Inspection on 18/04/07 for Stanwell Rest Home

This inspection was carried out on 18th April 2007.

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

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

Other inspections for this house

Stanwell Rest Home 25/03/08

Stanwell Rest Home 27/09/07

Stanwell Rest Home 31/08/06

Stanwell Rest Home 25/01/06

Stanwell Rest Home 26/01/05

Stanwell Rest Home 07/07/04

Stanwell Rest Home 09/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Stanwell Rest Home 72/76 Shirley Avenue Southampton Hampshire SO15 5NJ Lead Inspector Christine Walsh Unannounced Inspection 18th April 2007 09:30 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 Stanwell Rest Home DS0000012167.V332274.R02.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. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanwell Rest Home Address 72/76 Shirley Avenue Southampton Hampshire SO15 5NJ 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) 023 8077 5942 stanwellcarehome@btinternet.com Stanwell Rest Home Limited Mrs Margaret Haug Care Home 34 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number disorder, excluding learning disability or of places dementia (26), Mental Disorder, excluding learning disability or dementia - over 65 years of age (26), Old age, not falling within any other category (34) Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users in category MD not to be admitted under 55 years of age. The eight service users to be accommodated in the separate apartments must be in the category of OP and in need of personal care only. The apartments may only be used by service users whose assessed needs can be met within that environment. 31st August 2006 Date of last inspection Brief Description of the Service: Stanwell Rest Home is a care home that is registered to provide personal care and accommodation for a maximum of thirty-four older people. The home is situated in a residential area of Southampton close to Shirley shopping centre and within easy access of public transport. Accommodation is split between two buildings. Twenty-six residents can be accommodated within the main building. This building consists of three former residential properties that are linked internally. Accommodation is spread over two floors. Eight further residents who only require assistance with personal care needs can be accommodated in self-contained apartments situated at the rear of the main property. Range of fees, house shared room £327 - Apartments £420 Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was undertaken by Mrs C Walsh regulatory inspector. The visit commenced at 09:30 and ended at 17.00 and the home did not know we were visiting. As part of the process Mrs Walsh met with the assistant manager, staff, spoke with residents, two visiting relatives a district nurse and reviewed the thirty requirements issued following the last visit to the home in August 2006. Eight weeks prior to the visit the manager was provided with comment cards for residents, relatives, staff and health care professionals, these form part of the key inspection process and assists the inspector to form an overview of the standard of care provided within the home. A considerable number of these were returned with positive comments about the service provided. What the service does well: What has improved since the last inspection? The home has made significant improvements to the level of care provided, medication procedures, the environment, activities, recruitment and the numbers and competencies of staff. The assistant manager has reviewed all care plans which provide better detail on how the residents must be supported to provide a consistency and continuity of care, however the manager is aware further improvement can be made in this area and discussed how this could be achieved. This forward thinking and demonstrates that the manager is keen to improve standards for the residents. Following a the last visit to the home a pharmacy inspector was called upon to carry out a comprehensive review of the home medication procedures as these had been identified as a serious concern. In total ten requirements were made which covered all areas of medication management and administration. All ten requirements have been met and residents are now receiving a better service Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 6 in terms of receiving the correct medicines at the correct does and time by trained staff. Improvements are being made to the environment and include redecoration, the replacement of old carpets, furniture and furnishings and a better scheduling of cleaning. Offensive odours are now being eliminated more efficiently. A relative said: “The home appears a lot cleaner and tidier” The home has plans in place to improve the quality and variety of activity that is provided to the residents. The assistant manager spoke of having an activity coordinator and makes sure residents who want to, go out at least once a week in the homes mini bus. Improved staffing levels during the morning mean residents are enabled to go about their day in the way that they prefer instead of being got up to have breakfast at a specific time. The importance of respecting the resident’s rights, choices and improvements to their dignity and privacy is now more evident and the staff appear more aware of the basic principles of care and now receive training in this area. A staff member said: “Its important to treat people as individuals and to respect their dignity and privacy” A relative said: “My mother is very well cared for, we couldn’t ask for a better home”. A Resident said: “I am very happy living here, the staff are very kind and helpful” The home has made improvements to its recruitment procedures and no new staff starts without having provided two references and have a clear protection of Vulnerable Adult (POVA) and Criminal