Inspection on 04/02/08 for Stanford House

This inspection was carried out on 4th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stanford House 08/01/07

Stanford House 01/03/06

Stanford House 27/10/05

Stanford House 17/02/05

Stanford House 20/11/04

Stanford House 03/02/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Stanford House 15 Dudley Road Sedgley Dudley West Midlands DY3 1ST Lead Inspector Mrs Cathy Moore Unannounced Inspection 4th February 2008 07:20 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 Stanford House DS0000024973.V358945.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. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanford House Address 15 Dudley Road Sedgley Dudley West Midlands DY3 1ST 01902 880532 01902 673518 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) Mr Stanley James Alan Blundell Mrs Wendy Jacqueline Blundell Mrs Wendy Jacqueline Blundell Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Old age, not falling within any of places other category (8) Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th January 2007 Brief Description of the Service: Stanford House is located a short walk from the centre of the village of Sedgley town centre and the facilities it offers. A main bus route between Wolverhampton and Dudley is available nearby. The service provides care and accommodation for ten older people, over the age of 65 years. There are four single bedrooms, and three providing dual occupancy. People who use the service share communal facilities on the ground floor, comprising of a lounge and a lounge/ dining room. A chair lift is available for people who require assistance accessing the first floor. There is a well-maintained and attractive rear garden with a parking area at the front of the premises. The ranges of fees were not available in the services, service user guide or Statement of Purpose as they should be. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector and a pharmacy inspector carried out this unannounced inspection on one day between 07.20 and 16.00 hours. Prior to the inspection we asked the manager to complete an Annual Quality Assurance Assessment (AQAA) to give us up to date information about the service. We also sent questionnaires to people who use the service, their relatives and staff to complete. During the inspection we spoke to five people who use the service and three staff. The manager was actively involved in the inspection process. We carried out the inspection mostly in lounge areas so that we could observe daily routines and involvement between staff and the people who live at the service. We looked at parts of the premises, which included; living areas, two bedrooms, bathing facilities, the kitchen and laundry. We observed the main mealtime to assess the standard of meals provided. We looked at the care provided to two people who live at the service, we looked at their daily and care records. We looked at staff files to see how well training and recruitment is managed by the service. Our pharmacist carried out a medication audit looking at medication management and safety. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. What the service does well: We received many comments from people about the service provided which included; “ Mother is safe and well cared for”. “ Give my mother a quality of life that otherwise she would not have”. “ Quite happy have got a friend here”. The manager is also the joint owner and has a good relationship with people who use the service, their relatives and staff. The service environment is generally well maintained. It is bright, cheerful and homely. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 6 Staff we observed were; friendly and helpful. They were polite to the people in their care. The service actively encourages people who use the service to maintain contact with family and friends. Over 50 of the staff team have achieved NVQ level 2 or above in care which means they have been assessed as competent to carry out their work roles. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is adequate. The statement of purpose and service user guide needs to be reviewed to ensure that all people have access to up-to-date information about the service provided. There was a lack of evidence to confirm that all people have been issued with a terms and conditions document. Assessment of need documentation does not highlight all needs and risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the service’s registration certificate and saw that this was an old National Care Standards Commission (NCSC) version. The certificate is no longer accurate as it states that the service is registered to provide care to thirteen people when it can only provide care to ten and that it can provide care to two people with a mental disorder under the age of sixty five years when there is no-one accommodated with this diagnosis in this age group. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 9 We were provided with the service’s statement of purpose and service user guide. These were not up to date which means people who use the service do not have access to current and valid information about the service. For example; fire training dates for the manager showed 2001 yet she has updated this training since 2001 and the documents included names of staff who are no longer employed. The documents did not include the range of weekly fees as it should. There were nine people living at the service when we inspected. The one empty bed was due to a person being transferred to another home to be nearer to her daughter. We looked at two peoples’ care files and did not see a terms and conditions to inform them of their rights of residency and current fee applicable to them. We were pleased to see that assessment information had been obtained for one new person, which was lacking during our previous inspection carried out in January 2007. However, the services assessment of need documentation did not include all health conditions such as varicose eczema and high blood pressure. Consequently these health conditions had not been included in this persons care plan. