Inspection on 25/05/07 for Stapleton House

This inspection was carried out on 25th May 2007.

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

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

Other inspections for this house

Stapleton House 07/10/08

Stapleton House 19/05/08

Stapleton House 31/08/06

Stapleton House 07/02/06

Stapleton House 28/07/05

Stapleton House 11/01/05

Stapleton House 05/07/04

Stapleton House 06/11/03

Stapleton House 11/07/03

Stapleton House 23/10/02

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

CARE HOMES FOR OLDER PEOPLE Stapleton House Back Borough Road Jarrow Tyne And Wear NE32 5XW Lead Inspector Irene Bowater Key Unannounced Inspection 25th May 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stapleton House DS0000000276.V336006.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. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stapleton House Address Back Borough Road Jarrow Tyne And Wear NE32 5XW 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) 0191 430 0179 0191 483 3294 The.willows@ashbourne.co.uk Excelled Healthcare Services Limited ** Post Vacant *** Care Home 45 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (31), Physical disability (4), Physical disability over 65 years of age (6) Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2006 Brief Description of the Service: Stapleton House is a purpose built home providing both personal, nursing and dementia care for older people. It is a two storey building serviced by two passenger lifts. All bedrooms except one are en-suite, and there are lounges, one with an adjoining conservatory, and separate dining rooms. The corridors and doors are wide and allow access for people using wheelchairs. There is a 12-bedded dementia care unit situated on the first floor. This is a self-contained unit with individual bedrooms, dining room and lounge. There are adapted bathrooms, showers and toilets close to all resident areas. The home is located in a quiet, discreet area with well-laid gardens to the rear overlooking a green belt area, which offers a picturesque view from some bedrooms and the communal areas. The home is close to the town centre of Jarrow, to all amenities, and public transport, including the Metro railway system. Car parking facilities are available. The current fee rates range from £359 to £482 and includes the nursing care contribution, which is set nationally. Private fee rates vary from £430 to £460. Items not covered by the fees include, hairdressing, toiletries, newspapers and clothing. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • • • • • Information we have received since the last visit on 31 August 2006. How the service dealt with any complaints and concerns since the last visit . Any changes to how the home is run. The provider’s view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on 25 May 2007. During the visit we: • • • • • • • Talked with people who use the service, relatives, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit . We told the manager what we found. What the service does well: The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs. Staff involve the residents, their representatives and other professionals in the care planning to makes sure their needs can be met. The staff have formed good relationships with the residents and make sure their rights to privacy and dignity are met. Residents said: Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 6 ● ● ● “they are good” “I’ve no complaints” “I am happy” There is good communication with other professionals to ensure peoples health care needs are met. There is plenty of food which is nicely cooked and people can choose what they want to eat. Residents said: ● ● ● “There is plenty” “The food is nice” “I get what I want” Visitors are made welcome and there are good links with the community. Residents and relatives said they would be able to use the complaints procedure if they had a concern. The activities organiser work hard to provide activities inside and outside of the home. The staff receive the training they need to care for individual needs. The recruitment policies are followed. Everyone is kept informed about any changes in the home. The residents have a homely comfortable place to live. What has improved since the last inspection? The care plans have improved. They now follow a “person centred approach to care”. Staff now follow all medication requirements. This makes sure people receive their medication safely. Repairs to the radiators in communal areas have been completed. Staff have reviewed the practices at mealtimes so that peoples dignity is not compromised. In house maintenance checks are carried out with records kept. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stapleton House DS0000000276.V336006.R02.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 Stapleton House DS0000000276.V336006.R02.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): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission assessments ensure the residents care needs will be met. EVIDENCE: Care plans show that the manager carries out comprehensive assessments before anyone is admitted. The care managers’ and nurse assessments were also available. Information is also available about residents’ previous lifestyles, including background, cultural, religious or other needs and how this will help residents to settle into the home. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 10 The assessment looks at what each person can do to take of themselves and what support they will need with the tasks of daily living and personal and health care. Where possible the relatives and representatives are involved in this process. Stapleton House DS0000000276.V336006.R02.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 good. This judgement has been made using available evidence including a visit to this service. The care plans are comprehensive and person centred this ensures people’s needs are recognised and fully met. Health and personal care is well met so that the care people receive is based on their individual needs. Robust systems for the administration of medicines are in place and ensure that people using the service receive their medication safely. A good level of personal support is in place, which promotes peoples rights to privacy and dignity. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 12 EVIDENCE: All of the plans were clearly set out. Accredited assessments tools for the prevention of pressure sores and wound care, moving and assisting, catheter care, continence promotion, nutrition and mental health status were completed reviewed and updated monthly. Care plans are regularly reviewed and updated according to changes in social, personal and health care needs. Residents who have reduced appetite or low weights are regularly weighed and intervention sought from dieticians. Their recommendations are acted upon and the care plans updated as necessary. People who are at risk of pressure damage, dehydration or have poor appetite have daily charts to record their position and what food and drink they have been offered. Not all of these charts were completed in detail. Up to date information regarding changes in wound care is documented on a regular basis and regular reviews take place with residents’, their relatives and care managers to make sure the home is still meeting their needs. The residents have access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. Appropriate pressure relieving devices are available to support the staff and residents in daily activities. Advice is sought from tissue viability specialists, speech therapists and continence advisors. Visits from the multi disciplinary team are recorded in individual care plans. The home has comprehensive medication policies and procedures for staff to use. Records are in place for all medicines received, administered and disposed of. A random audit of Controlled drugs and Medicine Administration Records (M.A.R.) showed no discrepancies. Handwritten directions on the M.A.R. now have two signatures. There is a register of staff who are authorised to administer medication. Senior care staff have completed a Safe Handling of Medicines course. Although medicines were safely stored the treatment room was untidy and disorganised. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 13 The manager carries out regular audits to make sure residents are receiving all of their medication. Should there be any discrepancies a full internal investigation is carried out and remedial action taken. There was a good rapport between staff, residents and relatives, which was friendly and professional. Care was delivered in private and staff were seen to knock on doors and wait for permission before entering. Stapleton House DS0000000276.V336006.R02.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 are well supported to take part in a range of social activities, which provides stimulation and interest for residents living in the home. Support from relatives and representatives provide residents with opportunities to maintain their previous lifestyles. Residents are well supported to make choices and take control over their lives. Choices of nutritious and appetising meals are available to ensure individual dietary needs and preferences are met. EVIDENCE: The home benefits from a designated activities organiser who arranges events both inside and out of the home. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 15 Evidence of events are displayed and an activity diary is available. This records the activities people have taken part in or refused. Events have included shopping, visits to Newcastle, the theatre, in house film afternoons, arts and crafts and pie and pea suppers. Visitors were seen to come and go throughout the inspection. They are able to use the lounges or residents bedrooms for visits. It was confirmed that there are no restrictions regarding visiting times. Residents have brought small items with them personalised and reflective of their previous lifestyles. making their rooms The home has two dining rooms on the ground floor and one on the upstairs unit. One dining area on the ground floor has been changed to a smaller area to try to give a more positive mealtime experience for those people who need a lot of help. All of the dining tables apart from those in small dining room were nicely set. Several of the residents chose to stay in their rooms and staff took meals to them. Breakfast consisted of cereals, porridge, fruit juices, toast, butter and preserves. Residents can request egg or bacon sandwiches during the week and a full cooked breakfast is available on a Sunday. The lunchtime menu consisted of fish or egg, chips, peas or beans. Followed by coconut sponge and custard. Alternatives such as sandwiches, salad and omelettes were also available. All of the food was nicely presented and of ample portion size. Hot and cold drinks and snacks are readily available throughout the day. Comments from residents included: “The food is nice” and “there is always plenty to eat”. Staff were kind and gave assistance in a discreet manner. The home is going to introduce the “Nutmeg Gold” menu planner, which will give a nutritional analysis of the menus provided. This is to make sure the residents have a balanced diet based on their preferences. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedures are clear and easily accessed. This helps people to feel confident that their views are listened to and acted upon. Robust arrangements for Safeguarding Adults help to protect people from harm. EVIDENCE: The home has detailed complaints procedures, which clearly sets out how and to whom to make a complaint. The procedure is available in the Statement of Purpose, Service User Guide and is displayed in the home. Since the last inspection the Company has resolved two complaints. One complaint is being dealt with in partnership with the Local Authority. There are procedures in place to safeguard the people living in the home. The staff have received training and know when to involve external agencies. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 17 One safeguarding adults investigation has been resolved and one alert has been made on 23 May 2007, which is currently being investigated by external agencies. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, warm, suitably maintained and decorated so that the residents have a homely and comfortable place to live. There are some infection control issues, which could put people at risk. EVIDENCE: The home is a two-storey building, which is service by two passenger lifts. A separate twelve bedded dementia care unit has been provided upstairs. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 19 There are dining rooms and lounges on each floor. pleasant garden which residents are able to access. One lounge leads to a All areas were nicely decorated and furnished. The home does have a redecoration and refurbishment programme. All bedrooms apart from one have an en-suite facility. encouraged to bring small items with them. Residents have been This makes their own rooms personalized and reflective of their lifestyles. There are specialist baths, shower facilities and adapted toilets close to all resident areas. The shower room near to the front door is not used as it could compromise residents’ privacy and dignity. This room is used for storage of hoists, wheelchairs and obsolete equipment. It was confirmed that the water is run on a weekly basis in unused areas. One specialist bath on the twelve-bedded unit was out of use. This was brought to the managers’ attention and a request for repair actioned. Several of the light cords remain grimy, knotted and cannot be cleaned easily. On the day of inspection the home was clean and tidy. There was an odour from the upstairs sluice and one identified bedroom. The clinical waste holder was rusty and commode pots were being stored on the floor as no shelving has been provided. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The current staffing levels meets the residents’ needs. A training programme is in place to ensure staff has the competence to care for the residents needs. The residents are kept safe and supported by comprehensive recruitment procedures to prevent unsuitable people from working in the home. EVIDENCE: The home has two units. There is qualified nurse on duty throughout twentyfour hours with seven care staff in the morning, six care staff in the afternoon and three care staff overnight. There were sufficient ancillary staff on duty including laundry, catering, administration and activities organiser. A maintenance person has recently been recruited. Agency staff are not used in the home. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 21 The staff continue with their NVQ level two training although the 50 target has not been reached. Five staff files showed that the recruitment procedures are followed. All contained evidence of completed application forms, interview records, two written references, terms and conditions of employment and induction records. Criminal Record Bureau and POVA First checks are carried out and these records are held securely. Personal Identification Numbers (P.I.N.) numbers of qualified nurses are checked with the Nursing and Midwifery Council to make sure nurses are registered. Evidence from the files and from discussion with staff confirmed that they have received training in moving and assisting, first aid, food hygiene, and infection control and fire safety. Other training includes, safe handling of medicines, protection of vulnerable adults, care planning, “Yesterday, Today and Tomorrow” which includes dealing with challenging behaviours. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager who provides leadership. This ensures the home is run in the best interests of people using the service. Clear systems for consultation and quality monitoring make sure that the views of residents are sought and acted upon. Residents personal accounts are well managed to ensure their best interests are protected. The health, safety and welfare of residents are being protected as far as reasonably possible. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 23 EVIDENCE: The manager is a first level registered mental health trained nurse who has many years experience. She has completed the Registered Managers Award and also has a degree in Health and Social Welfare. She is currently awaiting her interview to become registered with the Commission for Social Care Inspection. The quality assurance systems include internal monitoring of complaints, maintenance, catering and domestic services. . Storage and administration of medication is audited on a regular basis. Care plans are also internally audited with a number being randomly selected each month. The regional manager carries out regular audits and reports with actions and outcomes are available in the home. Regular relatives and resident meetings are held with minutes recorded. Records are available to show that residents’ finances are being looked after. All transactions are recorded, receipts and signatures are available A random check of three accounts were correct. Staff have had training in safe working practices with records kept. Fire training is completed every three months for night staff and six months for day staff. A fire risk assessment is available and up to date. Water temperatures are recorded to ensure temperatures of 44 C is not exceeded. Accidents are clearly recorded and the manager completes monthly accident analysis to examine and track any trends. All internal maintenance checks are dated and signed. External service contracts were available and up to date. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 2 3 X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 25 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. 1. Standard OP7 Regulation 13,15 Requirement The registered persons must ensure that all positional change charts, fluid balance and food charts are completed in detail. The registered persons must ensure that the specialist bath on the dementia care unit is repaired. The registered persons must ensure that the light cords are free from knots and easily cleanable. Timescale of 01/11/06 not met. The registered persons must eradicate the odour in the upstairs sluice and the identified bedroom. The registered persons must replace the clinical waste container and provide cleanable shelving in the sluice. The registered persons must ensure that 50 of care staff achieves NVQ level 2 or equivalent. Timescale of 31/03/07 not met. Timescale for action 01/07/07 2 OP21 23 01/07/07 3. OP26 13,23 01/07/07 4 OP26 13,23 01/07/07 5 OP26 13,23 01/07/07 6. OP28 18 31/12/07 Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 26 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 OP35 Good Practice Recommendations The registered persons should ensure that individual receipts are provided to enable detailed audit. Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Stapleton House DS0000000276.V336006.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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