Inspection on 13/11/06 for Stansfield Hall

This inspection was carried out on 13th November 2006.

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 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

Stansfield Hall 30/07/09

Stansfield Hall 10/07/08

Stansfield Hall 16/07/07

Stansfield Hall 26/04/06

Stansfield Hall 17/10/05

Stansfield Hall 14/06/05

Stansfield Hall 07/10/04

Stansfield Hall 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Stansfield Hall Stansfield Hall Temple Lane Littleborough Lancashire OL15 9QH Lead Inspector Jenny Andrew Unannounced Inspection 13th November 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stansfield Hall DS0000052796.V306072.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. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stansfield Hall Address Stansfield Hall Temple Lane Littleborough Lancashire OL15 9QH 01706 370096 01706 370096 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) Rajanikanth Selvanandan Care Home 22 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (21) of places Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 22 service users to include: up to 21 service users in the category of OP (Older People) not falling within any other category; up to 1 named service user in the category of DE (Dementia) under the age of 65 years) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 26th April 2006 2. Date of last inspection Brief Description of the Service: Stansfield Hall is located approximately two miles from the centre of Littleborough. The home provides personal care and accommodation for 22 service users: 21 aged 65 years and over, and one with dementia care needs, aged under 65 years. The home provides 14 single and 4 double bedrooms, 3 of which were let as singles at the time of the inspection. Access to the home is up two steps, although there is good ramped access to the side of the home via the conservatory. Grab rails are provided at each side of the steps. All accommodation is on ground floor level. For safety reasons there is limited access to gardens. A small patio area is provided and is used by service users in fine weather. Parking for approximately 8 cars is provided with further on street parking available as needed. There are a number of shops nearby but they are not easily reached by residents. A regular bus service to Rochdale and Todmorden stops close to the home. The most recent Commission for Social Care Inspection (CSCI) report is available in the entrance area and the Service User Guide advises residents and their relatives of this. At the time of this inspection weekly fees were £320, approximately £1387 per calendar month. Additional charges are for hairdressing, chiropody, newspapers, dry cleaning, private telephone line rental/calls, and external activities in the form of a small donation for transport. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written using information held on The Commission for Social Care Inspection (CSCI) records and from information obtained from the last key inspection on 26 April and random visit on 15 August 2006. This site visit to Stansfield Hall took place over 8 hours and the home had not been told beforehand that the inspector would visit. The inspector looked around parts of the building, checked the records kept on residents to make sure staff were looking after them properly as well as looking at how the medication was given out. To find out more about the home the inspector spoke with six residents, three carers, the cook, manager and the owner. Comment cards asking residents and relatives what they thought about the care at Stansfield Hall had been given out before the inspection. Two residents and 2 relatives filled the cards in and returned them to the CSCI. At the key inspection visit in April 2006, there were many things that needed putting right in order to improve the quality of the service for the residents living at the home. In order to make sure that the home took steps to put matters right an extra visit to the home was made on 15 August 2006.and whilst some improvements were noted, there were still a lot of outstanding issues. A new manager had been appointed to the home and her application to become registered with the Commission for Social Care Inspection had been sent in to the Central Registration Team in the middle of October 2006. What the service does well: Before new service users came to live at Stansfield Hall, the manager made sure they had all the right details about them, so that they were clear that the home was the right place for them to live and that their needs would be met. The manager and staff team were giving good care to the residents who praised the staff saying “”they’re very friendly”, “respectful”, “work hard”, “are kind” and “come quickly when I ring my bell”. Other comments included “cannot fault the care given”, “have lived here for a year and very content”, and “couldn’t wish to live in a better place”. Food provided was nutritious, varied and the menu included a variety of meat, fish, fruit and vegetables. Choices were available at all meals. Residents’ comments about the food were “it’s good”, “home cooked”, “excellent” and “no grumbles”. