Inspection on 30/07/07 for Stanley House

This inspection was carried out on 30th July 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stanley House 07/07/08

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

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

CARE HOME ADULTS 18-65 Stanley House Bosbury Herefordshire HR8 1HB Lead Inspector Sandra J Bromige Key Unannounced Inspection 30th July 2007 09:30 Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 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 Stanley House DS0000068706.V339776.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 Adults 18-65. 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. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanley House Address Bosbury Herefordshire HR8 1HB 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) 01531 640 840 01531 640 826 Stanley House Limited Mrs Catherine Yeates Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11), Physical disability (11) of places Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care to service users of both sexes whose primary care needs on admission to the home are within the following categories: Physical Disability over the age of 18 (PD) 11 Mental Disorder over the age of 18 (MD) 11 The maximum number of service users to be accommodated is 11. 2. Date of last inspection New service Brief Description of the Service: Stanley House is a converted Georgian farmhouse owned and managed by four Directors. Two of the Directors work in the home on a day-to-day basis; Catherine Yeates as the registered manager and Linda Jones as the Administrator. This is a new service that opened in February 2007 and offers 11 places for male and female residents over the age of 18 who have a physical or mental disability (excluding dementia & learning disability). The accommodation is provided in single bedrooms with en-suites or dedicated bathroom facilities. The house is set in over 6 acres of grounds with beautiful views over the Herefordshire countryside. The gardens are well established and provide seating areas and benches and a tennis court, which families and visitors are welcome to use. The current fees range from £1300 - £1650 per week. Items not covered by the fees are personal clothing, hairdressing, cigarettes, specific requested outings/holidays incurring a charge, some specialist equipment (generally most nursing equipment is included, but in the case of a particular resident requiring something that would not normally be provided or is specific to the needs of one individual only we reserve the right to exclude the provision of such equipment), the home also reserve the right to charge for travel expenses, for individual outings. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. The Inspector spent 12hrs in the home. This was the first inspection that the home has had since it was registered and opened in February 2007. This was a key inspection – this is an inspection where we look at a wide range of areas. To help us plan the inspection we looked at pre-inspection information in the form of an Annual Quality Assurance Assessment requested from the home some weeks earlier, survey forms received from residents (2), relatives (3), and health care professionals (2). During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the manager and other senior staff. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening and talking to residents. No complaints have been received by the Commission about the service. What the service does well: The home has a comprehensive Statement of Purpose & Service User guide which is given to prospective residents and their families to enable them to make an informed decision about moving into the home. The manager visits all prospective residents and does an assessment of their health and social care needs prior to admission to ensure that the home is able to provide the care for that person. Residents are able to visit the home before moving in to see the facilities and meet the other people living there. Residents are provided with information about the terms and conditions of stay in the home. People living in the home are involved in decisions about their lives and the care and support they need. A relative commented that ‘the personal touch is very evident because of the different need for the individuals.’ Residents are encouraged to continue to manage their own monies where they are able. Group and individual social events are arranged in and outside the home. The home has already become well established within the local community. The days activities for individuals are not pre-planned as residents get up and decide what they feel like doing that day. A relative commented, ‘the staff provide as far as possible a ‘family’ atmosphere within the home and try to give the residents some variations such as day trips, shopping, BBQ’s, and personal pampering sessions’. A well balanced diet is provided with a good choice of food. Mealtimes are flexible particularly breakfast as residents eat at various times depending on the time they get up. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 6 Each resident has a care plan, which has clear information showing the identified healthcare needs of the residents, and how residents are supported to maintain their individual needs. The home has a complaints procedure which is displayed in the home and published in the Service User guide. A suggestions box is provided to enable people to comment on the service. Residents are safeguarded as staff have received training on protecting vulnerable people and Criminal Records Bureau checks are carried out for all people working in the home. The home offers a good standard of accommodation. The décor and furnishings are of a good standard and create a homely environment for the people living there. The home is clean and tidy. Comments receive have said, it is ‘a welcoming homely home’ in a ‘Good setting’. The staff working in the home are trained and skilled and there are enough staff to support the people who use the service. Comments received said, ‘they are lovely to speak to on the telephone and reassure me when there are issues, illness etc. They make use very welcome when we visit’. ‘They make the individual client feel they are well loved and cared for in a welcoming home’. The home is managed by one of the owners. She is a registered nurse and is well qualified and experienced in managing this type of service. Systems are being established to monitor the quality of the service including monthly visits by one of the Directors where residents and staff are spoken too in private. Staff are receiving mandatory training upon employment to ensure the welfare of the residents and staff in the home. What has improved since the last inspection? What they could do better: The