Inspection on 28/11/07 for Staverton House

This inspection was carried out on 28th November 2007.

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

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

Other inspections for this house

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Staverton House 51a Staverton Trowbridge Wiltshire BA14 6NX Lead Inspector Alison Duffy Unannounced Inspection 28th November 2007 09:00 X10029.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 Staverton House DS0000070477.V353292.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Staverton House Address 51a Staverton Trowbridge Wiltshire BA14 6NX 01225 782019 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) info@equality-care.co.uk Equality Care Ltd Mrs Charlotte Mary Sievewright Care Home 20 Category(ies) of Dementia (20), Mental disorder, excluding registration, with number learning disability or dementia (5) of places Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) - maximum of 20 places Mental disorder, excluding learning disability or dementia (Code MD) maximum of 5 places The maximum number of service users that can be accommodated is 20. This is a new service and therefore this is the first inspection 2. Date of last inspection Brief Description of the Service: Staverton House is a residential care home registered to care for 20 older people with dementia or associated conditions. Nursing or intermediate care is not provided. The home is purpose built and was opened on the 30th July 2007. The home is owned and managed by Equality Care Limited. In addition to Staverton House, the organisation has two other residential care homes. The director is Ms Lucy Wilcox. The registered manager is Mrs Charlotte Sievewright. The home is located in Staverton, a village near Trowbridge and Bradford on Avon. It has been built, in the grounds of another of the organisation’s care homes. The home is divided into ‘pods’ and covers two floors. Both floors have residents’ bedrooms, bathing facilities, a dining room and lounge areas. A passenger lift gives level access. All residents have a spacious single bedroom with an en-suite. This consists of a walk in shower, a toilet and hand wash basin. All areas of the home are furnished to a high standard with facilities such as Internet access. The home has been designed with consideration to residents needs. Colours have been used as a tool to aid orientation. All exit doors are linked to the call bell system, so residents are not at risk through leaving the building unattended. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 5 As this is a new service, the home is not fully staffed and not operating at full occupancy. When this occurs, staffing levels would be maintained at four carers and a senior member of staff throughout the waking day. At night there are two waking night staff and a member of staff provides sleeping in provision. In addition to the care staff there is a housekeeper and catering and domestic staff. An activities organiser of 20 hours, is being recruited. Fees for living within the home are between £700.00 and £750.00 a week. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 28th November 2007 between the hours of 9am and 1.45pm. The inspection was concluded on the 13th December 2007 between 9.15 and 6.30pm. There was a delay between the two dates as Mrs Sievewright was on annual leave. Mrs Sievewright was available throughout the inspection. At the start of the inspection, a tour of the accommodation was made with Ms Wilcox. Ms Wilcox and Mrs Sievewright told us about the way in which the home had been established. Both explained that everyone had worked really hard to implement the service, as it is at present. We spoke with residents in communal areas and within their own rooms. Due to health conditions of residents, significant feedback about the service the home provides was minimal. We observed interactions between staff and residents. We spoke to staff on duty including the chef, the housekeeper, the deputy manager and care staff. We observed the serving of the lunchtime meal. We looked at the medication systems and the management of residents’ personal monies. We looked at documentation such as assessments, care plans, staff training records and recruitment information. As part of the inspection process, we sent surveys to the care home to be distributed, to residents, their relatives, staff and visiting health care professionals. The feedback received is included in the main text of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: The home has been designed and built to a very high specification. Resident’s bedrooms are spacious, light and airy. All contain a range of additional features such as telephone sockets, television aerial points and Internet access. All have an en suite facility containing a walk in shower, toilet and hand washbasin. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 7 Orientation has been enhanced through the use of colour, signage and objects of reference. Positive aspects include red toilet seats, yellow bathroom and toilet doors and signage of a resident’s choice, on their bedroom door for easier recognition. Rooms not accessible to residents have been disguised, through being decorated as a continuation of the wall, with a handrail. All areas are comfortable, personalised and furnished to a high standard. Memorabilia is being collected to refresh memory and promote communication. There is an attention to detail, such as labelling the lift controls for easier identification. All call bells are readily accessible. Management have very clear expectations of service provision and how they wish to deliver this. There is a clear resident focus and a detailed understanding of residents needs. Staff have been carefully selected to meet the focus of the home. A robust recruitment procedure is in operation. As well as identifying that staff are safe to work with vulnerable people, it has provided an assurance, that staff have the right attitude to fulfil their role. A detailed dementia care training programme has been developed. This involves various training providers and external speakers. Management have detailed knowledge of good dementia care. This is shared with the staff team regularly through informal discussions, supervision and staff meetings. Staff demonstrated a commitment to their role and an awareness of individual need. The home is cleaned to a good standard. Detailed cleaning schedules are in place. The store cupboards are ordered with organised systems of infection control, stock rotation and the management of hazardous substances. What has improved since the last inspection? What they could do better: While it is acknowledged that staff undertake activity with residents and an activity organiser is being recruited, further social opportunities, would be of benefit. This should include greater interaction with the local community such as going out shopping or for a coffee. Included in the fee, are aspects such as aromatherapy, physiotherapy and massage. These have not as yet been arranged, so attention to implement these sessions must be undertaken. If residents have been charged for services, but do not receive them, refunds should be given. Ms Wilcox confirmed that residents have never been charged for services, which have not been received. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 8 Questionnaires, as part of the home’s quality assurance system have been sent out to residents and their families. We suggested that the questionnaires could be made more user-friendly in order to be more conducive to residents’ needs. A system of auditing to regularly assess and monitor provision would be of benefit to complement the use of questionnaires. A more user-friendly complaint procedure may enable some residents to express their views more easily. A system to regularly audit service provision is needed, to ensure further development. Medication systems are well managed yet any medication with a short shelf live should be dated when opened. Documentation should demonstrate the dosage and time of any administration, of any variable dose medication. 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. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not relevant, as the service does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents can be assured that the home is able to meet their needs through a detailed assessment process. Assessment documentation reflects individual need enabling staff to have a good level of information, when supporting residents. EVIDENCE: Mrs Sievewright and Mr Livsey, the deputy manager told us that residents are carefully assessed before a placement is offered. Mrs Sievewright has a very clear admission criterion. Aspects such the level of the resident’s dementia and how they would fit in with existing residents are taken into account. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 11 Potential residents and their families are encouraged to visit any time to view the home. This can be unannounced so that an accurate reflection of service provision is seen. One relative told us that on their initial visit, they were made to feel extremely welcome and were put at ease. They said that the staff fully understood the difficulties and the emotions of finding a care home, for a loved one. They said ‘the staff seem to care about the relatives, as well as the resident.’ Mrs Sievewright confirmed that all admissions, since the home opened, have been staggered. This has enabled staff to have sufficient time with individuals, in order to support them to settle. Staff told us that having the time enabled them to get to know the resident and to start building relationships. One member of staff told us that residents needed time to build confidence in the staff, so that any anxiety was lessened. Mrs Sievewright told us that no further new admissions would be taken until the home is fully staffed. We looked at the assessment documentation of three admissions to the home. The file contained an enquiry sheet, a pre-admission assessment and an admission assessment. Mr Livsey explained the importance of an on going assessment. He explained that often when first meeting the potential resident, communication may be difficult and emotions may be fragile. This may restrict the amount of information gained. With further discussion and various attempts, Mr Livsey believed, greater depth of information could be gathered. The assessment documentation was generally clear and well written. The information highlighted individual need, potential risks and personal preferences. Past hobbies and particular interests, such as watching sport on the television were identified. The information gave detailed information, such as needing assistance to tie shoelaces. Others stated ‘likes to talk about oversees holidays’ and ‘unable to wear slippers, as they stick to the carpet.’ One assessment stated ‘has Alzheimer’s.’ We advised that the ways, in which the condition presents in every day life, should be identified. Specific assessments such as tissue viability, manual handling and nutrition formed part of the assessment process. Potential risks and preventative measures formed part of the care plan. A dependency-rating format was also in place. Assessment documentation highlighted any special requirements, which needed to be put in place before admission. This included notifying the chef of particular dislikes and specific training for staff. One assessment highlighted the need for staff to have more information about a particular dementia. In response to this, detailed information had been taken from the Internet and was available on the resident’s file. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. 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. Care planning is of a good standard and reflects the support residents require. Residents have good access to health care intervention and receive support as required. Clear, ordered medication systems minimise the risk of error. Residents’ privacy and dignity are maintained. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 13 EVIDENCE: Within surveys from relatives, there were many positive comments about the care provided. These included ‘when visiting, staff are very welcoming and usually aware of where relative is at that time. Staverton house has a warm, friendly atmosphere and residents always look clean and well presented.’ Further comments included ‘the care home is of the highest standard,’ ‘the level of provision at Staverton House appears exceptional’ and ‘there is no room for any improvement. All the staff do a wonderful job.’ One relative commented ‘if Staverton House was a hotel, it would be a five star plus.’ All residents have a well-written, up to date care plan. One relative told us they were involved in the development of their relative’s plan. They also told us that they are always kept up to date with events and any changes made. This includes any resistance the resident may give in terms of receiving support to maintain their personal hygiene needs. Within a survey, a relative told us ‘as XX has only been in care for a short period of time, support/care needs are continually being re-assessed and changed as necessary. Usually changes or new ideas are discussed with family, which is appreciated.’ Another relative however, stated ‘family would have liked to have been consulted on contents of care plan at earlier stage to enable staff to be made more aware of areas of concern regarding personal hygiene and daily tasks such as dressing.’ This view was forwarded to Mrs Sievewright. Mrs Sievewright respected this view although expected, staff to involve residents’ families at all stages of provision. Care plans gave good detail about residents preferred routines. One highlighted a perfect evening, which included ‘football on television and a lager.’ Triggers of anxiety such as crowded areas and noise were highlighted. Plans identified tasks, which residents required assistance with. This included supporting a resident to dress appropriately. Another identified the use of picture boards, as a tool to enhance communication. In some instances, we advised greater clarity. For example, phrases such as ‘needs assistance with orientation’ and ‘maintain current level for as long as possible’ were stated. We advised that these statements, should detail how, such matters are achieved in practice. Another plan identified that a resident uses particular words, as a means of expression. We suggested that the resident’s vocabulary should be clearly identified within documentation. Daily records were generally well written. The records identified social needs as well as the provision of personal care routines. A number of records demonstrated the time and strategies staff gave to minimise agitation. All demonstrated family visits. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 14 A number of entries however would benefit from more factual information. This included aspects such as ‘appears more confused than usual’ and ‘getting a little verbally aggressive.’ ‘No problems’ and ‘no complaints’ were also used on occasions. We advised Mrs Sievewright, to ensure that such terms, which may portray negativity, are not used. Residents have good access to health care services. If possible, residents are encouraged to maintain their own GP. Three surgeries are currently used. Documentation highlights good intervention from GP’s following the initial recognition of any health care condition. Residents have access to the Community Psychiatric Nurse as required. Health care conditions such as diabetes are clearly managed and monitored. The usual parameters of the resident’s blood sugar levels, to maintain wellbeing are clearly stated within the care plan. Guidelines are in place for staff, regarding what to do if the blood sugar level falls, above or below the stated parameters. All care plans contain assessments in relation to tissue viability, manual handling and nutrition. Potential risks and preventative measures are identified. Plans contain a weight record, which is regularly monitored and discussed with the GP if required. Due to their health care conditions, residents do not administer their own medication. All rooms however, have a locked metal cupboard in the en-suite facility for this