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 6 Although there had been some changes in the staff team, many of the staff had worked at the home for several years and got to know the residents routines and likes and dislikes. The home was good at making sure service users’ health was well looked after and the service users felt safe and cared for. What has improved since the last inspection? What they could do better: Where risk assessments showed high or medium risk to residents, the care plans needed to identify these areas and show how the home were trying to lessen the risks. Some minor things still needed to be put right in the building, such as new flooring in one of the toilets and a resident’s en-suite shower had not been finished. Whilst there had been a big improvement in staff training, not all staff had yet completed all the required training to make sure residents were cared for safely. The gas appliances had not been serviced but an appointment had been made for this work to be done. Some work needed to be done around the building to make sure it was as safe as possible in case of fire. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 7 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. Stansfield Hall DS0000052796.V306072.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 Stansfield Hall DS0000052796.V306072.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 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were assessed before coming into the home to ensure their needs could be satisfactorily met. EVIDENCE: A Statement of Purpose and a Service User Guide were written and a copy of each was available in the entrance area. Since the last key inspection in April both the Statement of Purpose and Service User Guide had been updated. A copy of the Service User Guide had been given to each resident and it was pinned up behind their bedroom doors. One resident commented upon how interesting he had found the document. The manager was in the process of getting the home’s terms and conditions of residence signed by residents and/or their relatives. Individual records were kept for each resident. The assessments of the three most recently admitted people were inspected. A recognised assessment model was used which covered daily living activities. The manager stated she would Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 10 go out and undertake an assessment before admission, irrespective of how the resident was to be funded. This documentation was in place in each of the 3 files. In one instance, the Local Authority was funding the person’s placement and a full service delivery agreement and assessment were in place. Two of the residents spoken to said they had chosen the home as it was the only home who could accommodate them in a double room. They said they were satisfied with the admission process and pleased they could choose to stay in their room all the time. Following a requirement made at the last key inspection with regard to providing staff with dementia care training, this had been addressed. The manager and 12 of the staff had undertaken this training and the remaining staff were to receive the training within the next few weeks. Stansfield Hall DS0000052796.V306072.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls in care plans were identified but in the main, the residents’ health and personal care needs were being met. EVIDENCE: The care plans for three residents were inspected. Since the last inspection, improvements were noted in the detail recorded on the care plans. Social histories were in place on two of the plans and on the other one, a note was attached and signed by the resident, stating they did not wish to discuss their past life with the staff. Religious needs of residents had been recorded on all 3 care plans which had been reviewed and updated on a monthly basis. Discussion took place with the manager in respect of a resident who was at risk of falling. A risk assessment had been written and the advice of the Falls Co-ordinator had been taken. However, the care plan did not address the identified risk and did not record the necessary action staff needed to take to reduce the risk. The manager agreed to address this. All 3 files had Waterlow (skin care) assessments in place as well as other assessments for identified risk areas such as smoking, use of bed sides, night Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 12 time checking etc. Moving/handling assessments were done for people who needed such assistance and they were reviewed regularly. The new manager had identified a shortfall of moving/handling equipment and new moving belts/ turntables etc. had been purchased. In addition, moving/handling training for the staff had been arranged and all but the most recently recruited member of staff had attended the training. Upon admission, nutritional assessments were not being done. The manager said she had recently spoken to the community dietician and was in the process of making arrangements for the home to receive MUST (Malnutrition Universal Screen Tool) training which would ensure residents nutritional needs would be thoroughly assessed upon admission together with the required action to be taken. Residents’ weight was however, regularly monitored and where weight loss was detected, care plans addressed the problems. Since the last inspection, the manager had improved the recording system for visits made by District Nurses, GPs or other professional health care visitors to the home. Also residents hospital appointments and outcomes of visits were being recorded. From these records, it was established that residents’ health care needs were being well met. Those residents consenting to flu inoculations had received them, some residents had received annual health checks, another resident had been referred to the McMillan nurses and one resident had been involved with a physiotherapist. The residents spoken with said the staff called out their GPs when they needed them. The 2 relatives who had returned comment cards considered they were sufficiently consulted