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Inspection on 04/06/07 for Standon Hall Care Home (The Beeches)

Also see our care home review for Standon Hall Care Home (The Beeches) for more information

This inspection was carried out on 4th June 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Standon Hall Care Home (The Beeches) Nr Eccleshall Stafford Staffordshire ST21 6RN Lead Inspector Mrs Yvonne Allen Key Unannounced Inspection 4th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Standon Hall Care Home (The Beeches) DS0000022377.V342333.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.V342333.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.V342333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. DE over 60 years only Date of last inspection 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 fees charged by the home range from £334.20 to £555.00 per resident per week. 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. This information was provided by the home on 13/11/06. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was carried out by two inspectors and took six hours to complete. A CSCI Pharmacy Inspector also inspected the medication system at the home on the same day. Inspectors met with the General Manager and the Acting Manager for the home and were assisted by them during the inspection process. There were no comment cards returned to CSCI from residents or visitors prior to the inspection and only one from a resident at the time of the visit which has been included in the summary. Due to the limited capacity of most of the residents in the home their thoughts and comments were difficult to obtain. There was one visitor present at the time of the inspection whose comments have also been included in the summary. All of the key inspections were assessed during this inspection with evidence gathered using the following methods – Direct Observation of care practices Examination of records and documentation Examination of the medication procedures by a CSCI Pharmacist Discussions with people who use the services plus a visiting relative Discussions with the managers and some staff members Discussion with the General Practitioner for the home Tour of the home internally and externally including taking photographs of the environment This was a disappointing inspection with most of the outcomes for the people who live there requiring some degree of improvement. What the service does well: Care Planning was good – with good evidence of comprehensive risk assessments and individual needs were clearly identified. There are some very dedicated caring staff who have worked at the home for many years and have the skills and experience to meet the needs of the residents. There is good management support – although there have been a number of managers at the home over the last few years; there is a general manager in Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 6 place who has overseen management of the home. She, in turn, is supported by the Regional Manager who is also the Responsible Individual for the home. Both managers had some good ideas for improvements at the home but now need the support to put these into place. There was one visitor present at the time of the inspection visit. He commented that he was “very happy” with the care given to his relative. The inspector spoke to a lady who lived at the home – she stated that she “enjoyed having a whirlpool bath” and that she had “really enjoyed her meal”. What has improved since the last inspection? What they could do better: The continuing decline of the building and the lack of action in respect of addressing previous requirements regarding the external environment have raised serious concerns with the CSCI. Previous meetings with the Provider in relation to this have amounted to very little improvements being made, despite promises to do so. As a result of this, and other issues of concern identified at the inspection visit, the CSCI have issued the Providers with a Warning Letter outlining their concerns and of the intentions of the CSCI to take enforcement action against the Providers should the condition of the home fail to improve and requirements be met. The exterior of the home remains very poorly presented and in need of urgent repair and redecoration. A number of window frames are particularly poor with most of the paint flaking off exposing the wood underneath. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 7 Internally the home, although having had some cosmetic improvements, remains in need of modernisation and, particularly in Beeches 1, there was a distinct lack of privacy in respect of bedroom doors. The environment was in need of further adaptation in order to meet the needs of the people who live in the home. The carpeting along the corridor in Beeches 1 was badly stained in spite of constant cleaning – this was in need of replacement. The dining room floor in Beeches 1 was also sticky underfoot despite having been cleaned. The kitchenette in Beeches 2 was dirty at the time of the inspection visit with badly stained worktops, black mould along the ceiling and cobwebs and dead insects along the inside window frame. The temperature of the refrigerator was not recorded and foodstuffs were not labelled. Immediate requirements were left to address this with the Providers. There were concerns relating to health and safety – in respect of the lack of safety glass in windows. There were concerns relating to the pathway leading from a fire escape in Beeches 2 and of whether the home meets the current fire safety regulations. The CSCI have requested visits from both the Fire Safety officer and Environmental Health in respect of the above concerns. There were concerns raised in most