Bureau Record (CRB) check as is required. This is important to ensure residents are not placed at potential risk of harm from others. The area of training and supervision has also improved; staff said they are feeling more supported and competent to carry out their day-to-day roles and responsibilities and in meeting the needs of the residents. What they could do better: Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 7 Following this visit to the home five requirements have been repeated and one immediate requirement was made. The home could do better to protect the health and safety of the residents and it was these areas that cause immediate concern. Despite the home-identifying residents at risk from falling from windows for over two years it has failed to place sufficient restrictors on windows in that time to prevent falls, although risk assessments claim that it has been done. An immediate requirement was issued to have the said work completed within forty-eight hours. The other area of concern regarding the resident’s health and safety is the storage of corrosive substances harmful to health (COSHH). A number of harmful substances were found to still be accessible to residents. Therefore the home must ensure better attention is made to locking them away and keeping the residents safe and protected from potential harm. Despite good work being undertaken on the assessment process, the recording of care needs and review of these the home could do better to ensure all areas of the residents needs are fully reviewed to reflect their current and changing needs and to inform staff of how the residents wish to be supported, this includes risk, nutritional and moving and handling assessments. The managers have done well to improve the quality and level of training and support it provides staff, there is evidence that some staff have received adult protection training, however the home could do better to ensure the residents are protected from potential risk of harm all staff must receive training in adult protection. The home has done well to make some improvements to the environment, however the home must still consider how it can make the environment more dementia friendly, enabling the residents to move more freely and safely around the home and be provided with alternative ways in which they can make choices. The home has done well to seek the views of the residents and improve the information on how to make complaints but it could do better to ensure that the quality information obtained from people who use the service is captured and used to further develop and improve its level of care it is currently providing. The home is very good at making all relatives welcome to the home, providing them with a cheery smile and offering beverages, however consideration must be made to where residents can meet with their visitors in private, especially if they are sharing a room. The home has done well to appoint an assistant manager, allowing the registered and deputy manager to focus on the day-to-day needs of the residents, however the number of people with management responsibilities Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 8 appears to be causing some concern between staff who feel they are not being provided with clear leadership. A staff member said: “It would be better to have one person in charge that knows their job”. 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. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has made improvements to its assessment process and documentation enabling the home to better determine if it can meet the needs of prospective residents. The home does not provide intermediate care. EVIDENCE: As part of the inspection process three residents assessment plans were viewed, the assistant manager, a relative and staff were spoken with and relative and residents comment cards were viewed prior to the visit. Following the previous visit to the home the manager was required to improve the homes assessment process from undertaking a detailed documented assessment with the residents or their representative, obtain a care managers Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 11 assessment where applicable and reassess the needs through the transition and trial stay. The assessment process, detail and documentation have much improved. The assessment provides specific detail of the resident’s health, welfare and social needs. There is evidence of care manager assessments being obtained, OP7although the assistant manager said these are sometime difficult to obtain and there is evidence of reviews taking place. On the day of the visit the assistant manager was attending a review of a resident who had recently moved in. The assistant manager spoke of the transition of some residents from a home that was closing, to their service, and described how the information they had recieved did not reflect the needs of the residents and how the home is currently reviewing the residents assessment plans and care plans. This review is seen as good practice. Seven comment cards received from people who use the service including relatives said they had been provided with enough information about the home and felt their needs are being met. A relative said: “The comments I received about the home were all very favourable and complimentary about the staff”. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 9 and 10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has made improvements in meeting the health and welfare needs of the residents including the safe administration of medication and preserving residents privacy and dignity. The home must however continue to make improvements to resident’s personal plans to ensure a continuity of care is provided. EVIDENCE: As part of the inspection process three residents personal plans including risk assessment were viewed, residents, relatives, staff, a CPN and district nurse were spoken with and comment cards from residents, relatives and health care professionals were viewed. Following the previous visit to the home a number of requirements were made in respect of the residents personal and social care, their health care needs medication and residents privacy and dignity. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 13 The assistance manager commented that a considerable amount of time has been given to making the residents personal plans specific and more detailed, which has provided staff with information on how to provide a continuity of care. This was reinforced by staff who said that they found the personal plans easier to follow. The staff record daily how the residents have been and provide an audit trail of care, treatment and social engagement. Discussion took place with the assistant manager of how the home could provide a person centred approach to care including detail of how the resident likes to spend their day, from getting up to going to bed and making clear choices about what they would like to do and when. The manager demonstrated good knowledge of the needs of residents with dementia and agreed to look at developing the care plans further. The assistant manager has done well to review the care plans, however other areas of the residents support needs such as potential risks to them and nutritional assessments have not been reviewed. A requirement was issued for the registered manager to review the residents risk assessments and have these completed by 30/09/06, evidence in three personal plans viewed by the inspector showed that this has not been done for one resident who was identified as a concern following the last inspection. Therefore this resident continues to be placed at considerable risk such as falls from windows. An immediate requirement was issued at the time of the visit. The home has however considered where residents maybe at risk of falling out of bed and written evidence was seen. But further risks were observed that must be addressed to improve safety for staff and residents with regards to moving and handling. The residents appeared clean and tidy, and resident’s spectacles and dentures were clean. A district nurse said: “I frequently visit the home and have no concerns, the residents always look clean and tidy and they look after them very well”. All comment cards stated that residents always receive the care they need. The resident’s health care needs are well met and the home does well to continue to support resident when they show signs of requiring nursing intervention. The assistant manager spoke of the importance of trying to continue to support residents when they become very frail and their health is failing. The home is well supported by health care professionals and has good links with local GP’s, district nurses and community psychiatric nurses and psycho-geriatricians. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 14 A district nurse said: “The home is very good at looking after residents with failing health care needs, they keep good records and make sure they have the right equipment to support the resident”. A relative said: “I am very pleased with the way the staff have looked after my mother, she is very ill now but she wouldn’t have lived as long as she has if it wasn’t for the care and kindness of the staff”. A GP said: “The home has recruited an assistant manager who has brought very high standards and professionalism to the home”. Of the eight comment cards received seven residents said they always get the medical help they need. Following the last visit to the service where a number of concerns regarding the homes medication practices were raised a pharmacy inspector was asked to visit the service to audit the medication and in total issued nine requirements. These requirements were reviewed and improvements were found both in the administration, storage, ordering and training of staff. A medication round was observed and good practices were seen. The staff confirmed that they have received further medication training and that policies and procedures are now in place. The assistant manager confirmed that there are no residents who currently self administer but this is in the process of being reviewed and residents who are risk assessed as able and who wish to administer their own medication will be able to do so. The areas of dignity, privacy and respect have improved since the last visit to the home; the importance of this is highlighted in the residents’ personal plans, was observed through practice during the day, covered in training and fed back by the manager and staff. Two staff met with, demonstrated good values and spoke of the importance of treating the residents as individuals and not asking them to do anything they wouldn’t want to do. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 15 Privacy curtains in shared rooms are of a better quality and choices made by residents are better respected. The recruitment of more staff and using a keyworker system has also assisted in providing an individual approach. Residents living in the self-contained flatlets now have their own front door keys and there is a better emphasis on providing individualised care and support to assist the residents to maintain their independence. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports people who use the service to maintain contact with family and friends and ensures the residents receive wholesome and appealing meals. Improvements have been and continue to be made for the residents to experience a lifestyle that matches their needs and preferences and to exercise choice and control over their lives. EVIDENCE: As part of the inspection process the inspector viewed the personal plans of three residents, spoke with residents, observed practices and activities in the home and met with the cook, the staff and assistant manager. The home organises a range of activites to stimulate and entertain the residents which includes indoor activites such as bingo, listening to old time music, board gamers and outdoor activities such as seasonal festivities (BBQ) and going out once a week in the homes mini bus. Trips include visits to places of interest, and drives to the forest and seaside. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 17 A resident said: “I like to out on the mini bus if it is a nice day” Another said: “I like to go out, and I have my own Sky TV and DVD which the home had put in for me”. Suitable mobility equipment has been purchased for a resident in order that independent trips to the local shops and cafes can take place. The assistant manager went into detail of how the home is supporting the resident to maintain as much of an independent lifestyle as possible and further aids are being purchased to assist with communication. This demonstrates the home is considering the individual needs and lifestyles of the residents. However some hobbies and interests of the people who use the service could be missed as personal plans do not provide enough information of their specific interests and hobbies or describe how the home will plan to meet these. The home must also consider how it is going to meet the sensory and cognitive abilities of residents with dementia and how this area of activity can be improved upon. During the day of the visit the home was observed to be a hive of activity with visitors and calls to the home. Two visitors were spoken with who spoke highly of the staff and the care and attention they pay to the needs of the residents, and how they are always made to feel welcome. The visitors spoke of how they are kept informed of the care of their relatives, especially when they are unwell. A relative said: “The staff are always so friendly and welcoming” All comment cards received from relatives spoke of the kindness of staff and how they are made to feel welcome, however one raised a concern regarding the lack of privacy, especially for residents in shared rooms and asked that alternative arrangements be made for meeting their relative in private. The home is consider how this area of concern can be addressed. Through improved leadership, personal plans, more staff and specific training on the principles and core values of care, the home is making some headway in ensuring residents receive individualised care and are provided with support to make decisions and choices about their daily lives. This was particularly evident in the flatlets where residents now hold their own front door keys and are more involved in making choices about their daily life and care. There is Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 18 evidence of residents meetings where residents are asked to express their views on the meals and activities provided and residents do not have to be up and in bed by a certain time to meet the needs of the home. A member of staff said: The residents get a choice of food, to go out if they wish, play games, choose they’re own clothes” The same member of staff: “You can’t make someone do something they don’t want to do, so if they don’t want to go to bed, then they don’t have too”. This demonstrates that the member of staff has good values and a good understanding of the principles of care. The home provides support and care to residents with dementia and therefore should consider how they can support them to continue as far as possible to make choices and decisions for themselves. The home has a designated cook who prepares and cooks the main meals of the day from fresh produce. The cook has worked in the home for a number of years and is aware of the routine of the home and the needs of the residents. The cook said that she will meet with residents or relatives when they first arrive to establish their likes and dislikes, if they require a full, soft or specific diet such as diabetic. Nutritional assessments are undertaken at the pre admission stage, however there is little evidence of these being reviewed for residents who have lived in the home for a number of years. Advice from GP’s and supplements are provided when there is a concern about a residents weight and the home is now keeping a record of what residents are eating. At the time of the visit the residents were observed to be presented with regular drinks and snacks and appeared to enjoy a wholesome freshly made meal. The residents said: “The food is very good here” “We have plenty to eat” Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 19 All comment cards received from residents and relatives spoke of how good the food is. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service are provided with information, which enables them to confidently express their concerns and have them acted upon. The home has procedures in place to safeguard the people who use the service from potential risk of abuse, however the home must ensure that its entire staff receive training in adult protection. EVIDENCE: As part of the inspection process the inspector viewed the homes complaints and adult protection policies and procedures, spoke with staff and viewed comment cards from residents and relatives. Prior to the inspection of the service in August 2006 the Commission and social services were notified of concerns from a nurse at Southampton General Hospital in respect of the health and welfare of a resident in their care. The complaint was investigated under the safeguarding of adults procedure. This complaint has not yet been resolved, however the provider is still seeking a conclusion to this matter. Following the last visit to the home the manager was required to update the home complaints procedure to include the correct name and address of the Commission for Social Care Inspection. This has now