and kept informed with regard to the residents’ care and well-being. The incidence of pressure sores at the home was low but district nurse involvement was requested as needed. The residents spoken with and feedback from the 2 returned comment cards all said they received the medical support they needed and that chiropodist, optician, dentist and hearing aid specialists visited the home, as and when necessary. When checking care plans, recordings showed an optician and audiologist had recently visited two residents, and as a result, new glasses and hearing aid had been supplied. All but one of the carers handling medication had undertaken medication training and certificates had been issued. From speaking to one of the senior carers, who was giving out medication during the inspection, it was identified she was only part way through a distance learning course but would be completing it shortly. She had however, completed her NVQ level 2 training, which included medication, and she was able to answer all the inspectors queries competently. The Medication Administration Records (MAR) examined were up-to-date and where residents had not been given medication, the code letter had been inserted. The systems in place for the storage and disposal of drugs were Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 13 satisfactory. Controlled drug records were accurate and storage arrangements appropriate. The home was actively promoting residents’ independence by encouraging them to manage their own medications. One resident spoken to said he had lockable space where he kept the medicine. A detailed risk assessment had been written to ensure the staff team were clear about what their responsibilities were to ensure his safety. One of the returned comment cards stated the staff always listened to and acted upon what they said, whilst the other commented this happened sometimes due to the staff turnover. The 6 residents spoken with considered they were treated with respect and dignity and that staff ensured their privacy needs were met when they helped them with washing and dressing. One male resident said he liked the owner of the home assisting him when taking a bath, as he would have been embarrassed having a female carer. With the exception of one couple, residents all had single rooms and enjoyed the privacy this provided. A number chose to spend the day in their rooms but said they enjoyed the time staff spent chatting to them. The staff spoken to also said that when they had any spare time, they would sit with residents either in the lounges or in their rooms and this was seen to happen during the inspection. Due to a request made by a resident, the owner of the home had had a new en-suite toilet fitted in a bedroom. The resident concerned had really appreciated this facility as they said they felt their dignity needs were now better met. On the day of inspection, lunch was observed. The owner and a care assistant sat and assisted two residents to eat their meals and this was done sensitively and in an unhurried manner. Stansfield Hall DS0000052796.V306072.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. This judgement has been made using available evidence including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle, food and activities. EVIDENCE: Since the last key inspection, activities and stimulation for the residents had greatly improved. A part-time activity worker was employed for 6 hours a week and in her absence staff also spent time with the residents, encouraging them to play cards or chat on a one to one basis. An activity book was being used to record both group and individual daily activities. From entries recorded, it was identified that regular craft sessions, bingo, singalongs, organ playing, hymn singing and baking/cake decorating were taking place. All the residents spoken to said they were satisfied with the activities provided. Comment cards recorded satisfaction with activities and also said that whilst they were provided, they could choose whether or not to take part in them. One person said how much she had enjoyed making Christmas cards and that she was looking forward to the Christmas Fair. One trip out had been arranged for afternoon tea and several residents had enjoyed the outing. The manager was in the process of arranging activities for the Chistmas period. The recording of more social histories was also alerting staff to what other more varied activities they could do. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 15 The staff spoken to said they felt the manager had improved the atmosphere within the home and as a result, more of the residents were coming out of their rooms to join in the arranged activities. All the residents spoken to felt the staff respected their preferred routines and lifestyles and evidence of this was seen during the inspection. They could get up when they wanted, choose to eat where they were sitting or at the dining tables, had the choice of various lounges and could join in with social activities or not dependent upon how they were feeling. At the time of the visit, the manager was reviewing the key worker system, due to some changes in the staff team. The new system would involved a senior carer and a carer coworking so that there would be some consistency when one person was not on duty. Relative comment cards indicated they were made to feel welcome by the staff. Residents were able to receive visitors in private or choose to remain in the lounge. If residents wanted privacy without using their rooms, the conservatory was used. The residents spoken with were satisfied with the arrangements in place with regard