areas relating to the delivery of care. There was evidence of a distinct lack of communication skills from some staff members. One practice was observed to be of particular concern, in relation the feeding of a resident as this was observed as a blatant disregard for the training the carer had received. Concerns regarding lack of communication and interaction from some staff members have been raised previously at this home. This lack of understanding of individual needs and poor communication skills demonstrated by some of the staff, identified that not all the diverse needs of people would be met at the home. Most of the people who live at this home have some degree of dementia and confusion and it was identified that dementia awareness training sessions were only an hour and a half in length. It was identified that, through direct observation at the time of the visit, this training was insufficient to ensure that staff were equipped with the required skills to meet individual needs. There have also been concerns raised about lack of staff supervision of the lounge areas. There was a complaint received by CSCI in March of this year in which it was identified that an incident had occurred due to a lack of staff supervision in the lounge and, more recently another incident has occurred of a similar nature and is still being investigated under POVA. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 8 The Providers must review their arrangements for staff supervision of the lounge areas and make improvements to ensure the safety and protection of the people who live there. There was no dedicated Statement of Purpose and Service User Guide as these related to two homes – Standon Hall and The Beeches and was not specific to The Beeches. The medication procedure was not robust and areas of concern were identified by the Pharmacist Inspector. Several requirements have been made to address and improve this. 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.V342333.R01.S.doc Version 5.2 Page 9 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.V342333.R01.S.doc Version 5.2 Page 10 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): Standards 1,3 and 4. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is some information provided about the home but this needs to be more specific and individual to the home and a new Statement of Purpose is required. Individual needs are identified and assessed but some staff are not communicating with individuals and therefore some needs are not met. EVIDENCE: In the Annual Quality Assurance Assessment (AQAA) the Providers state “the pre-admission assessment policy ensures that all prospective service users are given information about the home and are re-assured that their needs can be Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 11 fully met. The home ensures that they can meet the needs of potential residents by always meeting families wherever possible as well as the client”. Examination of the Statement of Purpose and Service User Guide and records of pre-admission assessments contained in individual plans identified the following – There had been as new Statement of Purpose and Service User Guide developed just prior to the inspection visit in May 2007. These documents were provided to the CSCI at the time of the visit. Unfortunately the documents were combined for the two homes, and, as there are two separate registrations – one for Standon Hall and the other for The Beeches there will need to be two separate Statements of Purpose and Service User Guide. Some of the information contained in both will be the same, however the homes are registered for two very different categories of care and the people who live at the two homes have very different needs. The Statement of Purpose for The Beeches will need to be more specific about how the needs of the people who live at the home are met. Many of the residents accommodated have very complex mental health needs including challenging behaviour and the Providers must be very clear about how they meet these needs. There was evidence, contained in care plans that pre-admission assessments are carried out prior to admission. The needs of the people who live at the home are clearly assessed and identified in individual plans but not always delivered as per care plan. Through direct observation it was identified that some staff are not sensitive to individual needs and are not delivering care in an interactive way. This was especially observed during the mealtime. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9 and 10. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Although individual care is well planned it cannot always be guaranteed that care is delivered as per plan and privacy and dignity are compromised. The medication procedure is not robust enough and it cannot be guaranteed that medication is always delivered as prescribed. EVIDENCE: The Providers state in their AQAA – “We have comprehensively assessed working care plans that instruct all levels of staff on how to look after residents and to ensure that all their assessed needs are met. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 13 Individualised care plans are comprehensive, of good quality and reviewed monthly by the trained staff. Our service users have access to outside health professionals of their choice. Our system for storage and administration of medication is robust and all aspects from ordering to actual administration is checked regularly. In Beeches trained nurses are responsible for administration and recording of medication. Staff respect residents and strive to maintain their dignity by always asking and consulting with them about their preferences plus ensuring that all personal care is given in privacy.” Examination of a random selection of care plans identified that these were well organised and the general standard of care planning was good. Individual needs had been identified and risk assessments developed. Preferences and choices had been recorded. Plans had been regularly reviewed and updated. There was some evidence of involvement of representatives in care planning but this was minimal. The acting manager stated that representatives were invited to care plan reviews but that very few attended. Representatives are informed of any changes to the care of their relatives. There was evidence of the assessment and monitoring of general and psychological healthcare needs. Healthcare professionals were called upon as and when required and individuals were enabled and assisted to keep hospital and other clinic appointments. Unfortunately although care plans were well written and documentation was good, observation of direct care practices, as highlighted in the previous section, identified that care is not always delivered as per plan. The GP was visiting the home at the time of the inspection. He is the GP for all the individuals accommodated in the home. The inspector was able to speak with him in the presence of the general manager. The GP commented that he was generally satisfied with the health care of his patients and that communication with the management of the home had improved recently. However he was concerned with the general poor condition of the environment in which his patients live. Observation of the environment identified that individuals could not always be guaranteed that their care would be delivered in private. Bedroom doors on Beeches 1 contained an obscure glass window on which a section had been removed rendering the glass transparent so that the individual could be viewed through the door. Dignity was also compromised by the lack of interaction and communication of some of the staff. The pharmacist inspector examined the effectiveness of the home’s handling of medication and some failings were identified during the visit. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 14 The medication records were poor in their quality and could not be used to evidence that medicines were being administered as prescribed. The quantities of medication were not always being recorded upon receipt and any medication carried over from the previous month was not being consolidated on the new MAR charts. Staff initials were missing on the administration records and therefore the records could not confirm whether the medication had been administered or not. The records also indicated that on some occasions staff were signing the MAR charts to confirm that administration had taken place when in fact the medication had not been administered. It was seen on one occasion that a medicine for one of the residents had not been written on to the residents MAR chart and therefore the nursing staff were administering the medication without any written record. There was also no record of what happened to medication that was refused by the resident. The home was not keeping any records of medicines that they were disposing of. Chloramphenicol eye ointment had been applied to one of the residents for a period of 12 days. Normally antibiotic eye drops are applied for about a week. The home did not have any record of how long the ointment should be applied for so the Manager was asked to clarify with the GP the length of treatment. It was also seen that the administration of a Flupentixol injection not taken place on the correct day and had in fact been given two days later. A number of residents had been prescribed behavioural altering medicines on a when required basis. On examination of the records there did not appear to be any written plan identifying what behaviours would result in the administration of the medication. It was also seen that some residents were receiving this medication on a regular basis but there was no records to justify the need for this approach. The nursing staff were administering the medication across both the nursing and residential areas of the home. There did not appear to be any programme in place to assess the competency of each nurse to handle and administer medication correctly. No Controlled Drugs were found on premises at the time of the inspection and it appeared that none of the residents had been prescribed any Controlled Drugs for nearly two years. The Controlled Drugs cabinet breached the Misuse of Drugs (Safe Custody) Regulations 1973 because it had not been attached to the wall correctly. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 15 The treatment room where the nursing care residents’ medication was kept was too hot to store the medication appropriately. The thermometer was measuring the room temperature at 28°C and staff confirmed that the room always felt hot. The storage areas on the residential side appeared to remain within the temperature range of no greater than 25°C. The medication storage areas appeared to be reasonably well organised and there did not appear to be an excessive amount of stock present. All the medicines appeared to have a dispensing label attached with the exception of a tube of Betnovate C cream, which was found in the externals cupboard. It could be seen that the label had been removed from the outer carton and as a consequence the home could not evidence who the tube had been prescribed for. The external medicines were not being dated when opened and therefore a number of creams/ointments were being used well past the recommended expiry date. Within the treatment room the home had a small fridge, which was designated for storing medicine that required cold storage conditions. An ambient thermometer was discovered within the fridge, which meant that the home could not record the maximum and minimum temperatures of the fridge on a daily basis. Yet on observing the records a maximum and minimum temperature was being recorded on a daily basis. On questioning the nursing staff it was found that the temperature recorded in the minimum temperature column was the actual temperature measured using the ambient thermometer and the temperature recorded in the maximum temperature column was the temperature that the home felt the fridge should be maintained at. The records gave the impression that the fridge temperature was being maintained within the correct range. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Quality of life for people who live in this home is in need of improvement and although preferences and choices are identified there is no guarantee that these are always upheld. Food safety standards require improving on Beeches 1. EVIDENCE: The Provider states on the AQAA – “We offer flexibility with all things where ever possible. Visiting is open to suit individuals and meals are available to visitors to enable them to visit for longer periods if they so choose. This also enables families to celebrate special occasions enabling our service users to maintain strong family ties. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 17 Meals are nutritious and well presented and they get positive comments from both service users and visitors. A choice of menu is available at each meal. We have no fixed rising times and breakfast is served from 09.00am onwards. Service users retire at their request. We encourage service users to personalise their rooms to enhance the homely feel.” The therapeutic activity programme was continuing to improve and records were in place to evidence that preferences and choices are documented. However, the lack of interaction demonstrated by some of the care staff at the time of the visit, and on a previous inspection visit, questioned how individuals are helped to exercise choice and control over their lives and how this is put into practice when there is a lack of communication. It was particularly concerning to note - a male care assistant observed feeding two residents in the Beeches 2 dining room. At no time did this care assistant acknowledge or speak to the residents who he was spoon-feeding. There was no communication either verbally or any other way from this care assistant to either of the residents during the process of feeding lunch. The care assistant stood over the female resident and was heard to be “tutting” disapprovingly as he fed her. He was then observed kneeling at the side of a male resident who was singing during his meal and after each line of song the care assistant “shovelled” a spoonful of food into this man’s mouth not allowing him time for a breath, and again no communication. This was in the presence of 2 inspectors. Examination of this care assistant’s training records identified that he had received training in abuse of residents and that he had highlighted that forceful feeding constitutes abuse. Another female care assistant was observed preparing residents to go into the dining room for lunch on Beeches 1. Again there was no communication from her toward these residents either verbally or any other way. An inspector observed the whole process over a period of 15 minutes. Observation of the lunchtime meal confirmed that this was appetising, well presented and that there was a choice. However it was observed that individuals were served a meal without being asked which dish they preferred, so the choice is provided but not always delivered. It was also observed, in Beeches 1 that the food was taken off the hot trolley as it went through to Beeches 2. This hot food was placed uncovered on the side table in the dining room in Beeches 1. This food remained on the side for approximately 20 minutes whilst residents were accompanied into the dining room for their meal. The food was also next to a window, which was open, it was warm outside and insects were flying around. This practice contravenes food safety standards and must be reviewed. Food must be kept covered and maintained at the required temperature prior to serving. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 18 Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users and their representatives can be assured that any concerns they have relating to the care home will be listened to and taken seriously. Although staff undergo training in the recognition of abuse this is not always put into practice in the wrokplace. EVIDENCE: The Provider states on their AQAA – “The Manager and her staff are always available and approachable so problems are dealt with promptly. The complaints procedure is prominently displayed, robust and easy to follow. Complaints are dealt with quickly and residents and relatives can feel confident that their concerns are taken seriously and acted upon. Staff are trained in safeguarding vulnerable adults.” Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 20 There was a clear and accessible complaints procedure displayed at the home. This contained the details of the local CSCI office also. The General Manager has dealt with concerns and complaints effectively since the last inspection. She keeps a log of these together with the actions taken and responses to complaints. The acting manager, general manager and regional manager work together in dealing with complaints. The CSCI had received 1 compliant about the home earlier this year since the last key inspection where it was identified that a resident had sustained an injury due to a lack of staff supervision in the lounge area. Another recent POVA incident occurred just prior to this inspection visit where it was identified that another incident had occurred in the lounge area due to an absence of staff supervision. Examination of the staff training records identified that staff have received training in abuse. It was concerning to note, as previously highlighted, that two members of the care staff team displayed a lack of interaction and communication with the individuals for whom they were caring. One of these care assistants was displaying extremely poor care practice, which demonstrated little regard for the dignity of the residents he was feeding. Examination of his training record identified that not only had he received this training but that he had documented what constitutes abuse during the feeding process and yet his actions did not uphold the training he had received. This was discussed with the acting manager and general manager at the time of the inspection visit. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 21 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): Standards 19 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This home continues to offer a poor quality environment for the people who live there. EVIDENCE: In the AQAA the Provider states – “The Beeches is easily accessible and meets all health and safety requirements. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 22 We provide a homely atmosphere in which service users can personalise their own rooms to encourage “ownership.” Extensive planned maintenance allows us to maintain and improve the interior of the home and exterior gardens.” A tour of the home was conducted where the general manager accompanied the inspector. The exterior of the home was looking decidedly shabby and in great need of improvement. A number of window frames were particularly poor with most of the paint flaking off exposing the wood underneath. This has been raised at the previous inspection report and not addressed within the timescale. It was concerning to note that, outside the fire escape door from Beeches 2, this was overgrown with shrubs and the ground was covered with fallen tree branches. Also, leading off from this, the paving area was uneven and contained some broken and some missing slabs, which posed a tripping hazard, especially in an emergency situation. This has been raised as a matter of concern and a requirement of the last inspection report and has not been addressed within the timescale. It was also identified that the glass contained in the windows throughout the home is not safety glass and advice must be obtained from the Health and Safety Executive in relation to this. This was a previous requirement and has not been addressed within the timescale. Internally the home, although having had some cosmetic improvements, remains in need of modernisation and, particularly in Beeches 1, there was a distinct lack of privacy in respect of bedroom doors. Bedroom doors on Beeches 1 contained an obscure glass window on which a section had been removed rendering the glass transparent so that the individual could be viewed through the door. Bedroom doors did not have a lock in order for individuals to have the choice of locking their door. The carpeting along the corridor in Beeches 1 was badly stained in spite of constant cleaning – this was in need of replacement. The dining room floor in Beeches 1 was also sticky underfoot despite having been cleaned. The kitchenette in Beeches 2 was dirty at the time of the inspection visit and immediate requirements were left to address this with the Providers. There were no records to evidence that the temperature of the refrigerator was being monitored in this room. Food, which is served to residents, was being stored covered but not labelled or dated in this fridge. The milk was left out on the side and the waste bin containing food was uncovered. The work surfaces were badly stained. There were damp mould patches along the ceiling in the room and cobwebs and dead insects along the window frames. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 23 The environment is not homely, nor domestic in character and is in need of further adaptation in order to meet the needs of the people who live there. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 24 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): Standards 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are not always sufficient to meet service users’ needs. The recruitment procedure will need to be tightened up in relation to obtaining references in order to ensure that people in the home are safe. EVIDENCE: The Provider states on the AQQA – “Excellent training programme with the back up of our training department – TIC Ltd. Our staff are long serving, work as a team and provide consistency of care. Well established robust recruitment policy ensure that and procedures ensure that appropriate staff are appointed.” At the time of the inspection visit there were 9 elderly individuals accommodated on Beeches 1 with mental health personal care needs and 1 Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 25 individual with nursing care needs and 13 elderly individuals on Beeches 2 all with nursing needs mental health. On Beeches 1 there were 2 care staff all day and 1 at night and on Beeches 2 there was 1 nurse and 3 care assistants for the morning shift and 1 nurse and 2 care staff for the afternoon/evening shift. At night there is 1 nurse and 1 care assistant on duty. There was a staff member supervising the lounge on Beeches 2 during the day whilst there were individuals seated in there. However this has been an issue of concern raised to the CSCI earlier this year in a complaint received since the last key inspection. The CSCI found that a regulation had not been met in relation to staff supervision of the lounge area on that