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. Care plans do not include all needs, health care conditions or risks. They do not give sufficient instruction for staff on how to deal with needs. Not all health care and other needs are being identified and managed. The service (mornings) does not provide sufficient stimulation and engagement between staff and people who use the service. Some aspects regarding medication are poor and potentially place the people who use the service at risk. Staff are polite and friendly to the people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at two peoples care plans. We found that certain health care conditions such as varicose eczema and high blood pressure had not been included for one. For the other dementia needs and new needs such as the management of weight loss and constipation had not been included. We saw Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 11 that care plans are not being reviewed as effectively as they should be for instance; at least twice in January 2007 daily notes showed that this person was having problems with bowels; ’14.1.08 constipated today’,‘ 16.1.08 having trouble having a bowel movement today’, ‘3.2.08 very aggressive this morning but seemed constipated’, this ‘need’ had not been included in the persons care plan in order to manage and prevent further constipation. Daily notes for this person also showed that she had experience confusion; ‘ 4.1.08 Awake most of the night confused’, ’24.1.08 awake all night ..Very confused wanting to go home’, again there were no instructions about the management of this confusion in her care plan. When asked staff told us; “ She does not get constipated very often”. We were further concerned that this persons care plan review at the end of January 2008 said; “No change”. We saw evidence of input from a range of healthcare professionals for the people whose care we looked at which is good as it means external people are addressing healthcare needs. Examples of which follow; ‘ 13.2.07 Dr examined took water sample’, 10.7.07 GP MOT and medication review’, 10.7.07 chiropodist’, ‘12.10.07 flu injection’, ’21.1.08 GP check’. We did identify that there were shortfalls internally regarding the identification of risk and healthcare problems, which could place people at risk. For example; we noted from records that one person had lost half a stone in weight since April 2007 when she was 9 Stone in January 2008 her records showed that she weighed eight and a half stone. We did not see any care plan in place or other measures such as food intake monitoring to prevent further weight loss even though daily records showed some poor appetite as follows; ‘ 1.2.08 only eaten a small amount of breakfast. Seems to have forgotten how to eat. We had to explain what food is for and talk her through it’, ‘3.2.08 ..had to be prompted to eat’. ‘ 27.1.08 did not eat much dinner’, 6.1.08 refused dinner and ate very little’. During the inspection we observed that this person ate very little at lunchtime. Records showed that this person had not been weighed at all in December 2007 even though the service had recorded that she had lost 2lb in November 2007. Records for December 2007 told us that no-one had been weighed that month. We saw that risk assessments concerning slips and falls were in place however, these tended to focus on one area such as when using the bathroom. There were no full falls risk assessments or people moving assessments in place. Further, the ‘slips and falls’ assessments we saw were not dated and would therefore make auditing difficult. We were pleased however to identify from records and our history of the service that for some considerable amount of time there had been no deaths within the service and no-one had to be sent to hospital because they had fallen or were acutely ill. This was confirmed by the manager who told us; “ No-one has gone to hospital and no-one has passed away”. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 12 We were extremely pleased to see certificates to demonstrate that staff, have received accredited dementia training. One staff member told us; “ .. has vascular dementia” which is positive in that this shows that staff are aware of the different types of dementia. We were however, concerned to observe the lack of engagement between staff and this person all morning. When we arrived at the service at 7.20 hours this person was sleeping on and off in her chair. She had some breakfast then sat in another chair. All morning this person was asleep in the chair. Only when she was given a drink mid morning did this person have any interaction from staff to stimulate her. Three times during the morning we approached this person who responded well when being spoken to. She woke up and became very alert. During the afternoon the person joined in a game of bingo, with this activity and stimulation she looked like a different person alert and bright. Night notes for this person suggested that she does not sleep well. We did highlight to staff that if the person were stimulated adequately during the day it may prevent her sleeping during the day and better at night and also increase her orientation in terms of difference between day and night. The person said to us in the morning; “ Is it morning or night?”, showing that orientation is a problem. This lack of engagement and stimulation from staff was also having a