to their religious needs. The manager said one resident had received communion the day before the inspection and another person went out regularly to church. At a previous inspection in June 2005, some residents who were not able to go out had said they would like to have a service held at the home but no progress had been made with regard to this request, except for hymn singing by people from a local church. The statement of Purpose included contacts for local advocacy services. Those residents spoken with were happy with the way the home handled their finances. Feedback from residents spoken to and responses on returned comment cards, were positive about the food. The cook had worked at the home for 12 years and therefore knew the likes/dislikes and portion sizes of all the residents. Four weekly rotational menus were in place which showed a variety of meat, fish, fresh and frozen vegetables were served daily. At breakfast residents could have more or less anything they liked. One person had bacon and egg every day, two had bananas and apples before their breakfast and another resident enjoyed a banana with bread and butter. A choice of two snack meals were offered at lunch time with a more substantial dessert. At tea-time a hot meal was served together with an alternative and a lighter dessert. On the day of the inspection, the lunch meal was sampled by the inspector. It was home made chicken soup which was very tasty. This was followed by bananas and custard. The residents were offered bread with their lunch and seen to enjoy the soup or could have a sandwich as an alternative. Three residents commented upon the soup saying, “it’s very good”, “very nice” and “lovely”. Steak pie and tuna salad were the alternatives for the teatime meal, with a Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 16 dessert of sultana sponge pudding and custard. One of the residents spoken to said he was looking forward to a salad for his tea as he had enjoyed salads before coming to live at the home. The manager had reviewed the way in which residents meal choices were obtained so that she could be sure they were being offered real choices at each meal. Sufficient drinks were served throughout the day, with jugs of juice being available in the communal lounges. Bowls of fruit containing apples, pears and oranges were provided in the lounges so that residents could help themselves. The special dietary needs of the residents were being met with low fat, soft and diabetic diets being followed. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. An effective complaints system was in place which service users were familiar with and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: The service user guide, which each service user had a copy of, contained the home’s complaints procedure. Feedback from comment cards and from speaking to the residents, indicated they knew how to make a complaint. They said the owner and manager of the home were always around to speak to and would feel able to report any concerns to them. At the last inspection, residents had been dissatisfied with the time taken for staff to empty commodes. All the residents spoken to said this had now been addressed and commodes were emptied in the morning or whenever they had been used. The Commission for Social Care Inspection have not had cause to investigate any complaints in the home since the last key inspection in April 2006. No complaints had been recorded by the home. Discussion took place about the recording of minor concerns or issues raised as a result of feedback from the home’s quality assurance questionnaires. The manager said she would record any criticisms in a separate section of the complaints book, together with what action she had taken to address them. Feedback from residents indicated they felt safe living at Stansfield Hall. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 18 A procedure for responding to allegations of abuse was available as was an inter-agency procedure. Since the last key inspection, staff had read the home’s protection of vulnerable adult (POVA) policy in order to ensure their awareness of alerting and reporting procedures. The majority of staff, including the manager, had attended Protection of Vulnerable Adult (POVA) training. Those who had not were to receive in-house training over the next few weeks, until everyone had done it. The staff spoken to understood the importance of reporting malpractice, and the different types of abuse. The manager was also aware of how to implement the Inter-Agency POVA procedures. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were clean, adequately maintained and provided a safe, hygienic and homely setting for residents to live. EVIDENCE: Since the last key inspection, a new handyman had been employed to work at the home 2 days a week. A maintenance book was seen in which was recorded the jobs he needed to do and the majority of the shortfalls identified at the last inspection had been done. However, toilet 15 still needed to have new sealed floor covering fitted and the staff toilet was still being used to store combustible items. These items must be removed and stored elsewhere. Upon walking around the home, it was noted that whilst the environment was safe, homely and comfortable, a lot of the furnishings and fittings were getting shabby and the owner needed to address this as part of his maintenance and renewal programme. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 20 As many of the bedrooms had been inspected at the last inspection, only a minority were checked on this visit. They were clean, adequately decorated and provided spacious accommodation. The owner said that as a bedroom became empty, it was immediately re-decorated so that it would b e ready for the next occupant. One double bedroom had recently had an en-suite toilet fitted but the cubicle had not been finished. This must now be addressed. At the last inspection, it was identified that in some parts of the home, they were experiencing problems with water temperatures not getting hot enough. The owner had contacted a new heating company, who were on call 24 hours a day and taken out a new contract with them. They were due to come and service the boiler at the end of November and would be asked to look at the hot water system again, at this time. The home had sufficient aids and adaptations fitted so that residents could be as independent as possible. As highlighted previously, the manager had also purchased new moving/handling equipment so that residents and staff safety would be maintained and she was monitoring they were using the equipment correctly. One resident, who enjoyed reading, commented that he needed a bigger wattage light bulb or improved lighting in his room. The owner said he would address this. The home was odour free and residents spoken to said it was always fresh and clean. All were satisfied with the cleaning arrangements in place. One resident said “the cleaner cannot be faulted” and another commented, “my room is always kept spotless”. The manager was in the process of arranging specific training for the housekeepers and they were to start a Housekeeping Award on 22 November 2006. At mealtimes staff wore blue disposable aprons over their clothes so that the risk of infection would be greatly reduced and liquid soap and paper towels were supplied in all bathrooms and toilets. Satisfactory arrangements were in place for the laundering of residents’ clothes. Residents said their clothes were returned to them promptly, nicely ironed but that occasionally things did go missing. They did however, say that missing items were generally found quickly. During the inspection, the housekeeper went around the home replacing all towels and flannels with clean ones. The residents said this was done every day. Two residents commented about how nice the housekeeper was and that she would do little jobs for them. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. The home was adequately staffed to meet the needs of the current resident group. Whilst the majority of staff had received appropriate training, some had not although this was being addressed to ensure residents were cared for safely. EVIDENCE: From checking staff rotas and speaking to residents and staff, it was identified that staffing levels of 3 on each shift, up until 20.00 hours, was meeting the needs of the 19 residents living at the home. After this time 2 staff were on duty. Since the new manager took over, some staff changes had taken place, but several of the team had worked there for many years. The manager had ensured that staff were no longer working regular excessive shifts, unless to cover in an emergency situation. With the exception of the owner, the staff team were all women. However, the home owner assisted the male residents to bath, if they preferred to be bathed by someone of the same gender. The manager’s hours were recorded on the rotas, as were the owner’s when he was doing care hours. The manager said that initially, because of staff leaving without notice, she had had to work many of her hours on the floor. However, now the home had a full staff team, she was able to work on a supernumerary basis at least 3 days a week so that she could address management issues she had identified as needing attention. She was in the process of doing an action plan, in order to prioritise her work and on the week of the inspection was totally supernumerary. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 22 Residents comments about the staff and home were complimentary and included: “couldn’t wish for a nicer place”, “we have some lovely staff”, “I’ve never laughed as much as I have since coming here”, “the manager comes and has a chat with us” and “the owner works as hard as anyone”. Since the last inspection, the process for recruiting staff had improved. Staff were no longer starting work before the necessary checks had been done. In instances where staff needed to be started quickly, the manager had contacted the Commission for Social Care Inspection to request permission for staff to start, subject to a POVA first check being obtained and then working under supervision. The manager had also reviewed the reference questionnaire so that it included greater detail. Recruitment and selection policies and procedures were being followed and the 3 staff files checked for the most recently recruited staff showed that application forms had been completed and 2 satisfactory references been obtained. Two files contained full Criminal Record Bureau (CRB) checks and the third contained a Pova First but a CRB check had been requested and permission given by the CSCI for this person to commence work. It was noted that the application form needed to be reviewed to include full employment history. The manager said she would address this. Whilst the manager had paper copies of “Codes of Practice” these were not the type issued by the General Social Care Council. The manager said she would send for copies of the code and ensure they were given to new staff as part of their induction process. An up to date training matrix was available and was used by the manager to plan and monitor training provision. The majority of staff had received 3 paid days training in the previous 12 months. Since