per their religious beliefs. It was identified that care plans contain documentation of religious and spiritual needs. Care plans contain documented preferences in respect of daily routines. There was some attempt to meet these – especially in respect of food preferences. However, due to the limited mental capacities of most individuals at the home it was not clear to what degree choices were being upheld. Closer involvement of families and advocates into plans and evaluations of care would help to ensure and evidence that autonomy was promoted wherever possible. The lunchtime meal was observed as appetising and nutritious and there was a choice of main meal. Staff were observed helping individuals to eat. The provision and choice of meals has improved at the home since the last Key inspection. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at this home and their representatives can be assured that the systems in place help to keep them safe. The changes in manager of the home have not helped to develop a consistent approach of management of concerns and complaints. However, the staff and the General Manager listen to people and concerns are dealt with effectively. EVIDENCE: We looked at standards 16 and 18. The complaints procedure was prominently displayed in the entrance to the home and contained the details of the local CSCI office. These will now need amending with the details of the new Regional CSCI Office. The procedure is up to date and is displayed on a notice board in the home but is not always available in any alternative formats. There is no one person registered to manage the home and therefore take the responsibility for managing complaints. However ,the nurse in charge stated Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 19 that the nurses are able to deal with any concerns but that complaints are referred to the General Manager. Evidence was obtained that the General Manager overseas management of the home including management of complaints. Two visitors were spoken to at the time of the visit and they stated that they had had some concerns especially just lately about the move of their relative from Beeches 1 to Beeches 2. They went on to confirm that, following discussions with the General Manager and nurses on the unit, their concerns had been addressed. They were also happy to find their relative content and settled following the move. Another visitor – spoken to during the Random Inspection held recently at the home, confirmed that any concerns had had raised previously had always been attended to. CSCI had received 2 complaints directly about the home since the last Key Inspection. The one referred to the Provider to investigate had been addressed effectively - This complaint was very thoroughly investigated by the Company Clinical Director – Frank Cummins. Mr Cummins made recommendations and he has assured us that he will carry out regular audits and monitoring at the home. The second complaint was received very recently (on the day of the inspection visit) and has been referred to the Provider to carry out an investigation. The General Manager keeps a log of complaints she deals with. This is kept over on the main hall and was seen during the recent Key Inspection over there. There had been one Protection Of Vulnerable Adults (POVA) referral since the last Key Inspection. This had been reported and dealt with according to the local policies and procedures. The staff records seen confirmed that all staff undergo training in the recognition and reporting of abuse and staff members spoken to confirmed this. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment provided is safe and meets basic requirements. However the home is in need of modernising and completely refurbishing in order to offer individuals a good standard of accommodation. EVIDENCE: We looked at standards 19, 20 and 26. The home provides a physical environment that meets the specific needs of the people who live there. Occasionally there is slippage of timescales and maintenance tends to be reactive rather than proactive. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 21 Residents can personalise their rooms. There was evidence that the home is clean, warm, well lit and there is usually sufficient hot water. There has been some consultation with residents about the décor, especially for their own rooms. Toilets are appropriately located within the home, are easily accessible and in sufficient numbers. A tour of the home was undertaken during which a sample of six bedrooms was inspected. These were basic bedrooms and some were quite sparse. The General Manager identified that there was a “bed replacement programme” in place and some new beds were seen. Most of the remainder of the beds, including headboards and mattresses however, are worn and in need of replacement. Apart from a couple of bedrooms which had had new furniture, the remaining bedroom furniture, including vanity units was shabby and in need of replacement. Corridors had been repainted over the last couple of years and were brighter in appearance than previously and some pictures had been put up to help with orientation. The residents were seated in the main lounge in small informal groups. There is a smoking room located off this lounge and there was one resident who was smoking at the time of the inspection visit. Most of the residents ate in the main dining room but, if they preferred, they could have meals in their own room or the lounge area. Bathrooms and toilets were simply furnished and there are two baths, one of which is adapted. It is recommended that a walk in shower facility be provided at the home to enable individuals who prefer a shower to be able to have one. The kitchenette on Beeches 2 is showing signs of mould coming through the ceiling yet again. This has been addressed once before and was repainted, but is an ongoing problem. The housekeeper and domestic staff were seen cleaning the home, the laundry room was inspected and found to be run in accordance with infection control and environmental health guidelines. Staff had received training in COSHH for the new cleaning products. The kitchen was not inspected on this occasion as it had been visited recently during the main hall Key Inspection and was found to be satisfactory. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at the home are cared for by a staff team who are caring and most of the staff have the required skills to meet their needs. This outcome would be improved further by ensuring that all staff have the required communication skills and have received training in order to meet the specific needs of the people who live at the home. EVIDENCE: We looked at all the standards for this outcome. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The home recognises the importance of training, and tries to deliver a programme that meets statutory requirements and the NMS. There is limited understanding of the person centred way of delivering care and support, but Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 23 this is through lack of opportunity rather than a negative or ‘blinkered’ approach. All staff are clear regarding their role and what is expected of them. Representatives of the people using the service report that they meet their individual needs in a way that they are satisfied with. The home has a recruitment procedure that meets statutory requirements and the NMS. The procedure is followed in practice and there is accurate recording at all stages of the process. There is acceptable use of any agency or temporary staff which doesn’t adversely affect the quality of the individual care and support that residents receive. At the time of the inspection visit all the residents were accommodated in Beeches 2 There were 19 residents in total, 5 of who were in receipt of personal care and 14 nursing care. All had varying degrees of mental health needs including episodes of challenging behaviours. There was a nurse in charge plus 4 care assistants from 8am until 8pm then 1 nurse and 2 care assistants at night. The staffing arrangements appeared to be adequate at the time taking into account the dependencies of some of the residents and the fact that there were a few individuals who were wandering around the unit and required supervision. There was a therapeutic activities person employed for 2 hours per day for this home. The team of ancillary and kitchen staff were shared between this home and the main hall. This included maintenance support There was currently no Registered Manager in post as she had recently left. The General Manager was overseeing management of the home in the interim period. Examination of the staff rotas for a period of 2 weeks either side of the inspection visit identified that staffing was provided as outlined above. One of the care assistants spoken to had worked at the home for six months. She was not new to care and had previously worked in a care setting. She confirmed that she had undergone induction training and that this had been satisfactory and effective. She confirmed that she had received mandatory health and safety training sessions including Moving and Handling, Fire Safety, Food Hygiene, Abuse (POVA). Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 24 NVQ training in Care was on going at the home and all care staff were encouraged to undertake this training to at least level 2. Some go on to do level 3 training. Over 50 of care staff are trained to NVQ level 2 and above in care. There is a structured staff training programme in place at the home and the training is geared to meeting the needs of the individuals who live in the home. This training included Dementia Awareness and Managing Challenging Behaviours as well as other areas of care. This training programme is organised by the General Manager. Not all staff are booked to go on this training however and the manager will need to ensure that all staff delivering care are trained to meet the specific mental health needs of individuals. It was observed that the home recruits a large number of staff directly from overseas. Some of these staff members have limited communication and understanding of the spoken language. Moreover, a limited understanding and recognition of the care needs of individuals. It is imperative that these staff members receive a more comprehensive induction training and are assessed as “competent” before being asked to care for the people who live in the home. The staff files also identified that the recruitment procedure is robust and that staff are carefully selected to work at the home. The required checks are carried out on staff including Criminal Record Bureau and POVA checks. Two written references are obtained before employment is offered. When residents were asked if the staff were caring and helped them they stated, “yes”. The two visitors spoken to on the day of the visit and the one during the Random Inspection all commented that the staff were friendly, caring and attentive to the needs of the residents Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The interim arrangements for management of this home ensure that the home is run in the interests of the people who live there. There is a need to provide a Registered Manager to help ensure that standards are maintained and outcomes improved. EVIDENCE: We looked at standards 31,33,35,36 and 38. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 26 The general manager has the necessary experience to run the home. She is aware of and works to the basic processes set out in the NMS. The general manager is aware of the need to keep up to date with practice and continuously develop management skills, although it may be difficult to attend regular formal training courses. The home has a statement of purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. More work is needed in this area. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve. The AQAA gives us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. The general manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation. The home has highlighted areas where they need to make improvements and has an action plan for undertaking the work. Discussions with the General Manager identified that the interim arrangements for management of the home appeared satisfactory. She confirmed that she oversees all the management issues at the home and is supported by the Regional Manager who visits at least monthly. She also confirmed that the Providers are advertising to recruit a manager for the home, but that this may take some time, as they want to ensure that the “right” individual is recruited. The nurse in charge commented that it had been a difficult period with the manager leaving but that she felt very well supported by the General Manager. The residents accommodated in the home did not appear affected as many were unable to understand the situation plus standards of care and communication had been unaffected. The visitors commented that they had been informed of the manager leaving, but that they were satisfied with the continuity of care provided to their relative. The home has sound policies and procedures, which the general manager effectively reviews and updates, in line with current thinking and practice. The Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 27 general manager ensures that staff follow the policies and procedures of the home and of the organisation. There are effective systems to monitor staff adherence to policies and procedures during their practice. Examination of staff supervision records identified that processes ensure that staff receive feedback on their work. This was noted on examination of staff supervision records. Quality Assurance monitoring includes a Company monthly quality assurance report, which has to be completed by the general manager. This checks all the services offered at the home including healthcare monitoring (individual weights and pressure sores). Relatives/residents meetings are held 3 monthly but the general manager commented that these are not well attended. The manager and nurse in charge both commented that they speak to relatives on a one to one basis regularly. The visitors spoken to confirmed that they can approach and speak with the nurses or the at any time. There are also residents surveys sent out 6 monthly to obtain views about the services offered by the home. The general manager works alongside the maintenance person to ensure that a healthy and safe environment is maintained for the people who live at the home and the staff who work there. Records identified that equipment was regularly examined and serviced. This included fire safety and fire fighting equipment. Staff spoken to confirmed that they received regular training updates in Health and Safety. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 28 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 x 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 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 x 3 3 x 3 Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 29 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 OP19 Regulation 23(1) a Requirement Timescale for action 20/04/08 2 OP30 19(5) b The home is in need of completely updating and refurbishing in order to provide the people who live there with a standard of comfort to which they are entitled. It is required that the Providers inform the CSCI, in writing, how they plan to achieve the above and the timescales for this. It is required that staff members 20/04/08 who have been recruited directly from overseas receive a more comprehensive induction training and are assessed as “competent” before being asked to care for the people who live in the home. This is to ensure that the assessed needs of residents are recognised and met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 30 No. 1 2 3 Refer to Standard OP12 OP12 OP12 Good Practice Recommendations It is recommended that Provider arrange some trips out for the residents, so that individuals can enjoy different scenery and can benefit from observing different settings It is recommended that development of the sensory gardens be implemented including provision of new garden furniture so that people can enjoy the garden areas. It is recommended that the Provider supplies more in the way of outside entertainers to visit the home. This will help ensure that residents enjoy a varied and stimulating entertainment programme. It is recommended that closer involvement of families and advocates into care plans and evaluations of care would help to evidence that autonomy and human rights are promoted. 4 OP14 Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Standon Hall Care Home (The Beeches) DS0000022377.V359778.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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