negative effect on another person who has dementia type symptoms who told us; “I am so lonely. Nobody has spoken to me all morning. I haven’t done anyone any harm”. Pharmacist Inspector (Morag Ross) undertook inspection of the control and management of medication within the service on 4/2/08. The medication procedure available was not specific to the medication management within the service. For example, there was no procedure to follow for the storage of medication, receipt or disposal of medication. It was not dated, however there was a sticker attached which stated ‘reviewing July 03’. There was no evidence that staff who administered medication had read the procedure. This highlighted the importance of ensuring that all members of staff have access to a comprehensive medication policy in order to ensure that people who use the service are safeguarded. Medication storage did not always ensure that medication was safe and secure. Medication was stored in a locked cupboard in the pantry, which are not suitable storage conditions for medication due to exposure to moisture and heat from the kitchen. The cupboard was not very secure and there was an increased risk of unauthorised people having access to the medication. Medication was seen stored in a refrigerator, which was not secure or locked, which means that unauthorised people had access to medication and therefore increases the risk of harm to people who use the service. A pharmacist who visited the home on 13/11/07 had previously discussed safe and secure medication storage arrangements with the service. A copy of the report was left with the home. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 13 Some medication that was to be taken by mouth was stored next to medication that was only to be used externally. For example, a pot of cream was stored on the same shelf next to a liquid medicine. This means that there is an increased risk of contamination between the cream and the liquid medicine and therefore people who use the service are not safeguarded from harm. Some medication (Controlled Drugs), which requires special lockable storage arrangements, did not meet the required legal specifications of the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. For example, a locked cash tin was available to store this medication, which could be easily opened. This means that some medication was not stored correctly according to legal requirements. Medication records and documentation were checked to ensure medication was administered correctly. Some medication was provided in a pre-packed blister system provided by the pharmacy A random check did show that medication in the blister pack system was correct. Some medication could not be checked to ensure it had been administered correctly because monthly balances of medicines and the date of opening of new containers of medication was not available. This means that accurate checks on all medication could not be made to ensure that medication had been administered to the people living within the service. The medicine records seen were recorded with a signature for administration. It was therefore of concern that on arrival in the home we saw that all of the medication records had been signed for administration before the medication had actually been administered. The medicine policy, which was available stated ‘Having administered, record immediately’, which means that staff were not following a documented procedure. This means that it was not possible for us to determine whether the medication records available were accurate and therefore people who use the service were at an increased risk of harm. The system for medication administration was not safe. On arrival in the home we saw medication had been placed into medicine tots in the kitchen and then placed on a tray labelled with peoples names. Medication had been prepared in advance of the morning medication administration, which is called secondary dispensing and can lead to accidental mix-ups and errors. A pharmacist who visited the home on 13/11/07 advised the service that this was unsafe practice. The potential for a medication error is increased and therefore the people who live in the service are not safeguarded. Some individual plans of care were not kept up to date with medication information, particularly when a new treatment was prescribed or changed. For example, one individual plan of care did not record when the doctor had verbally changed an existing medication for the treatment of agitation and restlessness. The medicine record in use dated from 19/1/08 had a hand Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 14 written entry, which stated ‘Dr Singh said we can give 5ml if required from 22/1/08’. An entry in another file called ‘Change to care plan’ dated 7/1/08 stated ‘Dr Singh came to see her 7/1/08 due to her behaviour & lifelessness. He prescribed more antibiotics ceflexin & promazine 2.5ml at nights’. There were no further recorded entries relating to the medication changes. This means that due to a lack of ongoing and up to date records and information staff would not be able to ensure that people using the service were safeguarded. Staff we observed when they did have contact with the people in their care were polite and friendly. We saw that toilet and bathroom doors were closed when in use we saw that staff knocked doors before entering both of these good practice to increase privacy and maintain dignity. We did raise one issue with the owner manager WB in that the small. Bamboo privacy screen in room one was not adequate in terms of ensuring privacy. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. Daily routines and activity provision needs to be improved upon to ensure that all people who use the service have access to suitable and meaningful leisure time interests. Morning routines need to be reviewed to ensure that they address the needs of the people rather than the service. People who us the service are encouraged to maintain contact with family and friends and are enabled to exercise control over their lives. Meals provision needs improvement in terms of food intake monitoring and offering of choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the service at 07.20 all people who use the service were dressed in the dining room. Shortly after this we observed them having breakfast. There was only one staff member on nights this perosn also gave the breakfast out. Shortly before breakfast we saw that one person was asleep in the chair. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 16 We looked at two people’s records and care plans neither confirmed that their preferred rising times had been explored to assure us that people do want to get up early. To get a clearer picture we asked three people what they felt about getting up so early one told us; “ I get up at 7, I tell them to get me up”. The responses from the other two indicated that they were not so happy with the arrangements; “ I think 6 o’clock is very early to get up, we have to get up for breakfast. I think 8-8.30 is a nice time to get up”. “ She fetched me down at 6 o’clock”. This person did not look happy but indicated that she did not want to make any further comment. We discussed our findings with the owner/ manager who told us; “ They can stay in bed if they want to”. We told her that this was good but our evidence showed that some people are getting up early when they don’t want to. We told her that this must be addressed and that the preferred times for each person must be explored and taken into account in order for needs to be met. We observed people during the morning and found there was little stimulation or activity. A number of people were sleeping in their chairs. We looked at records concerning activity provision and were disappointed to see that one activity book finished on 19 July but did not state what year, the other one finished on 10 January 2007. The manager/ owner confirmed when we asked that there were no up to date activity records. We asked people about activity provision; one person told us; “ I like to watch the television”, we saw that she was watching the television and seemed to be enjoying this. Another told us; “ I am waiting for my daughter to bring some knitting in for me”. Others told us about their dissatisfaction concerning activity provision. One person said; “ I’m really fed up. All I do is sit”. “ Sit here every morning- boring”. We were concerned that the manager/ owner over heard this remark and said to the person; “ You don’t want to join in any activities”. The person responded; “ I do, I always join in when something is offered”. As we highlighted previously during the morning there we saw little staff presence in the big lounge people mostly sat in their chairs or slept in their chairs. One person told us; “ No one to talk to you, you are the only one I have spoken to today”. From the questionnaires we sent out we received the following comment; ‘They could do with activities the people living there’. We discussed the situation with the manager/owner and told her that improvement is needed. The manager/owner told us; “We do activities sometimes. we are having an entertainer next week”. We highlighted that activities do not always mean activity sessions but one to one attention, adequate engagement with staff and people being spoken to, people being taken out to the local shop or other places. The manager told us; “ This afternoon we will do bingo”. We watched her going around and asking everyone if they would like to play bingo. During the afternoon the bingo session did happen and all who joined in clearly enjoyed it. We have never received any concerns about the service’s visiting arrangements. This was further evidenced by the following comment we Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 17 received;” The home welcome visitors at any time of the day and is generally friendly”. We saw that advocacy information was referenced in the services service user guide. Bedrooms we looked at held a range of belongings people had brought in making these rooms feel homely and personalised. We observed the main meal time which consisted of roast lamb, boiled potatoes, green beans, cauliflower, carrots and gravy then yogurt or sponge and custard. Jugs of mint sauce were put on the tables for people to help themselves. The meal smelt very nice, was attractively served with good-sized portions. We saw that the tables were nicely laid and crockery was of a good standard. Our last inspection report showed that there was some improvement needed in terms of offering choice of meals. We did not see or hear staff asking people what they would like for their main meal that day or giving any choice. We were told; “ The choice is the set menu only”. Just before midday, before the meal was served, we asked some people who use the service if they knew what the meal was that day and they told us; “ I don’t know” and “ No I don’t know what is for dinner today”. It is clear therefore that the issue of meal choices has not improved. As stated previously we were concerned to learn from records that one person had lost weight and had a poor appetite. We asked how food intake was being monitored and were given a book. This book only recorded what the main meals were, not what people actually ate. We observed the person who has a poor appetite ate very little of her lamb dinner yet staff told us that what would be written in the book, was the lamb dinner which to an outsider would suggest that everyone had eaten this dinner when they had not. We highlighted this concern to the manager/owner and told her that where there were concerns about anyone’s food intake then precise records should be made of everything that person eats ( and preferably drinks) on a daily basis in order for them, doctors and others to pursue the weight loss if need be. One person told us; “ Food alright, cant grumble about the food”. Stanford House DS0000024973.V358945.