Inspection on 31/05/07 for Stanholm Residential Care Home for the Elderly

This inspection was carried out on 31st May 2007.

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

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

Other inspections for this house

Stanholm Residential Care Home... 25/05/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Stanholm Residential Care Home for the Elderly Mill Hill Edenbridge Kent TN8 5DB Lead Inspector Mrs Ann Block Key Unannounced Inspection 31st May 2007 9:00 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 Stanholm Residential Care Home for the Elderly DS0000066477.V339421.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. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanholm Residential Care Home for the Elderly Address Mill Hill Edenbridge Kent TN8 5DB 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) 01732 863748 Anexas Care Limited Karen Elsie Chuter Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care of one service user is restricted to one person diagnosed with dementia whose date of birth is 20/06/1925. 25th May 2006 Date of last inspection Brief Description of the Service: Stanholm is a care home for 22 older people located in the town of Edenbridge. Accommodation is on three floors and consists of four double rooms, fourteen single rooms, a lounge, dining room and separate quiet lounge. There is a secluded attractive garden. Access to the first and second floors is via a stair lift. Each bedroom has a hand basin a telephone point and call bell. A payphone is available and telephones can be installed in bedrooms. Ramps provide access to the garden and into the home; car parking is at the rear of the building. Local shops are in the town centre within a short walking distance. The railway station and bus stops are situated within a short distance of the home. Information about the service and weekly fees are available in a brochure that is given to prospective residents and their families and can be given verbally. Information provided by the owner records fees ranged between £490.00 and £565.00 per week as at February 2007. Additional costs are for hairdressing, chiropody, reflexology, occupational therapy, newspapers, toiletries and other personal items at cost. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block which included an unannounced visit to Stanholm on Thursday 31st May 2007. This is the second inspection of 2006/2007 and will continue to determine the frequency of visits/inspections hereafter. The commission is committed to inspecting for improvement, this inspection was based primarily on reviewing areas needing improvement raised at previous inspections and acknowledging areas where quality of life for residents has improved. The day was spent talking to residents, the assistant manager and staff and looking at a sample of records including residents care plans and daily records, medication records, staff recruitment records, accident and incident records. Three residents were case tracked which included talking to the resident concerned, talking to staff about their care and looking at a sample of associated records. Judgments have also been made using observation of practice. Feedback was provided to the assistant manager at the end of the visit. Overall residents feel they are being provided with a good service. Where judgments made at previous inspections remain the same, these have been included in the assessment of standards in this report. Due to timescale limitations surveys to residents, relatives and professionals were not used as part of this inspection. As part of the inspection the manager completed the commissions Annual Quality Assurance Assessment (AQAA), information from which has been included in the assessments of standards. What the service does well: A particular strength of Stanholm is the friendly, homely and welcoming atmosphere of the home with residents able to live in an environment which is well maintained and safe. Residents like the way people in the home ‘are warm and smiling’. The individual needs of residents are well met and there is effective liaison with other agencies such as health. Meals are cooked using fresh ingredients, well presented and choice is offered. Residents who have specific dietary needs know that these will be met. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 6 Sufficient staff are on duty each day with time to provide activities in addition to care, catering and domestic tasks. Residents know that any requests for care or support will be responded to promptly. Staff are well supported and have a real commitment to caring for older people. Choice, privacy and dignity are seen as very important and residents express a high level of satisfaction regarding their care. They say they would be happy to recommend the home to other people looking for care. Residents and visitors consider they are listened to and find the owners, manager and staff approachable. Communication between the owners, staff, residents and relatives is good and serves to manage any concerns so that they do not become complaints. What has improved since the last inspection? What they could do better: That residents are cared for by people who are competent and safe will be better managed when there is evidence that staff are properly recruited. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 7 Ongoing work to improve the environment of the home is needed as the owners are fully aware. Hopefully this will include installing a passenger lift and providing additional communal space as planned. Also, by continuing with redecoration and repairs to the outside of the house and reviewing the suitability of bathrooms. The risks of cross infection would be reduced by the fitting of a hand washbasin in the laundry. As a priority, the use of the shared bedroom for hairdressing should be discontinued as soon as an alternative is found. Deep cleaning of the serving area in the dining room and replacement of the serving trolley will reduce risks of cross infection. That medication is stored and administered properly will be better evidenced when it is stored more safely, including that for controlled medication, and medication training better equips staff who have responsibility for administering medication. The manager is aware that care plan formats and records need improving to better evidence how individual care and support is to be provided and records include how activities of daily living relate to objectives for the individual. Residents who are funded by social services will have greater security of occupancy when a statement of terms and conditions is provided to them. Residents who have monies held for safekeeping will have greater accountability offered to them when records are audited more frequently by a second person and expenditure is linked to individual receipts. 