use, if need be. Specific staff administer medication following training and competency checks. All medication is orderly stored in locked wall cabinets and trolleys in a specific room. Records demonstrate satisfactory receipt and disposal of medication. Staff signatures demonstrate each administration of medication. Residents had a record in their bedroom to evidence the application of any topical creams. Some residents are prescribed medication to be taken as required. Triggers to promote the administration of this medication are identified on the resident’s care plan. The home uses homely remedies. Each resident has a list of those remedies they are able to use. A GP has agreed this. One resident has their medication covertly. The resident’s GP and their family agreed this procedure, before admission. As good practice, we advised Mrs Sievewright to identify the date when short life medication, had been opened. This included eye drops. We also advised that the actual time of administration and dosage of ‘as required’ medication, be clearly stated within the medication administration record. There are clear policies and procedures in place. We advised that these, including the procedure to be followed in the event of a medication error, be filed with the medication administration record. We discussed the need to consistently report any medication error under regulation 37. We observed positive interactions between residents and staff. All exchanges of information were respectful and attentive. One resident portrayed a reluctance to get dressed. The member of staff skilfully gave assistance. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 15 All personal care was undertaken in private. We observed a member of staff administering medication. The member of staff knocked on residents’ bedroom doors and called out their name, before entering. Residents were sensitively encouraged to take their medication. Residents’ preferred form of address was used. One relative told us ‘they value XX as an individual.’ Another relative within a survey said ‘staff are invariably kind and courteous to residents, treating them with respect – this has been observed on many unannounced visits.’ Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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. While staff undertake activity with residents, designated staff and an activity programme would enhance opportunities. Routines of the home are flexible and are resident led, as far as possible. Residents are supported to maintain important relationships. Residents benefit from a varied menu where further developments to provision, are planned. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 17 EVIDENCE: During the inspection, we observed positive relationships between residents and staff. Staff spoke quietly and respectfully to residents. We observed one member of staff encouraging a resident to accompany them, to get dressed. This was undertaken sensitively and involved positive discussion about family members. The resident became animated and readily accepted the assistance offered. Staff told us that they were encouraged to spend time with residents. This included having a chat, talking about the newspaper, playing games or undertaking craft sessions. One member of staff told us about a card making activity. The purpose of some of the activities was for social interaction rather than necessarily achieving an end product. Staff told us about individual interests of some residents. They were clear that all activity needed to be short, in order to engage residents’ interest. While we observed staff spending time with residents, a formal activity programme was not in place. Mrs Sievewright told us that 20 hours has been allocated to activity provision. Successful recruitment has taken place and the post is due to be filled in the New Year. It is anticipated that the post will cover, the periods of late afternoon, when some residents become agitated and unsettled. Within a survey, one relative told us ‘family is very much aware that Staverton House is a new care home, and have made allowances for teething troubles. However, we are disappointed with the lack of activities in the early stages of residency. We were led to believe the Activities Coordinator for time of 20 hours, massage and aromatherapy would be available. Activities are still only running at 10 hours and massage, aromatherapy and reminiscence therapy have not yet started after 7 weeks. Number of residents should not determine the commencement of these things.’ Mrs Sievewright was aware that activity provision was in need of development. She was also looking to develop trips out, to local places of interest, shopping or for a coffee. Mrs Sievewright confirmed that specialist personnel to undertake massage and other holistic therapies have been recruited. These activities are included as part of the fee, for living at the home. Staff told us that relatives are welcomed at any time. They said many stay late into the evening and may assist with the personal care of their parent or spouse. Refreshments are always offered. The deputy manager told us, he felt it important to care for the relatives, as well as the resident. This ensured the well being of all concerned. He also told us of the importance of communicating effectively with relatives, to ensure they were up to date with all issues. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 18 One relative told us ‘the staff are sympathetic to the challenges, which caring for a loved one with dementia gives.’ They continued to tell us ‘staff genuinely care and see the person as a person who had a life before their illness. They don’t just see the dementia.’ They said they visited at different times of the day and we are always made to feel welcome. Residents are able to have a telephone in their room, if they wish. Three relatives within their survey mentioned that they could maintain regular contact within their relative through the use of the telephone. Two confirmed staff would give support, where required. Relatives also confirmed that staff kept them informed of events. Specific comments included ‘Staverton House staff are very good at contacting family to inform of any occurrences’ and ‘I am telephoned immediately what ever the time, day or night.’ They also told us they were kept informed of any changes to service provision via letter or a newsletter. Residents generally need to the support of staff to maintain their daily routines. Staff told us however, that routines are flexible and are worked around residents. For example, if a resident wakes early and there is no sign that they will return to sleep, they are assisted to get dressed. They will have breakfast early, with a potential second breakfast, when other residents have theirs. Drinks are offered throughout the day. However, if a drink is requested between the designated times, any member of staff is expected to make it. Residents are able to spend their time where they choose. For those residents, unable to readily express their views through speech, staff told us, it was important to get to know them. Through this, specific signs or body language could be interpreted. One member of staff told us, they worked with a family member to build confidence, with the resident. The resident, now accepts a shower, with assistance from the staff member. Within surveys, relatives told us, residents are encouraged to make their own decisions. One relative stated ‘allowed to make decision with regard to where time is spent e.g. in own room or communal lounge, bedtime, getting up time. Meals can be taken in own room or in dining room.’ Another said ‘XX is allowed to make own choices as far as possible within capabilities.’ The chef spoke with enthusiasm regarding the meals provided. All meals are based on residents’ preferences. There is always a choice of meal and three courses. The choice takes into account specific diets such as vegetarian, diabetic and gluten free. Homemade cakes and scones had been made with specific ingredients to enable them to be incorporated into the gluten free diet. The chef told us that each resident was seen, as a challenge. The challenge being, to ensure a positive enjoyable diet, was provided. Mrs Sievewright believed the food provision to be positive yet was aiming to develop the menus further. This would include more finger foods, which some residents would find easier to manage. We observed the serving of lunch. The chef served the food. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 19 Vegetable dishes and gravy boats were used. One member of staff delivered these to the tables. Residents were supported to help themselves to what they wanted. Other staff were not involved in the dining room so that the atmosphere remained relaxed and unrushed. Some residents ate in their room. Some residents were unable to settle, so were enabled to eat their food, while walking around. The menu was displayed on menu boards outside of the dining room. Within a survey, a relative told us ‘all staff are aware of special dietary requirements and ensure these are strictly adhered to. Food is home cooked, of a high standard and generous portions.’ Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Advocates, such as family members are clearly aware of the procedures for raising a complaint. Developing a user-friendly complaint procedure may enable residents to express their views more readily. Clear systems are in place to minimise the risk of abuse to residents. EVIDENCE: Mrs Sievewright told us, she is aiming to develop a positive culture in relation to complaints. She believes complaints are a beneficial tool to developing the service. The deputy manager also told us about the importance of customer service. He explained that any issues, which have arisen, have been addressed at an early stage through good communication. A relative told us that all staff are approachable and any concern would be easily raised. Within surveys, all five relatives confirmed they knew how to make a complaint. One relative told us ‘complaints procedures were included in information provided prior to relative taking up residency.’ Another relative said ‘this area has always been taken very seriously. Concerns are addressed at once.’ Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 21 A further relative said ‘the care home staff are always available to talk through any issues which might arise.’ Also, ‘staff are always friendly, polite and very helpful. Any concerns have usually been addressed promptly. A poster advertising the second day of the inspection, was displayed in the entrance area of the home. This enabled relatives to visit and give their views of the service provided. A complaints procedure, containing the information required by regulation is displayed in the entrance area. A more user-friendly complaints procedure, conducive to the needs of residents has not as yet been developed. Mrs Sievewright told us family members are strong advocates for residents, however consideration would be given to this area. A complaint log is maintained. When asked a hypothetical question about abuse, staff told us they would immediately inform Mrs Sievewright. In her absence they would inform management, within the organisation. Adult protection training forms part of the home’s mandatory training programme. A workshop with the local Safeguarding Adults Unit has been arranged for 2008. All staff are give a copy of the local Safeguarding Adults policy entitled ‘No Secrets in Swindon and Wiltshire.’ This is also displayed on the notice board in the main office. Abuse is discussed at interview and on a regular basis, within supervision and staff meetings. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The building has been designed to a high standard with considerable focus given to meeting the needs of residents with dementia. Areas are comfortable, furnished to a high standard and promote orientation. Residents’ benefit from a spacious room with good facilities. Cleanliness within the home is of a good standard. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 23 EVIDENCE: Considerable thought was given to the initial design of the building in order to meet the needs of the intended client group. Good dementia care was thoroughly researched, enabling a number of features, to enable residents’ better orientation within the building. For example, all toilet and bathroom doors are painted yellow. Toilet seats are red. Those rooms, not for the intended use of residents, such as the cleaning store, are disguised. This has been undertaken through the walls and doors, being painted the same. A handrail has been placed on the door, to give the appearance of the wall. All resident’s bedroom doors have a space, to display a photograph or picture of interest, for easier recognition of their room. Mrs Sievewright told us that she is planning to arrange key fobs, to match the pictures. Residents have a key to their room. Inside the resident’s bedroom, a shelving unit has been placed to display, favourite items. This again, aids as a tool for recognition, when the resident opens their bedroom door. All residents have a single room, with an en-suite facility. This consists of a walk in shower, toilet and hand wash basin. The rooms are spacious, measure above 12sq metres and are light and airy. All are well furnished, have telephone sockets, Internet access, television aerial points and light switches at waist height. All have a call bell system, which is readily accessible. Locked cupboards are situated in the en-suite facilities. These can be used for toiletries if a hazard is identified. Residents are encouraged to bring in their own furniture and personal possessions on admission. The layout of the home enables residents to walk around freely, Areas are divided into ‘pods.’ Each ‘pod’ consists of five bedrooms, a bathroom, toilets and a store cupboard. There is a lounge and dining area on each floor. A passenger lift gives level access to the first floor. The buttons in the lift have been labelled for greater understanding. Exit doors are fitted with an alarm, which triggers the call bell system if activated. The patio doors from the lounge open onto a large, well maintained enclosed garden. This enables residents to be able to walk around safely, without the risk of becoming lost. A specific key fob is required to gain access to areas, such as the kitchen, which are not accessible to residents. At present, as the home is newly built, a homely feel is beginning to become established. Mrs Sievewright told us that as residents are admitted, they are encouraged to bring personal belongings such as pictures, for the corridors. Mrs Sievewright told us, she did not believe personal possessions should only be confined to the resident’s room. Within a survey, one relative told us ‘the care home is like a hotel. Nothing is too much trouble. The rooms are spacious, the lounge/dining area is colour coordinated to cope with the ongoing issues associated with dementia.’ Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 24 The home was cleaned to a very good standard throughout. The housekeeper showed us the cleaning schedules, equipment and cleaning substances in use. All systems were organised and regularly monitored. The laundry area was clean, and ordered. Equipment was industrial in design. Specific laundry staff are deployed to undertake all washing and ironing. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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. Resident’s benefit from a committed, well trained and motivated staff team. Residents are protected through a clear, well-managed recruitment procedure. EVIDENCE: At present, staffing levels are maintained at three members of care staff and a senior member of staff on duty during the waking day. This is while there are 14 residents at the home. Ms Wilcox told us this would be increased when the home is functioning at its full occupancy of 20 residents. It is expected there will be a ratio of five residents to one member of care staff. At night there are two waking night staff and a member of staff provides sleeping in provision. In addition there is an administrator, catering and housekeeping staff. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 26 An activities organiser post is currently being advertised. Catering and housekeeping staff cover the morning, afternoon and early evening periods. At present, the majority of residents use their bedrooms or the ground floor lounge during the day. We noted that staff presence of the first floor was less than on the ground floor. On occasion, this meant one resident was walking around unattended, without staff noticing their need for assistance. Mrs Sievewright told us she would give consideration to the deployment of staff to ensure all residents were appropriately supervised. Staff told us about their role in detail. All were clear about residents’ needs and the most appropriate ways to manage certain behaviours. We observed good interactions. One member of staff was supporting a resident with their mobility, while complimenting them on their dress and hairstyle. Another was encouraging a resident to eat. The resident was not interested so a series of alternatives were offered. One member of staff demonstrated a passion for good dementia care. This included recognising the resident’s former life, empathising and creating opportunities for new skills and fulfilment. They told us in time, it was hoped to undertake much more individual work with residents, based on previous interests. Another member of staff told us, they loved working in the home because provision was so resident orientated. A relative told us ‘the staff are absolutely wonderful. They are committed, friendly and genuinely fond of residents.’ The relative said they were totally confident that their relative’s needs were met at all times. Within surveys from relatives, positives comments were received. These included ‘I am confident that all staff are carefully selected and encouraged to undertake training in care of people suffering all forms of dementia’ and ‘[my] relative is being cared for in a safe and caring environment where they are with people who understand the dementia illness and not being constantly challenged about their actions.’ One member of staff commented ‘it provides a fantastic service for the residents who are in our care. All the staff is happy and I love my job which makes it really nice place for us to work and for the residents to be.’ Mrs Sievewright and the deputy manager told us that the interviewing process had been robust for all staff. A certain calibre of staff with the ‘right’ attitude was sought and any one with any hint of institutionalised practice was discounted. Mrs Sievewright told us, as a result of robust questioning, the staff team now in place, is excellent. Mrs Sievewright said all have a genuine commitment to their role and the residents. We looked at the recruitment documentation of three new staff. All were ordered and contained the information required by regulation. All demonstrated that documentation such as the General Social Care Code of Conduct and ‘No Secrets’ had been given. Staff do not commence employment until a POVA First check is received. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 27 This ensures the applicant is not on the Protection of Vulnerable Adults list and therefore is suitable to work with vulnerable people. Within one file we noted that a staff member had been spoken to regarding a medication error. Any such error must be reported to us, under regulation 37. There is a training plan for the forthcoming year. The plan contains a range of mandatory subjects and other issues relating to residents’ needs. Many staff received their training before residents were admitted to the home. Additional sessions are being planned to target new staff. Some certificates had not been received from the training provider so were not in situ. All staff have a training record. All are asked to complete a training audit. A clear, detailed dementia care training programme is in place. This contains courses from a range of training providers and outside speakers. The deputy manager has NVQ level 3 in dementia care. This training was being investigated for other staff. The home has three manual handler trainers. Manual handling training is therefore undertaken regularly within the home. There are currently eight members of staff with NVQ level 2. Four staff are starting the award. Three members of staff are also starting NVQ level 3. This ensures over 50 of the staff team have NVQ level 2 or above. Topics related to individual health care conditions are addressed as required. A MRSA distance-learning training course is being accessed. A request for continence training has also been made to the local health centre. Other planned topics include sensory loss with an optician and adult protection with the local Safeguarding Adults Unit. Mrs Sievewright told us blood sugar monitoring was being addressed with the community nurse. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 29 Residents benefit from an organised manager who has high standards of care provision and a strong value base. Management and staff have worked hard to achieve the current standard of service provision. A more formalised quality auditing system would further enhance developments. The safe keeping of residents’ personal monies is well managed therefore minimising the risk of error. Residents’ well being is promoted through clear health and safety systems. EVIDENCE: Mrs Sievewright was appointed manager of Staverton House in May 2007. Mrs Sievewright is a RMN and has been a registered manager in various residential and nursing homes. Mrs Sievewright has also worked as an area manager, for a large organisation providing residential and nursing care. Mrs Sievewright is registered to undertake the Registered Manager’s Award and also intends to do a Diploma in Dementia Care with Bradford University. Mrs Sievewright has worked hard to develop the home and the staff team. She has established a good standard of care provision and has a clear focus for future provision. Ms Wilcox has recently introduced a quality assurance system. The system is based on surveys, which are sent to residents, their relatives and other interested parties such as GPs. From documentation, it was evident that a number of surveys had been sent out. Responses had been coordinated although the information was not clearly explained. It was not evident how the feedback was going to be used to develop the service. We advised that the questionnaires should be adapted to be user-friendlier and more conducive to the needs of residents. The system did not enable regular audits of service provision. Mrs Sievewright told us about a system she had used previously. This enabled a clear auditing system and a formalised action plan format. We felt this format, could be positively integrated with systems currently in place. The home holds small amounts of residents’ personal monies for safe keeping within the safe. The administrator told us that residents are encouraged to keep some money with them, to reduce anxiety. The records of transactions were viewed and three cash amounts were checked. All were found to correspond to the balance sheets. Numbered receipts demonstrated expenditures. The administrator undertakes all transactions. We advised that another member of staff should check and countersign these. Mrs Sievewright undertakes regular audits of the system. The building has been purpose built and therefore all equipment is new and under guarantee. Mrs Sievewright explained there have been teething problems with some systems, such as the heating. However, all matters have been addressed quickly. Ms Wilcox confirmed that all equipment would be serviced regularly. At present, all electrical portable appliances are visually inspected. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 30 We told Ms Wilcox that in time, these would need to be professionally inspected. Alternatively, a member of staff could be trained to undertake the procedure. Hot water is thermostatically regulated. Radiators have low temperature surfaces. There is a range of detailed risk assessments in place. These target matters such as slips and falls, cross infection, aromatherapy techniques and Christmas decorations. Some staff have received health and safety training. All are given a health and safety booklet so that they are aware of their responsibilities. Hazardous substances are securely stored. Information regarding the safe use of the products is readily available. Protective clothing is available, as required. Cleaning cloths are colour coded. This ensures kitchen-cleaning cloths for example, are not used in other areas of the home, therefore minimising cross infection. The fire log book demonstrated satisfactory testing of the fire alarm systems. The accident book detailed a number of falls. These were crossreferenced to residents’ records. Entries gave good detail and were monitored by Mrs Sievewright. Any fall that was not witnessed, gave an explanation of what position the resident was found in. Staverton House DS0000070477.V353292.R01.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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 17 18 ENVIRONMENT Standard No Score 19 4 20 3 21 4 22 X 23 4 24 4 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 X 37 38 3 X 3 X 3 Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 32 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 37 Requirement The registered person must ensure that any medication error is reported to CSCI. Timescale for action 13/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP7 OP9 OP9 OP16 Good Practice Recommendations The registered person should ensure that phrases such as ‘needs assistance with orientation’ should be clarified, to ensure residents receive the support they require. The registered person should ensure that negative terminology such as ‘no problems’ and ‘no complaints’ is not used within documentation. The registered person should ensure that any medication with a short shelf life is dated when opened. The registered person should ensure that staff record the dose and actual time when ‘as required’ medication, is given. The registered person should ensure a user-friendly complaint procedure is developed, to encourage residents to give their views more readily. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 33 6 OP33 7 8 OP33 OP35 The registered person should ensure a quality auditing system is developed to complement the use of questionnaires as part of the home’s quality assurance system. The registered person should ensure that questionnaires, as part of the home’s quality assurance system, are more conducive to residents’ needs. The registered person should ensure that another member of staff countersigns each transaction related to residents’ personal monies. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Staverton House DS0000070477.V353292.R01.S.doc Version 5.2 Page 35 - 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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