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): 16, 18. Quality in this outcome area is good. Processes are in place to enable people who use the service and their relatives to make a complaint if they have the need. Processes are in place which encourage the protection of vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In early 2007 we received a concern about this service regarding staffing levels night and morning times, which we put on record and looked into during this inspection. We have not received any other concerns or complaints since. Information we had access to tells us that the service has not received any concerns or complaints. We saw that the complaints procedure has been reviewed since our last inspection, it now details a 28 day deadline for dealing with complaints. We did see however, that the complaints procedures in the statement of purpose and service user guide, need to be updated as our previous name NCSC not current name CSCI is detailed. We asked two people who use the service what they would do if they were not happy about something or had a complaint, they told us; “ I would go and see the person in charge” and “No complaints, if I did I would tell the staff”. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 19 We have not received any information about incidents or allegations of abuse concerning this service. The owner/manager told us; “ No nothing”. We asked two staff if they had received abuse awareness training both confirmed that they had. Both confirmed that they had not seen or were not aware of anything concerning happening within the service. We found it positive in terms of ensuring that people are safeguarded that the service’s quality questionnaires ask relatives if they have seen anything concerning. Stanford House DS0000024973.V358945.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): 19, 20, 24, 26. Quality in this outcome area is good. Generally the home is well maintained, it is warm, comfortable and homely. People told us that they are happy with their bedrooms. Infection control does need some improvement and development to ensure that people who use the service are not at risk from infection transmission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provides an environment, which is bright, comfortable and homely. Two rooms are provided for day use, which include a large lounge dining room and a small quite lounge. We looked around the premises to include living space, the kitchen and two bedrooms and found them to be generally well maintained. We saw that radiators were guarded to prevent burns. We saw on files that people are informed on admission what will be provided in their bedrooms. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 21 We looked at two rooms and found these to be comfortable again, radiators were guarded and wardrobes secure to prevent risk. We asked two people who use the service what they thought about their bedrooms they told us; “ I like my room, I’ve got my own room and everything I want” and “ I like my bedroom”. From our observations we found the environment to be clean. We did not detect any offensive odour, which is good as this makes the service a more pleasant environment for people who live there. We did identify some aspects concerning infection control, which need to be addressed to prevent any risk of infection transmission. Material towels were provided in toilets and bathrooms ( although paper towels were also provided). Communal items such as bar soap and sponges were left in the bath and shower room. Hand wash signs were not displayed in all toilets and the bathroom. Appliances in the laundry are of a domestic type we suggested to the owner/manager that a commercial washing machine would be beneficial. The flooring by the washing machine was not intact and could harbour bacteria. No sink for hand washing purposes is provided in the laundry, which could place both staff and people who use the service at risk of infection transmission. We recommended to the owner manager that a lock be put on the laundry door to prevent access to the boiler, which could get hot and pose as a scalding risk. Stanford House DS0000024973.V358945.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): 27, 28, 29, 30. Quality in this outcome area is adequate. Staffing numbers night and morning times are not adequate to meet the full needs of people who use the service. Over 50 of the staff team have achieved NVQ level 2 in care. Recruitment processes need some development to ensure that people who use the service are fully protected. Some further development regarding training would improve this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have described our observations and highlighted our concerns about staffing levels and the impact they are having on individual people who use the service in different sections of this report. We found that staffing levels night and morning times are not adequate to meet needs. For most of the morning we observed that of the two carers on duty one was cleaning and the other cooking not leaving staff to supervise and stimulate the people who live there. We were told when we asked; “ Yes this has been a normal morning- it is like this everyday” and “Staffing- mornings are a hard one and evenings we have to do teas”. We identified that one person who has dementia and who does not sleep