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. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is good. Residents have good systems to know whether the home is suited to them and can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose, service users guide and brochure. A schedule of fees is available. A staff list with training and schedule of accommodation are an addenda. The service users guide and statement of purpose needed updating in some areas and some additional information included. The owners will provide the commission with an up to date copy when completed. Copies will also be available to interested persons, including residents. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 10 The care files for the most recently admitted residents did not contain a full assessment of need although in practice their needs were being well met in the home. Residents confirmed they had met the manager before they were admitted and had talked about their needs, likes and dislikes. The manager recorded in the Annual Quality Assurance Audit (AQAA) that she always visited each resident before they were admitted and that a new more detailed preadmission assessment form had been developed. When asked whether they had enough information about Stanholm at the time they were admitted residents spoken to said they had. One said that she had been ‘wheeled over in her wheelchair’ to have a look at the home and liked it the minute she came in, to the point where she said ‘right, I’m staying here’. She said it was ‘the homeliness’ she liked and the smiling faces’. Another resident said she wanted to stay somewhere locally as she had previously lived in another home in the area. The resident had settled well in Stanholm and both staff and facilities were suitable to meet her needs. Staff said they made prospective residents welcome when they visited and the resident could stay for a meal and chat to other residents to see whether they would like the home. Whilst there are some residents who display a degree of confusion associated with older age, it was clear that needs were being met in the home, mainly because staff were familiar with the resident and the resident with the home. The AQAA provided by the home stated that each private resident has a contract between the home and themselves. There is no system to provide a statement of terms and conditions for residents who are funded by Social Services. Intermediate care is not provided. Respite care can be provided if there is a vacant room. There are no specific short stay rooms, residents are free to join in the daily life of the home. In this way they can ‘test’ the home and residential life before they commit to a permanent stay. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is good. Residents’ health and care needs are well met but will be improved when recording and medication storage is reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA records that the manager is aware that care plans need developing and evidence from those seen confirmed that assessment. Each resident has a care plan but there is room to include better detail of specific needs and how these will be managed. Examples of where there were deficiencies were talked through with the assistant manager who understood what was required. Care plan have dates when they were reviewed. One resident spoke of meeting her care manager as part of an external review process. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 12 Daily records are made for each resident. Many records are simple and record activities of daily living such as ‘slept well’ or ‘had a good day’, stayed in the lounge’. The positive use of the daily record to evaluate a person’s day was also discussed with the assistant manager. Risk assessments are carried out with action needed to reduce or remove the risk. Staff were aware of risks to individuals and of the rights of older people to take risks. Staff spoken to and practice seen evidenced that staff have a very good understanding of individual need. They made sure that care and support was given as the resident wished or in their best interests. Residents confirmed that the majority of staff were ‘excellent’ and knew how health and personal care was to be given. Residents spoke of attending local and area health services. One resident spoke of continuing with health professionals she had been using before moving into Stanholm. Another spoke of the district nurse visiting regularly. A notice was on display ‘advertising’ a visit from a domiciliary optician service in June. Care files contain space to record health appointments but could usefully reliably include outcomes from these visits and updating of care plans if the need dictates. Where there are health risks these are properly managed with suitable equipment and procedures being used. Medication is provided by a local pharmacy in blister packs with pharmacy printed medication administration records. There is lockable storage for medication. The storage of controlled medication should be reviewed to reduce the risk of it being in public view. Eye drops are not stored in a properly clean or safe environment. Changes to medication are normally recorded in the medication administration record. In respect of one medication, there was no system to record the phone call giving change of dose other than in the senior communication book. Medication records confirmed that medication was being given as directed by the prescriber, including those recorded in the controlled drugs register. The AQAA records that all staff administering medication have had training. The level of training varied from in depth courses to a questionnaire and leaflet based course which didn’t evidence that it equipped staff with the necessary skills and knowledge for the safe handling of medication. Residents confirmed they are always treated with dignity. Screening is provided in shared rooms. Care is taken to return the right clothes to the individual. Privacy is maintained when personal care is given. One shared room is still used for hairdressing as has been the case for many years. The residents using that room are aware that the room is used for this purpose and that no alternative can be found at present. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 13 Staff spoke of how they supported residents during the last stages of life. Local health professionals assist in pain management. The assistant manager spoke of liaising with families regarding post death arrangements . Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 14 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 good. Residents live a life where they are the decision makers with spiritual and social stimulation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents confirmed they are able to make choices about their daily lives including when they get up and when they go to bed. Staff have a good understanding of preferred lifestyle including those who are now less able to express their choices verbally. One resident said there were set bath days and sometimes daily routines depended on staff availability but understood this was likely to happen in any care setting. The AQAA records that there are many more opportunities for residents to get out and about and to have activities and entertainment if they choose. Staff also felt that there were more opportunities and talked of outings locally including one to Hever Castle. Staff take part in fundraising activities to Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 15 provide additional money for outings. Residents talked about making trips into the town and of going to a restaurant nearby for coffee and cake. Festivals are celebrated. A member of care staff has a separate role as activities coordinator two afternoons a week. One the afternoon of the site visit she asked what residents would like and said they wanted to play Ludo. She was also helping some with a word search. Bingo was planned for the following day. Entertainment is also brought in such as musical events and visits from a local school. A whiteboard in the dining room gives detail of planned events such as hairdressing and reflexology. A resident spoke of a visit from the local priest. During the afternoon a visit from ‘pat a dog’ took place. Stanholm has long been renowned for its role in the local community. Visitors are welcomed to the home. Residents spoke of visits from family and friends. A number have local contacts and like to keep in touch with them. A room on the first floor has been set up to offer relatives or friends somewhere to stay if necessary, alternatively, a bed and breakfast is situated over the road. Visitors are also welcome to stay for a meal. A smaller ‘quieter’ lounge offers a greater level of privacy than the main lounge although a number of visitors like a chat with other residents. Resident praised the quality of meals. One person has very specific dietary needs and spoke of how these were met. Staff confirmed what she was able to eat and how they made sure it was provided. Each lunchtime there is a choice of main meal followed by a dessert trolley and cheese and biscuits. Afternoon tea includes homemade cakes and supper offers a lighter cooked meal or sandwiches. Drinks are taken round in between meals and on request, a water jug is provided in each room. Residents can choose whether to eat in their rooms or in communal areas. The range of dining options, which includes the main dining room, a dining table in the lounge and over knee tables offers further choice. Residents who require assistance to eat are given one to one time to allow the meal to be a pleasurable experience. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 16 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. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken to said they felt they had a number of people who they could talk to. Mention was made of talking with the manager about minor niggles and of action being taken, in this way often these niggles are dealt with before becoming a full blown complaint. A complaint procedure is on display which gives contact details including external agencies. Forms to record complaints are availble in the hallway. The form gives space to record the investigation and outcomes. The majority of staff have now received training in adult protection, the remainder have training booked. Staff said that the training was delivered in house by an external trainer. They had a good awareness of the forms abuse might take and ensured that any action which might constitute abuse was properly addressed and residents safeguarded. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 17 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): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. Residents have a homely, well maintained and comfortable environment in which to live but which will benefit from further upgrading and renovation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The facilities at Stanholm have remained the same for many years. People moving into the home are aware of what the home can offer in the way of access, communal and personal space. Residents have use of a good sized lounge which leads into a smaller ‘quieter’ lounge. A dining room leads out into the garden. The dining room has space for the majority of residents to eat at one sitting, others use tables in the lounge or eat in their rooms. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 18 Ramped access to the dining room and lounge offer people with mobility difficulties ease of access. Access to the upper floors is by stair lift. The new owners recognise there are deficiencies which impacts on full use of the home, particularly where people have mobility difficulties and, as funds allow, are progressing work. There are plans to install a passenger lift to replace the current stair lifts and to build a conservatory to allow for more communal space. All such improvements have a major impact on the budget for the home given current funding levels. The owners have already started on improving the environment including redecorating the lounge and dining room, recarpeting communal areas on the ground floor, fitting a new ‘dumb waiter’ lift between the kitchen and dining room and purchasing a dishwasher. A maintenance person is contracted on an ‘as needed basis’ to carry out further repairs and renewals. At the time of the site visit he was repainting the exterior walls. Windows still need to be repainted and areas of rotten wood in frames repaired. Certain restrictions to work are imposed as Stanholm is a listed building. Residents have use of gardens to the side and front of the house. Access is by use of a brick path which, whilst attractive, presents a risk of falls. One resident has had an area of garden redesigned which she loves as she has to stay in her room for most of the time. The assistant manager thought a fire risk assessment had been carried out. This was not inspected at this site visit. She also believed there were no outstanding requirements from the Environmental Health Officer . The ground floor bathroom is the bathroom most used and has a Parker bath. Two other bathrooms are rarely used other than for the toilet. The second