the last inspection the manager had addressed the training shortfalls identified at the last inspection. All staff had done fire training, all but the newest recruit had undertaken moving/handling and good progress had been made in respect of food hygiene and health and safety. The ongoing training programme was to be continued until all staff, including night and bank staff, had undertaken all the mandatory training. Courses had already been booked for first aid on 7 December, dementia on 23 November and infection control on 30 November. Of the 16 care staff employed, 6 had NVQ level 2 qualifications and one senior was undertaking level 3 training. The manager was aware of the need for new staff, who were not already qualified, to undertake NVQ training and two of the most recently recruited staff had already enrolled on NVQ level 2 training courses. The manager was aware of the need for at least 50 of staff to obtain NVQ 2 qualifications. Since the last inspection, the manager had implemented Skills for Care inhouse induction training. It was apparent she had spent time and effort in Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 23 formulating questionnaires for part 1 of the induction, so that staff competency could be thoroughly assessed. She was in the process of writing questionnaires for the other sections of the training. Two of the three most recently recruited staff had started the training. The manager was also undertaking this training with all staff who for whatever reason, had not undertaken any formal NVQ training. This good practice is acknowledged. Following the last inspection, when it was identified training certificates were not always held on staff’s files, the manager had addressed this. A staff training and supervision file was in place for each of the staff employed. The files contained evidence of all training they had received, since the new manager had started work, as well as recording minutes of supervision meetings. The home was registered to accommodate one person with dementia. Since the last inspection, when a requirement for dementia care training to be undertaken was made, the manager and 8 staff had completed this training, with more sessions planned for the remaining staff. One of the staff interviewed, who had attended the training, said she had found it extremely interesting and was now able to more fully understand the needs of this client. Stansfield Hall DS0000052796.V306072.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. This judgement has been made using available evidence including a visit to this service. Residents were benefiting from a better run home, with the manager taking steps to promote and safeguard their health, safety and welfare. EVIDENCE: A new manager had been recruited and had started work at the beginning of August 2006. Her application to be registered with the Commission for Social Care Inspection had been submitted to them in the middle of October 2006 and the inspector had received confirmation this was being processed. She had many years of experience in managing a care home and had already completed her NVQ level 4 care award which included a unit on equality and diversity. As well as all the necessary mandatory training, she had undertaken a management of aggression course in January 2005, which did not need renewing until 2008. She was now in the process of registering to undertake the required units of the Registered Managers Award. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 25 It was evident that since her appointment in August 2006, the manager had worked hard to address the problems identified at previous inspection visits. Due to the large number of areas needing to be improved, she had prioritised areas in relation to the health and safety of residents and still had outstanding things that she had not yet had time to address. Progress had been made in staff training, supervision, increase of staffing levels, the purchase of more moving/handling equipment, reviewing of self medication, fire and other risk assessments, reviewing of policies/procedures (which was ongoing) and servicing of equipment. With the exception of the annual gas service, all health and safety requirements made at the last and previous inspections had been met. Residents knew who the manager was and said they would go to her or the owner if there was a matter they needed addressing. Residents described the manager as “very good”, “friendly and has a chat with us”, and “is very kind”. They also passed very positive comments about the owner and one resident said “he’s smashing” and another said, “he spends time chatting to us”. Staff considered the manager to be open and approachable and felt she had already made changes within the home that benefited the residents and themselves. The home had a Quality Policy that was included in the Statement of Purpose and the provider had recently signed up to Investors in People. In order to measure the quality of the service being received by residents, the manager had reviewed the resident questionnaires, making the print larger and bolder so they could be more easily read. She had recently circulated the questionnaires and was in the process of reviewing the feedback. As previously highlighted, she agreed that where criticisms were raised, she would record them in a separate section of the complaints book, together with action taken to address the issues. Resident meetings were not presently being held, although the manager said she would organise these as part of the quality process. In order to obtain a wider range of feedback, questionnaires should now be circulated to relatives