well some nights comes down stairs during the night. With only one staff member on nights we asked how this one person managed to supervise the person who Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 23 was downstairs and provide care and supervision to others upstairs. We were told; “ We put a blanket over her and leave her”. We highlighted our concerns about staffing levels to the owner/ manager who told us; “ Afternoons are better, staff have more time”. We told her we were glad about this but our concerns remained about night and morning times and that either a cleaner should be employed or an additional carer night and morning. We told the manager that she needed to do a full review of staffing levels based on individual need. Over 50 of the staff team have achieved NVQ level 2 or above which is good as this means that a high proportion of the staff have been assessed as being competent to carry out their work. Records told us that a number of staff have been employed by the service for some considerable time. In the last year only a few new staff have been employed. We looked at two staff files to see how well recruitment is managed to ensure that people who use the service are protected. We found some shortfalls with both that need to be addressed. For one we saw that the service had waited for her to commence employment until they had received her full enhanced Criminal Records Bureau (CRB) check which is good. However, the staff member had not provided dates of all previous employment. The second staff member had commenced work before her full CRB had been received yet there was no risk assessment of file. Further her references were not authentic in that both were addressed to ‘ whom it may concern’ and both were from previous work peers not a manager these shortfalls could place people who use the service at risk. We found from evidence certificates and speaking to staff that it is clear that the owner/manager is very much committed to staff training, which is very good as training helps to safeguard people who use the service. Staff were very proud of their training and certificates were displayed throughout the premises. Whilst this is advantageous to visitors as they can see the training staff have received, it prevents quick auditing. We discussed this with the owner/manager and recommended that a training matrix should also be produced so at a glance training dates can be confirmed then sample audits can be carried out on the certificates displayed. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is adequate. Management processes need some development to ensure that the service is functioning effectively and people who use the service are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is also the joint registered owner of the service. She has managed and owned the service for many years. We asked the manager if we could have a look at her Registered Managers Award certificate. She told us; “ I did my NVQ level 4 nearly 5 years ago. I still have not had my certificate”. We found that it was clear that the manager is Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 25 keen to update her knowledge base as she attends all training for example; accredited dementia training with her staff. We were surprised by talking to the owner/ manager to learn that she was not up to date with our methodology and ways of working. The manager did not know about our guidance ‘Key Lines of Regulatory Assessment’ (KLORA) which is important as this is the tool we use for measuring performance and deciding on an overall quality rating for each service. The owner/manager made the following comment shortly after we arrived at the service; “ You did not send me a letter to say you were coming so that I could get all the records ready”. Which shows that she is not aware that we no longer carry out announced inspections. As highlighted in this report we found areas such as medication safety, which gave us serious concern. Other areas such as staffing levels, care plans, dementia care and the proper highlighting of medical conditions also have given us concern. We discussed our concerns with the owner/manager during the day and highlighted that she has legal responsibility to ensure that concerns are not identified again. We looked at the service’s quality assurance processes and were pleased to see that questionnaires are being used and meetings are held although it has been some time since a meeting has been held for people who use the service July 2007 and some staff meetings are brief for example; the minutes of the meeting held in May 07 just described discussion about those staff who needed food hygiene training. We were pleased to see that some audit processes are in place in areas such as the environment. We spoke with the manager/owner and told her that audit processes must cover all aspects of the running of the service particularly medications, care planning and daily notes in order for her to identify and rectify any service shortfalls herself. We looked at the way money for two people who use the service is looked after. We were pleased that it is locked away and that each persons money is held in a separate container. However, we found records to be very basic, one written on the back of a pencil case label. We were pleased that money did balance against records but we identified that two signatures were not available for each transaction and the hairdresser does not always provide as an example; receipts as she should do, to evidence expenditure and to better safeguard people. During the inspection we saw that certain products that could have a potential to be hazardous were not locked away as they should be to prevent risk. We saw two containers in the laundry and two big containers of bleach on the kitchen floor. We looked at a range of records and certificates concerning health and safety. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 26 We saw that no records to confirm testing of the hot water supply had been made for January 2008. The last service certificate for the stair lift available was dated 23.3.07 when this should be carried out every six months. There were no recent certificates to evidence that the emergency lighting and fire alarm system had been serviced. The last records for staff fire training and drills were dated April 07. The owner/ manager told us that all this work had been undertaken but she did not have certificates to date. We were pleased to see a letter from West Midlands Fire and Rescue Service dated 9.11.07 confirming that fire safety was ‘satisfactory’. Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 27 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 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x 3 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 2 x 2 Stanford House DS0000024973.V358945.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)b Requirement A written plan must be in place for each person showing as to how that persons needs in respect of their health and welfare are to be met. This plan must be kept under review. To ensure that the health and welfare of each person is met processes must be in place to make proper provision for their health and welfare. Suitable arrangements must be made to ensure that medicines are stored securely with restricted access to authorised members of staff to ensure that people who use the service are protected from harm. Suitable arrangements must be made to ensure that medicines requiring special storage arrangements are stored under The Misuse of Drugs (Safe Custody) Regulations 1973 as amended. Medicine records for the administration of medication must document administration or DS0000024973.V358945.R01.S.doc Timescale for action 04/03/08 2 OP8 12(1)(a) 04/03/08 3 OP9 13(2) 15/02/08 4 OP9 13(2) 04/03/08 5 OP9 13(2) 15/02/08 Stanford House Version 5.2 Page 29 6 OP9 13(2) 7 OP9 13(2) 8 OP27 18(1)(a) a code documented for refusal after the medication has been offered for administration in order to ensure that the people who use the service are safeguarded. Medication must be administered 11/02/08 using a safe system, which ensures that each person has their medication administered directly from the container they are supplied in to protect people who use the service from a medication error. The medicine policy should be 15/02/08 reviewed and updated in order to ensure that the health and welfare of service users taking medication are safeguarded. Having regard to the size of the 15/02/08 home, the statement of purpose and the number and needs of people at all times suitably qualified, competent and experienced persons are working at the service in such numbers as are appropriate for the health and welfare of the people who live there. 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 OP1 OP9 OP9 Good Practice Recommendations To ensure that all people have up to date information about the service the statement of purpose and service user guide must be updated and reviewed regularly. Care plans should document up to date medication records. This is in order to ensure that medication records for people who use the service are accurate. A safe system should be introduced to ensure that DS0000024973.V358945.R01.S.doc Version 5.2 Page 30 Stanford House 4 OP9 5 6 7 8 9 OP12 OP12 OP15 OP15 OP25 10 11 12 OP26 OP27 OP29 13 14 15 OP31 OP35 OP38 16 17 OP38 OP38 external medications are stored separately from internal medication in order to ensure that the people who use the service are protected from harm. A system should be introduced to ensure that the date of opening of medication containers and balances of medicines are carried over onto a new medicine chart in order to ensure accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner. Daily routines should meet the needs of the people who use the service not service needs. Processes must be implemented to ensure that each person has access to suitable and meaningful activities and adequate stimulation. Where concerns are identified concerning weight and appetite concise records should be made of full food and fluid intake each day. To ensure that food provision meets the needs and preferences of each person menus and options each day must give choice. The manager should ensure that hot water valves are adjusted at each testing that shows the temperature to be outside of the standard. Hot water mixing valves should be anti-scald tested and serviced annually. To prevent risk of infection transmission a sink should be provided in the laundry. For audit purposes the names of the sleep in person for each night and the on call person should be detailed on the staff rota. To ensure that people are properly safeguarded recruitment processes must be managed in accordance with DOH POVA guidance page 13 and Regulation 1919(10). For audit purposes the hours the manager works should be detailed on the staff rota. To ensure peoples money is safeguarded two signatures and official receipts should verify each transaction. To ensure that people are safe risk assessments should be in place for all risks such use of the stair lift, falls and moving and handling and access to the fire in the front lounge. To ensure that people are safe all COSHH products should be stored in a locked cupboard and as manufacturers instruction. To ensure that people are safe a suitable lock should be installed on the laundry door. DS0000024973.V358945.R01.S.doc Version 5.2 Page 31 Stanford House 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. 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