floor bathroom has a walk in bath and was being considered for replacement by a shower unit. Two toilets are sited between the lounge and dining room, a handwash basin is sited outside the toilets which is not ideal as it increases the risk of cross infection. The assistant manager said that following the last inspection the floors in these toilets were replaced. Unfortunately water was again leaking onto the floor from one toilet, the assistant manager was to ask the maintenance person who was on site to fix the leak. Some rooms have en suite facilities. There is a sluice machine on the first floor. Staff have their own toilet which is sited between the kitchen and laundry. It has been pointed out at a number of previous inspections that this also increases the risk of cross infection and a separate washbasin should be sited in the laundry. In other respects laundry standards are good, with practices in place to reduce the risks of cross infection where there is contaminated laundry and ensuring that residents’ clothing is kept in good repair. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 19 Residents’ risk from hot surfaces or water are reduced by covering radiators in high risk areas and fitting thermostats to hot water taps. Regular testing takes place to ensure the hot water remains at a safe temperature. Residents’ rooms are individual in size, layout and furnishing. Residents can bring in their own furniture and effects if they wish. One resident pointed out the items she had brought in and which made her feel more ‘at home’. Aids and equipment are provided as needed. One resident has a pressure relieving mattress for example. Toilet riser seats and grab rails are provided. A mobile hoist can be used as necessary. A call system is installed with points in each bedroom and communal areas. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 20 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. Residents have staff whom they like and provide a caring service but where the process is not supported by proper recruitment practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents like the staff and they feel they are treated well. Generally excellent relationships were seen during the site visit. One resident said ‘most of the staff are really good, just one or two arent quite as caring’. A male carer is employed who was clearly well liked by both male and female residents. The manager recorded that she was pleased to be able to employ male carers and this gave residents the opportunity a choice. A keyworker system is theoretically in place. Residents spoken with didn’t know who their keyworker was, possibly as the allocation has recently changed. A roster is held giving names of staff on shift, practice has been for many years that staff are recorded by their surnames, it is found this system works well. Staffing levels include four care staff on duty each morning and three in the afternoon and evening. Two waking staff are on duty at night. Two team leaders, a manager and assistant manager offer a senior structure. Senior Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 21 staff are on call on a rota basis. One team leader said she had worked at the home for some time and had been offered a team leader post to give her more experience in a senior role. As already mentioned one carer works as the activities coordinator two afternoons a week. Residents felt that generally there were sufficient staff to meet their needs, call bells were answered quickly when they were used, although more often staff knew the residents routines hence there was little use of the call system. Agency or bank staff are not used, employed staff do extra hours to cover vacancies on shifts. Staff spoke of times when they came in voluntarily to take residents out or to help on trips. The assistant manager and carer/activities coordinator both said they had been going to retire but came back to help out’. The assistant manager spoke of working flexible hours to fit in with the needs of the home and her personal commitments. Recruitment is taking place for care staff. Files for four more recently recruited staff were seen. It was found that two staff had been employed using criminal records bureau certificates from previous employers, no application had been made in respect of employment at Stanholm. The criminal records bureau certificates for both staff related to employment with care providers and the manager hadn’t realised they were no longer transferable. POVA first checks hadn’t been carried out as such checks cannot be requested unless a criminal records bureau application is made. Three files held only one written reference. A health declaration had been completed by each applicant. The contract maintenance person said that he had a criminal records bureau check carried out in relation to working at Stanholm and understood why such a check was necessary. The current application form has no space to record employment history. There was no evidence of a system to ensure employment history is verified and that the reason for leaving work with vulnerable people is confirmed in writing. The reference request seen to be used was not set up in a manner which provided the referee with space to record the employment, status of the referee, dates of employment or signature. Employment procedures include a disciplinary and grievance process. Where necessary steps are undertaken to follow the disciplinary procedure and to involve other agencies as necessary. Staff referred to training they had undertaken. The AQAA records that over 70 of staff now hold or are in the process of undertaking NVQ level 2 in care. Staff spoke of areas of learning they had obtained through NVQ training. Records of induction were seen in two files, one had the signature of the inductor but not the member of staff. The induction covered topics necessary to prepare the person to work with older people. The assistant manager said that the home was using more in house training where external trainers visited the home to give group training. As already mentioned the current training for Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 22 medication did not provide staff with the necessary skills. The team leader who was working as cook on the day of the site visit said she had a current basic food hygiene certificate. The AQAA refers to the manager’s awareness that more training for staff is needed. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is good. Residents live in a safe and well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed by a person who has the experience and skills to manage a home for older people. Information provided refers to the manager previously working in a care home in a senior role. The AQAA recorded that the manager is working towards her Registered managers Award qualification and attends regular training to update her skills and knowledge. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 24 Residents said they liked the new manager, all said she was very approachable. One resident said the manager was ‘wonderful’ and spoke of how the manager helped her ‘sort her house out’ another said the new manager was ‘good’. Staff and residents said the manager had the best interests of residents at heart and spoke of how she and two staff had undertaken a bike ride to raise funds for trips out. Staff and residents felt the new manager was less formal than the style of manager they had been used to. The majority of staff liked this less formal approach mentioning that they felt their conditions of work had improved and they were more able to use their own judgment. Regular staff and resident meetings are held. Relatives’ views are taken into account and they have opportunities to talk with the manager and owners. Quality assurance surveys are provided regularly to residents and relatives with completed copies seen on file. Information from the surveys is used to improve the service. Residents said they felt listened to. A number of residents have amounts of money held for safe keeping. The assistant manager holds overall responsibility for maintaining records for these finances. A sample of money and records balanced. Receipts are obtained for some purchases, others are part of the house shopping invoice or joint invoices. The assistant manager said that the owner occasionally audits the accounts but records didnt evidence this was being done regularly. As the assistant manager is the only person dealing with these finances the records should be audited more frequently. Money is requested from families as necessary and a copy of the relevant account page sent with the request letter. A safe is available to hold small items for safekeeping. The AQAA records that staff now received regular supervision, this was confirmed by staff spoken to at the site visit. The manager and assistant manager spend time working alongside staff and in this way also provide on the job supervision and support. Staff say they have had core training to include moving and handling, infection control and fire safety. Those spoken with knew the correct procedures in the event of fire and spoke of regular fire drills and training being held. With some environmental exceptions, practices are in place to reduce the risks of cross infection. The main exception was the lack of deep cleaning to the serving area in the dining room and use of a serving trolley where debris was collecting under the edges. Otherwise, food storage is good. The assistant manager said that fridge and freezer temperatures were now checked daily. Information provided states that servicing of supplies and equipment is carried out within the recommended timescales. The owners ensure that business planning is in place. The owners regularly visit the home and provide support for the manager. A current certificate of employers’ liability is on display. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 25 Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 X 1 Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 27 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 OP29 Regulation 19 Requirement All people working at the home must have evidence that they are safe and competent to do so through proper recruitment being carried out. This will include: • A criminal records bureau certificate obtained. Unless there are exceptional circumstances, this must be obtained before the person starts work. Criminal records bureau certificates are not transferable between employers. A satisfactory POVA first check carried out before the person starts work Two written references received before the person starts work with evidence of the authenticity of these references obtained. Processes in place to record and review a full Version 5.2 Page 28 Timescale for action 30/06/07 • • • Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc 2 OP38 13 (3) employment history which includes systems to obtain in writing the reason for leaving work with vulnerable people. The serving area in the dining room and the serving trolley must be deep cleaned or replaced to reduce the risks of cross infection. 31/07/07 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. 4. 5. Refer to Standard OP2 OP8 OP9 OP9 OP9 Good Practice Recommendations A statement of terms and conditions should be provided to residents who are funded by a local authority. Care files should contain not only health appointments but routinely include outcomes and how these affect the overall care plan. Directives for medication changes, such as anti coagulant medication, should be properly recorded. The siting of controlled drugs should be reviewed to remove them from the possibility of being on public view. Staff administering medication should have medication training which includes knowledge of how medicines are used and how to recognise and deal with problems in use. It is unlikely that the training currently offered to staff is suitable to equip them with the skills and knowledge in handling medication. Storage of medication needing refrigeration should be reviewed to ensure it is stored in a clean environment and in a manner which reduces any risk of contamination from or to other substances. As has been recommended at previous inspections, a separate hand washbasin should be fitted in the laundry to reduce the risks of cross infection. It is recommended that record is held of interview DS0000066477.V339421.R01.S.doc Version 5.2 Page 29 6. OP9 7. 8. OP26 OP29 Stanholm Residential Care Home for the Elderly 9 OP29 10 11 OP30 OP35 questions and answers to monitor that equal opportunities are met in the recruitment process. The employment reference request should be set up in a manner which provides the referee with space to record the nature of the employment, dates of employment and status and signature of the referee. The induction record should be signed by both inductor and inductee. Whilst there is no suggestion that finances are mismanaged, to provide better accountability for money spent on behalf of a resident, expenditure should be more closely linked to receipts and the accounts audited more frequently by a second person. Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Hub Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stanholm Residential Care Home for the Elderly DS0000066477.V339421.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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