homes terms and conditions need to be reviewed to ensure that they provide information for the individual residents about the payment of any nursing care contribution towards their fees and how this is managed by the home. Care plans need to be discussed with the residents and/or their relatives to ensure that they agree to the content. Some care plans need more detail to ensure that they show all action to be taken by staff to enable the residents care needs to be met in a consistent manner. Key workers should be allocated to each resident as stated in the homes Service User guide. A receipt should be issued when money is handed to staff for safekeeping. Two signatures Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 7 should be recorded for all entries of residents’ monies and a running balance should be maintained. All medication received and given to residents must be signed for on the Medication Administration Records. If the medication is not given a code must be written on the Medication Administration Records to give the reason why it was not given. The homes medication policy must be reviewed to ensure that medication is being managed safely. Medication, creams or ointments that are not prescribed or listed within the ‘homely remedies’ policy must not be given to the residents. Two staff should sign any handwritten entries on the medication charts. The temperature of the room where the medicines are being stored should be checked and recorded each day to ensure that it does not exceed 25°C. Gaps in the employment history of prospective staff should be explored at interview for the protection of the people living in the home. Window openings of all windows above the ground floor must be risk assessed to ensure the safety of the residents. The fire alarm should be tested every week and recorded. The temperature of the hot water from taps where residents have access should be checked and recorded each month. The home should write a policy for First Aid in the home. First Aid kits should be provided in both of the vehicles used for the transportation of residents. 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. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people to use the service and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract that tells them about the service they will receive. The contract needs reviewing to include information relating to the payment of the nursing contributions so that residents are aware of how this affects their individual fee payments. EVIDENCE: The home has produced a comprehensive Statement of Purpose & Service User guide. This was on display in the home and a copy was seen in residents’ rooms. These documents need some minor changes, which was discussed with the manager at the time of the inspection. Written information from residents and relatives confirm that they received enough information prior to making a decision to moving into the home. Three residents were case tracked. They all had contracts in place from the funding authority and from the home outlining the terms and conditions of residence. The residents’ agreement produced by the home needs reviewing to include information for individuals about the payment of the nursing care contributions and how this is taken into account with residents’ individual fees. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 10 The home manager prior to admission had assessed all three residents. These assessments were very informative and enabled the home to develop a care plan for these people prior to admission. A resident confirmed that they had visited the home prior to coming to stay. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are involved in decisions about their lives and the care and support they need, although their individual care plans are not being discussed with them or their representative, to ensure that they are fully aware of the content and agree to the goals and action plans in place. EVIDENCE: The care records were looked at for the three residents case tracked. The care plans overall are comprehensive and informative and have written action plans for staff to follow to work towards the desired outcomes. The care plans are being reviewed by the staff in the home. More detail is needed in some action plans stating what should be done and how, particularly for prescribed creams & ointments and continence aids. One resident’s record had an incident recorded involving ‘assisted restraint’ by staff. There was no procedure within the care plan in the event that this incident needed to be repeated. The Inspector discussed with the manager the urgent need for training to be arranged for staff on restraint procedures. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 12 There is no evidence to show that the care plans have been discussed with the residents and/or their next of kin to seek agreement to their content. A resident confirmed that they had not seen their care plan. There is no key worker system in place as stated in the homes Service User guide. It is evident from observation during the inspection and discussion with residents that they are supported by the staff to make decision about their lives. A resident told the Inspector that they managed their own monies and another resident was taken to the local town by staff from the home to access their monies. A maximum of £100 can be held in the homes safe on behalf of residents for safekeeping. Records of monies held by the home for two residents’ case tracked was seen. The home is not issuing receipts for cash received. The staff are not following the homes procedures for expenditure of monies as there should be two signatures for all transactions and this was not seen. A running balance is not always being complete to enable ease of audit of these accounts. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style, and supported to develop their life skills where their individual health permits. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: Social events for the residents have been arranged such as swimming, horse riding, outings, individual activities and a coffee morning has been held in the home for families, friends and people from the local community. It is evident from the care records and discussion with residents that other activities are planned in consultation them individually. The home were seen to offer choice with in house activities and the days activities for individuals are not generally pre-planned as residents get up and decide what they feel like doing that day. The home have the staff available to meet these daily choices. A relative commented that ‘The staff provide as far as possible a ‘family’ atmosphere within the home and try to give the residents some variations such as day Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 14 trips, shopping, BBQ’s, and personal pampering sessions’. The home provide two vehicles for staff to take residents out and about. A local minister of religion visits the home each week. Visitors were seen in the home spending time with the resident in the privacy of their own room. The dining room is in the centre of the home and provides a natural meeting place for staff and residents to sit and chat, have meals and snacks. Residents who are able to, help themselves to drinks throughout the day from the kitchen located next to the dining area. Residents were seen eating meals in the dining area, the lounge and in their rooms. Staff assisted residents with eating where required in a discreet and sensitive manner. A 4 week menu is provided and displayed in the home and residents comment on the menus. Choice is available at all times. Mealtimes are flexible, particularly breakfast as residents eat at various times depending on the time they get up. A light lunch is served at lunchtime and the main meal in the evening as residents may be ‘out and about’ during the day. A generous budget is provided by the home for the provision of food. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The policy and systems currently in place for the management of medication is not satisfactory and have the potential to place residents at risk. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The three care plans seen have clear information showing the identified healthcare needs of the residents and how residents are supported to maintain their individual needs. It is evident from the care plans, discussion with residents and observation of the staff that allowing choice is recognised, but some residents also need gentle guidance to help maintain their personal standards. The home is flexible and do not have daily routines. Care records show that residents health is monitored and reviewed and action taken where appropriate. This is supported by the comments from relatives and visiting healthcare professionals to the home: - ‘The staff at the home do their utmost to ensure that X needs are met’. ‘The staff are very prompt to update me of any changes in X’s health and general well being’. ‘What from X tells me the staff bend over backwards to make X’s stay at the home as Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 16 pleasant as possible in the circumstances’. ‘They understand X because of their experience with X’s illness’. ‘Trained impression that healthcare needs met’. ‘Individualised care package’. The home has a policy for the management of medication. This has been looked at by a Pharmacy Inspector and guidance has been sent through separate correspondence regarding the shortfalls in this policy. The home does not currently have a ‘homely remedies’ policy in use, although it was evident from a resident’s care plan that two preparations had been used that were not prescribed. The manager was not aware of the guidance from the Royal Pharmaceutical Society of Great Britain regarding the management of medication in care homes. This information was obtained from the website. The Medication Administration Records are printed by the dispensing pharmacy. These records are used to record the receipt and administration of medication. Two items had not been recorded when received and there were a number of gaps on the Medication Administration Records for two residents’ where there was no signature or code used to give the reason for it not being given. There were no signatures on the Medication Administration Records for two prescribed ointments. Two prescribed medicines had been handwritten on the Medication Administration Records and there were no signatures against these entries. Most of the medication is packaged as part of the Monitored Dosage System used in the home. A box of medication was chosen to audit, but this was not possible, as the date of opening had not been recorded. An audit of Temazepam was checked and correct. Creams & ointments were not secure; this was rectified at the time of the inspection. Copies of prescriptions are not being held in the home. The temperature of the medication fridge is being monitored each day, but the temperature of the room where the medication is stored is not being monitored. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The homes Service User guide contains a copy of the homes complaints procedure. The home has a suggestions box at the entrance to the home to enable people to comment on the service. Written feedback from residents and relatives confirm that they know how to complain if the need arises. The home has not received any complaints since it opened in February 2007. A resident told the Inspector they would ‘speak to Cathy’ if they had any concerns. Staff have received training on safeguarding adults. The manager was advised to obtain a copy of the local Herefordshire procedures for the Protection of Vulnerable Adults, which she did immediately, to support the homes policy. Criminal Records Bureau checks for staff are being obtained prior to employment. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home was registered and opened in February 2007. It is set in its own extensive grounds and has been converted to offer a good standard of accommodation. The facilities of the home are suitable to accommodate residents with a physical disability. The décor and furnishings are bright and homely and age and gender appropriate. There is a lounge with a television and a sunroom with double doors leading out onto the patio where there are tables and seating. The dining area is in the centre of the home and forms a natural ‘meeting’ place for residents and staff to get together for meals and have a chat. The accommodation is on 3-storeys with access via a shaft lift. The bedrooms are all single occupancy and have an en-suite or a dedicated bathroom for that Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 19 particular bedroom. The bedroom seen was very clean, nicely decorated and well furnished and had an electric profile bed. The resident had chosen to move into this room and told the Inspector they were ‘pleased with the room’. Residents’ surveys confirmed that the home is always fresh and clean. Other comment received stated it is a ‘welcoming homely home’ in a ‘good setting’. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, although the care staff numbers during the daytime are not in line with the homes Statement of Purpose. EVIDENCE: There were 9 residents living in the home at the time of the inspection. On duty both days was a registered nurse and 2 care staff and a registered nurse with one carer at night. These are in line with the staffing rota seen, but are not in line with the staffing arrangements stated in the homes Statement of Purpose. The Statement of Purpose states there is 3 care staff during the day. A therapist/support worker was also on duty on the first day of the inspection. A housekeeper was employed by the home in July to keep the home clean and launder the residents’ clothes. A maintenance person is employed 3 days per week. The manager’s hours are not supernumery at present as she is rostered as the team leader for Team A. One of the Directors works at the home as the administrator and another handles all the health & safety training. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 21 Male & female staff are employed in the home aged 18 – 65 . Two staff have NVQ level 2 or above and 5 staff are working towards their NVQ level 2 or above. Three staff files were seen. They contained information to show that the required pre-employment checks had been done, although some aspects of the recruitment needed improving for the protection of the people living in the home. There was no evidence to show that gaps in one person’s employment history had been explored at interview, as there were no interview records. On one reference the employment dates had not been confirmed. Advice was given that they should amend the employment application form for ‘employment history’ to ask for the beginning and end dates of employment and their reason for leaving that employment. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and competent and is establishing quality assurance systems to enable the home to monitor the standard of service. Aspects of health & safety management need to be improved to ensure the safety of the people living in the home. EVIDENCE: The manager is also one of the four owners of the home. She is a registered nurse and is well qualified and experienced to manage this service. Comments from relatives state; ‘they are lovely to speak to on the telephone and reassure me when there are issues, illness etc. They make us very welcome when we visit’. ‘They make the individual client feel they are well loved and cared for in a welcoming home’. This is a new service that has been running for less than six months. As part of the quality monitoring of the service monthly checks are carried out on the Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 23 environment internally and externally and for medication, cleanliness, accidents & complaints. Reviews by Commissioners are carried out shortly after placing residents and at six monthly intervals to ensure that the service being given to their clients is of a good standard. Staff meetings take place once a month to cascade information to the staff and take onboard any suggestions or issues they may wish to raise. Monthly visits are carried out by one of the Directors to check on the quality of the service. These reports are very thorough and both residents and staff are spoken with in private. Discussion with staff and staff files confirm they have received fire, moving & handling, health & safety, food hygiene and infection control training. The water temperature and management of Legionella records were seen. An external contractor is employed by the home for the management of Legionella. The homes records showed that the hot water temperatures are not being checked from all hot taps every month. Fire system records were seen which showed that fire alarm tests were being done monthly and not weekly as required. The Inspector found an upstairs window could be opened to a gap sufficient for a person to fall or climb out. An immediate requirement was issued for the window openings to be risk assessed and the manager has confirmed that this has been actioned. Accidents are being recorded and followed up by the manager. The home does not have a policy for First Aid and the vehicles provided for transporting residents do not have a first aid kit. Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 2 X X 1 X Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5A(4) & (5) Requirement Timescale for action 31/08/07 2 YA6 3 YA6 4 YA20 5 YA20 6 YA20 The contract must be reviewed to include the information about the payment of nursing care contributions, so that the people know how this is managed by the home for their individual fees. 15(2)(a)(c) Care plans must be discussed & (d) with the resident and/or their representative to ensure that they agree with the content. 15(1) Care plans must set out in detail all action to be taken by staff to ensure that the individuals care needs are met in a consistent manner. 13(2) All medication received and administered must be signed for on the Medication Administration Records. If medication is not given a code must be used to give the reason why it is not given to ensure that residents are being given their medication as prescribed. 13(2) The homes medication policy must be reviewed to ensure that medication is being managed safely. 13(2) Medication, creams or ointments DS0000068706.V339776.R01.S.doc 30/09/07 30/09/07 31/08/07 31/08/07 31/08/07 Page 26 Stanley House Version 5.2 7 YA42 13(4)(a) & (c) that are not prescribed or listed within the ‘homely remedies’ policy must not be administered to the people living in the home as this may place them at risk of harm. The window openings of all windows above the ground floor must be risk assessed to ensure the safety of the people living in the home. An immediate requirement was made. 01/08/07 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 6 7 Refer to Standard YA6 YA7 YA20 YA20 YA34 YA42 YA42 Good Practice Recommendations Key workers should be allocated to each resident as stated in the homes Service User guide. A receipt should be issued when money is received for safekeeping. Two signatures should be recorded for all entries and a running balance maintained. Two staff should sign any handwritten entries on the Medication Administration Records to ensure that it has been accurately transcribed onto these records. The temperature of the room where medication is stored should be checked and recorded each day to ensure that it does not exceed 25°C. Gaps in employment history should be explored at interview for the protection of the people living in the home. The fire alarm should be tested weekly and the outcome recorded. The hot water temperatures from all outlets where residents have access should be tested each month and the outcome recorded. The home should write a policy for first aid and should ensure that first aid kits are provided in both of the vehicles that are used for the transportation of residents. DS0000068706.V339776.R01.S.doc Version 5.2 Page 27 8 YA42 Stanley House Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park Droitwich Road Worcester WR3 7NW 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 Stanley House DS0000068706.V339776.R01.S.doc Version 5.2 Page 28 - 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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