been actioned and is Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 21 clearly displayed in the entrance to the home for residents and visitors to read. This was required so that residents or relatives who feel their concerns or complaints are not being listened to can call upon the commission for assistance and advice. Positive comments have been received from residents and relatives and staff appear knowledgeable of what to do if someone makes a complaint. A resident said: “There is always someone available to speak to if I am unhappy” A relative said: If we have any concerns we always go to the manager and things get done”. All comment cards received from staff and those staff spoken with clearly described what they would do if a residents or relative made a complaint. This is in line with the homes policies and procedures. The home has appropriate policies and procedures in place to provide guidance and information to staff on how to report concerns and identify what is abuse; these include the local authorities policies and procedures. The staff spoken with at the time of the visit gave details of what they felt constituted abuse and what they would do if they witnessed an abusive act. A member of staff said: “I haven’t recieved abuse training but if I saw something that I felt was not good for the resident I would report it immediately”. The majority of staff have received abuse training, it was a requirement following the last visit that all staff must receive training especially those who have worked in the service pre August 2006. The assistant manager spoke of a new training programme, which includes abuse and how they try to get staff to attend training especially those who fail to turn up. This is a staff performance issue and must be better managed by the manager to ensure all staff have been equipped with the skills and knowledge to protect the residents. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service maintains a clean, pleasant and hygienic environment for the residents to live in and improvements are being made to the environment to meet their needs. EVIDENCE: As part of the inspection process the inspector toured the building, viewed residents bedrooms and spoke with the assistant manager, residents and staff. The home provides a warm and welcoming appearance, which is identified by residents and relatives as homely and comfortable, however following the last visit to the home it was issued with three requirements in respect of the environment and the cleanliness of the home. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 23 Mr Conway the owner was required to forward a plan of how he intended to improve the environment to assist residents to move safely and independently around the home. This was not received but on touring the home some improvements have been made such as replacement carpets and redecoration and refurbishment to some areas of the home. In some areas of the home it remains tired and worn out in appearance, requiring redecoration such as first floor bathrooms. Mr Conway must still provide the Commission for Social Care Inspection with a plan of how and when the changes will take place. The assistant manager was made aware and appeared to recognise the importance of providing a dementia friendly home in order to maintain and promote independence and to lessen disorientation and confusion of the residents. This was discussed at length and the manager put some good ideas forward. The home however does not fully safeguard the residents from risk of harm, as first floor windows do not protect residents from falling. Following the previous visit to the home it was issued with a requirement to review all residents risk assessments. Stanwell Rest Home provides a service to people with complex needs. Current risk assessments identified that some people who use the service are at risk of wandering, leaving the home and falling from windows. At the time of the visit to the home the evidence available demonstrated that insufficient action in response to previous requirements had been taken to reduce the risk of falling from first floor windows. Following the inspection an immediate requirement was issued requiring the provider to respond to this matter within 48 hours. Since the visit the provider has confirmed in writing that he has attended to the risks and the action taken will be considered at the next key inspection. Following the last visit to the home concerns were raised in respect of the homes cleanliness and unpleasant odours permeating throughout the home and the inappropriate attire of staff. A significant improvement has been made in this area with the employment of an extra cleaner and staff receiving infection control training. The assistant manager said the home has regular contact with a continence advisor, residents are assisted to go to the toilet regularly and regular cleaning of carpets has helped to reduce unpleasant odours. A relative said: “The home is always clean and tidy” Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 24 A staff member said: “The cleaners work very hard and are very good with the residents Improvements to the laundering facilities have improved and staff were observed wearing appropriate clothing and using disposable gloves and aprons. These are colour coded for specific areas of work such providing personal care and mealtimes. The staff with whom spoken with at the time of the visit, comment cards received and training records viewed evidenced that staff have received infection control training. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 25 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service have their needs met and are protected by improved numbers of skilled and competent staff, who are recruited using robust recruitment procedures. EVIDENCE: As part of the inspection process the inspector viewed the homes duty rota, staff recruitment and training records, met with staff and the assistant manager. The home has made significant improvements to the numbers of staff it has on duty through out the day and how the staffs duties are deployed. Staff are informed at handover which areas of the home they will be covering and it has introduced a keyworker system. The staff with whom were spoken with said it felt more organised and they are much clearer about who is doing what. The deputy manager spoke of how the home has employed extra more experienced staff that work hard and well together. A resident said: “The staff are wonderful they are always there when you need them” Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 26 A relative said: “They seem to have more staff around, however they could still do with more staff in the evening”. This was also raised by another relative who said: “The home could do with more staff in the evenings, this is a very difficult time for residents with mental impairment and the layout of the home is hard to manage without adequate staff”. Through observation it was clear that the home runs very smoothly in the morning and staff go about their roles and responsibilities in a relaxed unhurried way and readily engage with residents and visitors. However the evenings still pose some difficulties for staff especially when residents are unsettled and restless, tea is being prepared and served by carers, a staff member is administering medication and these difficulties are not helped by the make up of the environment, three houses in one. This was brought to the attention of the assistant manager who recognised that early evenings still pose a problem for the home and would raise these concerns with the registered manager and owner. The staff with whom were spoken with said they enjoyed their work, one said: “I have worked in the home 6 –7 years, but I wish I had started earlier in care because I love it” Another said: “I have worked at the home 17 – 18 years and still enjoy it very much”. Happy staff provides a happy environment for residents to live. The home is keen to encourage staff to undertake a national Vocational Qualification (NVQ) in care and currently have over 50 of their staff qualified in NVQ2 or above. Following the last visit the service a requirement was issued in respect of the homes recruitment procedures; staff were being recruited before the appropriate checks had been obtained. The files of all new staff were viewed and demonstrated that the home is now adopting a robust recruitment procedure. Staff complete an application, come for interview, two references are obtained and criminal record bureau (CRB) Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 27 and protection of vulnerable adult (POVA) checks are obtained before the member of staff starts working in the home. New staff members are undertaking a “Skills for Care” induction programme, which provides extensive information to support staff to appropriately care for the residents and is the foundation for staff moving on to do a NVQ. Staff are supported to work through the programme through group teaching and there was evidence of letters being sent to staff to attend certain days, however it was reported that attendance was poor and some staff were falling behind. This a performance issue and must be addressed appropriately by the management team as it is vital that all staff receive the required foundation training to care for the residents. Following the last visit to the home a number of requirements were made in respect of training, especially abuse, medication and dementia care. The assistant manager said that the home now has an extensive training programme which includes mandatory training such as moving and handling, first aid, fire and health and safety and person specific training such as abuse, dementia care, Parkinson’s, skin care, dignity and privacy to name but a few, these will be provided in the very near future. The staff with who were spoken with said the area of training had improved. Six staff comment cards received prior to the visit indicated that they had received some mandatory training such as fire, first aid and moving and handling. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 28 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): 31,33,35,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service safeguards resident personal monies by efficient and accurate accounting. Improvements have been made in the best interests of the people who use the service, such as resident involvement, how the home is run day to day and staff supervision, however further improvements are required to safeguard the residents health and welfare. EVIDENCE: As part of the inspection process the inspector met with the assistant manager, administrator and staff and viewed records and comment cards. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 29 Following the last visit to the home concerns were raised with the day to day management of the home and understanding of the level of responsibility the home has in respect of providing a good standard of care for the residents. Since the last visit the owner has appointed an assistant manager with the remit to focus on all areas of which were falling below standard and the registered manager remains in charge of the day to day management and care of the residents. This approach demonstrates that the owner Mr Conway was very keen to raise standards in the home and ensure the residents are receiving good quality care. This arrangement appears to be working well and a member of staff commented on how much things had improved since the assistant manager had started. A relative commented on how better organised the home appeared to be. However in comment cards received from staff some discontent was noted under the question “If you could change one thing to