occasion. More recently, prior to this inspection visit, a POVA incident has occurred in the lounge area again due to a temporary absence of staff supervision of that area. The activities person works 10 hours per week at The Beeches. She divides her time between Beeches 1 and 2 and works closely with the acting manager. It is recommended that these activity hours be increased should the number of residents accommodated in the home increase. There was another activities person in place who worked at the other home on the complex. At the time of the visit the housekeeper, domestic and laundry staff were on duty – these staff work between the two homes – Standon Hall and The Beeches. There was a head cook on duty preparing meals for both homes. He was assisted by kitchen porters. There was also an administrator on duty for the two homes – she was from the Company and was covering whilst a replacement was found for the previous administrator who had left. There was a full time maintenance person on duty who worked between the two homes. A random selection of three staff files was examined in respect of staff recruitment and training. None of the three staff files examined had the required acceptable references in place. References were headed “To whom it may concern” and were not specific to Standon Hall the Beeches. A worker registration form had been completed but not yet sent off. For one employee the POVA check date was 2 months after the start date. However, the above related to recruitment in 2005 and two other files checked indicated that the POVA checks were now carried out as required with employees not starting employment until after the check was back. There was evidence of staff induction training and supervision. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 26 Staff training had been given in many areas including mandatory health and safety update training. As outlined in the report – there is a need to ensure that the training received by staff is put into practice and communication improved. It was also identified that, although staff had received training in dementia awareness, this had only amounted to one and a half hours training in total and this was felt to be inadequate considering all the people accommodated at The Beeches had some degree of dementia care needs. It is a recommendation that all staff delivering care receive further training in dementia and other related mental health needs. There is a need to step up the NVQ training at the home. The AQAA stated that there were no care staff who held NVQ level 2 in care at the time but that 45 of care staff were working toward this qualification. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 27 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): Standards 31,33,35,36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a period of instability of management at the home, the effects of which have been cushioned by the presence of a general manager. The proposed registered manager has some encouraging ideas to help improve life in the home for the people who live there. The management of the delivery of care will need to be closely monitored in order to ensure that the home is run in the best interests of the people who live there. EVIDENCE: Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 28 On their AQAA the Providers say – “The manager has completed her request for registration as registered manager and this is to be sent to the Commission within the next two weeks. She has experience in dementia care and is RMN qualified. She id not only supported in her role by a comprehensive well developed quality assurance system that includes rigorous audit process but also by the General Manager of Standon hall. The regional manager also visits the home regularly and offers supervision and advice. Regular checks of the fabric of the home, lifting equipment are recorded and audited regularly. We have an active Health and Safety Committee in the home. Residents’ finances are protected by policies and procedures to ensure that they are protected from financial abuse. These are subjected to regular audit.” The general manager of the two homes was on duty at the time of the inspection visit and the acting manager was called in also. Discussions with both managers identified that they had some encouraging plans and ideas for improving The Beeches both the internal environment and more facilities for the individuals accommodated at the home. The acting manager had put up symbols and pictures on doors to help people with orientation and she had other ideas for further improvement. The acting manager had the skills and expertise to manage the home and the CSCI have now received her application to become Registered Manager for the home. This home has lacked continuity of manager over the last few years and it is hoped that this will now be improved. Examination of records identified that there was a quality assurance system in place at the home. This audited several areas including – Linen stock Medication Clinical audit Care plan audit The CSCI also receives regular Regulation 26 reports completed by the Regional Manager. There is a recommendation for the audits to include daily cleanliness checks and also for observational audits on staff communication skills and care practices. There is also a need to seek the views of residents and/or their representatives on a regular basis and to show how improvements have been made as a result of the audits. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 29 Records relating to the maintenance of personal allowances were examined and these were found to be in order at the time. The process was transparent and there were no individuals with excessive amounts of monies (which were not invested into an individual account). As highlighted previously, staff supervision was taking place and recorded. However managers will need to focus on further supervision of staff observed to lack communication skills. The managers worked together with the maintenance person to ensure that a healthy and safe environment was maintained. Records identified that equipment was regularly examined and serviced. This included fire safety and fire fighting equipment. As outlined above the CSCI were concerned about a fire escape from Beeches 2 where the ground was littered outside with fallen tree branches and then the paving slabs were very uneven with some broken and missing slabs. The CSCI have requested that the fire safety officer carries out a full inspection at the home to ensure that it complies with the current fire safety regulations. The Provider will also need to obtain written confirmation from the Health and Safety Executive that the glass in the windows throughout the home complies with health and safety requirements. The CSCI have also requested a visit to the home by the Environmental Health department in relation to concerns over cleanliness in the kitchenette area in Beeches 2 and food safety standards on Beeches 1. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 30 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 1 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 1 x x x x x x 1 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Requirement A Statement of Purpose and Service User Guide must be developed which is specific to The Beeches. Staff must possess adequate communication skills and care must be delivered as per plan with dignity and respect. The flaking paint must be removed from the window frames on Beeches 2 and these must be made good. PREVIOUS TIMESCALE OF 06/05/07 NOT MET Advice regarding safety glass must be sought from The Health and Safety Executive and this must be installed in windows accordingly. PREVIOUS TIMESCALE OF 22/02/07 NOT MET Staff interaction with residents must be improved upon in order to ensure that choices and preferences are upheld in all activities of daily life within the home. The paving slabs located at the front of Beeches 2 must be made DS0000022377.V342333.R01.S.doc Timescale for action 05/08/07 2. OP7 12(4)(a) 05/07/07 3. OP19 23(2)(b) 05/08/07 4. OP38 13(4) 05/07/07 5. OP14 12(5)(b) 05/07/07 6. OP38 13(4) 05/07/07 Standon Hall Care Home (The Beeches) Version 5.2 Page 32 7. OP29 19(1) 8. OP18 13(6) 9. 10 OP19 OP9 23(20(d) 13(2) 11 OP9 13(2) 12 OP9 13(2) 13 OP9 13(2) 14 OP38 16(2)(j) good. PREVIOUS TIMESCALE OF 06/03/07 NOT MET The staff recruitment procedure must be tightened up and all required checks done and satisfactory references obtained before employment is offered. All staff delivering care must be able to demonstrate that they are aware of what constitutes abuse, have received the appropriate training and are safe to care for the residents. The carpets along the corridor area in Beeches 1 must be replaced. The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Appropriate information relating to the use of when required medication must be available to ensure that this type of medication is administered safely, correctly and as intended by the prescriber, to meet individual health needs. Staff who administer medication must be trained and competent and their practice should follow written policy and procedures to ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. The procedure for handling and storing meals in Beeches 1 must DS0000022377.V342333.R01.S.doc 05/07/07 05/07/07 05/09/07 05/07/07 05/07/07 05/07/07 05/07/07 05/07/07 Page 33 Standon Hall Care Home (The Beeches) Version 5.2 15 OP38 23(4) 16 OP38 16(2)(j) 17 OP10 12(4)(a) 18 OP10 12(4)(a) 19 OP27 18(1)(a) be reviewed and maintained in accordance with food safety standards. The Providers must obtain a report from the Fire Safety Officer to evidence that the home is compliant with current fire safety regulations. The Providers must obtain a report from Environmental Health to evidence that the home is complaint with current regulations governing standards of hygiene. Bedroom doors in Beeches 1 and 2 must be fitted with a lock in order for the resident to have the choice of locking their door. These must be of the type recommended by the fire safety officer. Where the glass in bedroom doors on Beeches 1 has been tampered with this must be made good. The Providers must review their arrangements for staff supervision of the lounge areas and make improvements to ensure the safety and protection of the people who live there. 05/08/07 05/08/07 05/09/07 05/07/07 05/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 Refer to Standard OP27 OP28 OP33 Good Practice Recommendations It is recommended that activity hours be monitored, as, should the number of residents increase in the home, dedicated activity hours should be increased accordingly. NVQ training should be stepped up for care staff. Quality assurance should include daily environmental DS0000022377.V342333.R01.S.doc Version 5.2 Page 34 Standon Hall Care Home (The Beeches) 4 5 OP36 OP22 cleanliness checks, observation of staff interaction with residents and care practices. The results of surveys should include the views of residents and/or their representatives. Some staff should be more regularly supervised – those who display communication and interaction difficulties. There should be a programme of bed replacement introduced to replace the old metal beds with a more comfortable type bed. Standon Hall Care Home (The Beeches) DS0000022377.V342333.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside STAFFORD ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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