and visiting health and social care professionals. All residents and relatives interviewed were happy with the arrangements regarding personal monies. The registered provider did not act as appointee for any residents. Where the home had involvement with residents’ monies, appropriate records and receipts were held. Residents’ monies were checked and found to be in order at the last key inspection so this was not done on this visit. Since starting work in August, the manager had met formally with each member of staff for supervision and had recorded these meetings. Discussion took place about introduction of small group supervision, in order to try and ensure that all staff received regular supervision. The manager was to consider this. As she worked on the floor, she also observed staff practice and Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 26 addressed shortfalls or good practice individually with the staff. Those interviewed considered supervision sessions to be helpful and supportive. No staff meetings had yet been held but a senior staff meeting was scheduled to take place at the end of the week. The manager then planned to hold a full staff meeting. Provision of health and safety training had greatly improved and the majority had completed the required courses, including night staff. Those who had not would be attending the relevant courses over the next few weeks. The manager had identified that there was no fire risk assessment in place. An independent fire company had visited the home and prepared a risk assessment report for the home. From checking through the report, it was identified there were several areas that needed to be addressed. The owner was aware of these and said that the handyman would be prioritising this work over the next few weeks. All requirements previously made in connection with the maintenance of equipment had been met with the exception of the annual gas inspection. Following the inspection, the provider advised the CSCI, by telephone, that he had recently taken out a new gas contract with British Gas who were booked to service the gas appliances on 14 December 2006. Following this inspection, a copy of the service record should be forwarded to the CSCI office. At the last inspection, some residents had said the water in their wash hand basins was not always hot enough to wash in. Whilst the thermostatic mixer valves had been checked and serviced on 30 August 2006, some hot water outlets were still running cool. The owner said the gas maintenance people would be asked to address the problem when they came to service the appliances. Stansfield Hall DS0000052796.V306072.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 x X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Stansfield Hall DS0000052796.V306072.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 13(4)(c) Requirement The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This specifically refers to care plans recording action required with regard to residents who fall regularly. Timescale for action 31/12/06 2. OP9 18(1)(c) 3. OP19 23(2)(b) 4. OP30 18 (1)(c)(i) The registered person shall 31/12/06 ensure that the persons employed by the him to work at the care home receive training appropriate to the work they are to perform. This relates specifically to medication training. The registered person shall 31/12/06 ensure that the premises to be used as a care home are kept in a good state of repair. This relates specifically to new sealed floor toilet 15 and the completion of work in the new en-suite toilet. The registered person shall 31/01/07 ensure that the persons employed to work at the care DS0000052796.V306072.R01.S.doc Version 5.2 Page 29 Stansfield Hall 7. OP38 23(4)(c) home receive training appropriate to the work they are to perform including structured induction training. The registered person shall ensure after consultation with the fire authority, make adequate arrangements for detecting, containing and extinguishing fire. This specifically related to the shortfalls, identified in the fire risk assessment.. 31/01/07 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. Refer to Standard OP8 Good Practice Recommendations The manager should undertake nutritional assessments for all residents upon admission. These should also be undertaken for any resident already in the home, who is losing or gaining weight and action to address the problem be included in the care plan. As a result of residents’ requests, a church service should be arranged in the home, at least on a monthly basis. All staff should receive protection of vulnerable adult training. Staff should continue to undertake NVQ level 2 training until at least 50 of staff have obtained the qualification. The manager should review the current application form to include a full employment history. All staff should receive a copy of the General Social Care Council’s “Code of Practice”. The manager should obtain feedback about the service from a wider range of people e.g. relatives, professional visitors to the home. Regular resident/relative and staff meetings should be held and minuted. Upon successful registration, the manager should complete the Registered Managers Award. DS0000052796.V306072.R01.S.doc Version 5.2 Page 30 2. 3. 4. 5. 6. 7. 8. 9. OP12 OP18 OP28 OP29 OP29 OP33 OP33 OP38 Stansfield Hall 10. OP38 A copy of the gas maintenance report should be forwarded to the CSCI office following the service of equipment. Stansfield Hall DS0000052796.V306072.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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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