improve the way the home works, what would it be? “To have just one person in charge, that knows their job, and to deal with complaints immediately instead of letting them build up”. “To deal with problems as they arise instead of letting them manifest themselves” “More support from management” This is a management performance issue and they must consider how they will address these issues to ensure staff concerns do not poorly reflect on the running of the home and care of the residents. Through the course of the visit it was identified that improvements to the quality of care has been made and that the managers and staff are working to improve on areas of concern. This is monitored by the owner Mr Conway and the assistant manager and regular staff and residents meetings are taking place. There is evidence that quality questionnaires have been undertaken with relatives and residents but currently this does not extend to other stakeholders and the outcome of the quality audit has not produced a development plan for the service. This was required following the last visit and the requirement will be repeated. The home supports and provides a safe place for resident’s personal spending money to be held. Records seen demonstrate that the administrator is very Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 30 careful to ensure all residents monies are kept safe and accounted for at all times. The home does not have appointee ship for any one living in the home and prefers that resident’s relatives/representatives manager their financial affairs. The assistant manager has the role of supervising all staff and everyone is issued with a timetable of supervisions and are issued with a letter notifying and reminding them a week before the supervision takes place. The manager provided evidence that all serviceable utilities are regularly checked and serviced and fire fighting equipment and drills are undertaken as required by the fire safety regulations and the assistant manager is aware of the new fire safety legislation. However the home continues to fail to provide a safe environment for the residents to live, following the last visit to the home a requirement was issued for all residents to be risk assessed against the risk of falls from windows. Despite residents still being identified at risk the windows remain unrestricted. An immediate requirement was issued at the time of the visit. The home was also required to ensure all corrosive substances hazardous to health (COSHH) must be locked away safely. There was evidence of such substances left accessible to residents and therefore the requirement has been repeated. The visit in August 2006 identified that residents had been assessed as at risk from falls from windows and window protectors were in place, this was dated 2005, however during the visit in 2006 it was established that the windows had not been protected placing some residents at considerable risk. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 31 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 3 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 1 Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. OP7 Regulation 15 (2) (b) (c) Requirement To ensure the changing holistic needs the people who use the service are met all areas of their personal plans must be regularly reviewed such as risk assessments and nutritional needs. Timescale for action 18/05/07 2. OP7 13 (4)(a) (b)(c) To safeguard the people who use 18/05/07 the service from potential risk of harm they all must have an individual and full risk assessment undertaken on them, including the risk of falls and risk of leaving the home. All risk assessments must detail the specific risk to the residents and clearly states how the risk will be minimised. This requirement has been repeated. 3 OP38 13(4)(a) (b)(c) The people who use the service who have been risked assessed, as at risk from falls from windows must have restrictors placed on their windows. DS0000012167.V332274.R02.S.doc 19/04/07 Stanwell Rest Home Version 5.2 Page 33 4 OP7 13(4)(a) (b)(c) The resident who is currently sleeping on the floor must have an up to date moving and handling assessment on them to ensure theirs and staff’s safety. People who use the service must be safeguarded from potential abuse; therefore all staff must receive training in adult protection. This requirement has been repeated from the last inspection dated 31/08/06. 31/05/07 5 OP18 18(1)(a)1 0(2)13(6) 30/06/07 7 OP19 23(1)(a) 23(2)(a) The environment must be improved to meet the needs of all people living at the service who may have dementia, such as signs, colours and appropriate communication tools. A programme of improvement must also be available. This requirement has been repeated from the last inspection dated 31/08/06. 30/06/07 8 OP33 24(1) (2)(3) Quality audit outcomes must be available with an action plan for making improvements in the quality of the service for all those who use the service or their representatives and be available for Commission for Social Care Inspection as and when requested. This requirement has been repeated from the last inspection dated 31/08/06. 30/06/07 9 OP38 13(4) (a)(c) The registered manager must ensure all COSSH substances are safely locked away at all times and after use. DS0000012167.V332274.R02.S.doc 18/05/07 Stanwell Rest Home Version 5.2 Page 34 This requirement has been repeated from the last inspection dated 31/08/06. 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 OP13 Good Practice Recommendations Consideration should be give to how residents will be provided with a private, comfortable place to meet with their relatives. Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Stanwell Rest Home DS0000012167.V332274.R02.S.doc Version 5.2 Page 36 - 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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