Inspection on 15/09/05 for Steephill

This inspection was carried out on 15th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Steephill 20/05/05

Steephill 07/12/04

Steephill 22/06/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Steephill Steephill Court Road Ventnor Isle Of Wight PO38 1UH Lead Inspector Liz Normanton Unannounced Inspection 1 09:40 15/09/0 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 Steephill DS0000012539.V250471.R01.S.doc Version 5.0 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. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Steephill Address Steephill Court Road Ventnor Isle Of Wight PO38 1UH 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) 01983 852652 01983 857776 Islecare `97 Limited Miss Maria Nicholson Care Home 37 Category(ies) of Dementia - over 65 years of age (8), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (37), Physical disability over 65 years of age (13) Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20/06/05 Brief Description of the Service: Steephill is a care home providing personal care and accommodation for up to 37 older people. Miss Maria Nicholson manages the home on behalf of Islecare ’97 Ltd. It is a large, detached, three-storey property located on the western outskirts of Ventnor. The town of Ventnor with its shops and amenities is approximately ¾ mile away. A bus service is available close to the home. There is a range of single rooms on all three levels, accessible via a passenger lift. There is off road parking to the front of the building from which there is level access into the home. The extensive gardens at the rear are available for use by residents. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the second of the inspection year. The inspector arrived at the home on a Thursday morning at 9.40 am and stayed until 5.00 pm. Time was spent in the office viewing residents’ and staff files some of which had missing information, which is detailed in the body of the report. Consultation took place throughout the day with the assistant managers. A full tour of the communal areas was undertaken and these were found to be homely. Several bedrooms were viewed and were well furnished and personalised. One bedroom was found to have a strong odour. The grounds were also viewed and the pathways were found to be breaking up in several areas. External fire escapes/routes were found to have leaf debris. Garden furniture was in a poor state of repair and there was a large quantity of cigarette stubs in one area. The kitchen was found to be in need of some repair, which is highlighted in the main body of the report. The inspector had a meal at the home, which was cooked to a very high standard. It was observed that residents were having choices about the meals they wished to eat. Independent interviews were held with four staff, and the overall view was that staff morale is high with all staff interviewed enjoying their work. The care staff had high regard for the home’s manager. Only a couple of residents were consulted on this occasion and both stated that they enjoyed living at the home. What the service does well: What has improved since the last inspection? The replacement of the older style commodes has taken place. Quotes have been obtained for the replacement of window frames. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 6 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. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 7 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 Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Initial assessments have been undertaken however there have been incidences when prospective residents have been admitted to the home without an assessment having been undertaken. Prospective residents and their representatives are welcome to visit the home to assess whether the home is suitable for them. EVIDENCE: Several residents’ files were viewed and the majority were found to contain details of needs assessments. The needs assessments contained details of moving and handling risk assessments and there was evidence of initial assessments provided by the care management team. There were no needs assessments for three recently admitted residents. The assistant manager explained that two residents had been admitted under emergency situations and one was for respite. The manager and assistant managers are responsible for undertaking needs assessments and will visit prospective residents at home, hospital and other residential homes. There is a structured questionnaire form to gather the necessary information to meet an individual’s care needs. There were some inconsistencies found in the completion of these Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 9 forms with some questions not being filled in. Each resident had a care plan based on the needs assessment and those who had not been needs assessed also had a care plan. A prospective resident for respite care was observed visiting the home with a relative. Care staff confirmed that prospective residents are welcome at the home and usually have a tour of the communal areas and view vacant bedrooms. All new residents are provided with a statement of purpose and service user guide. The inspector did not consult with recently admitted residents on this occasion. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 The home provides comprehensive care plans for each resident to inform care staff, of their individual care needs. The welfare of the residents is the home’s priority. EVIDENCE: Several residents’ care plans were viewed and were found to have details of the action which needs to be taken by care staff to meet individual’s care needs. The majority of care plans had been drawn up with the details provided in the needs assessment, however three care plans had been drawn up without an assessment. Each care plan also had a recent photograph of the individual attached. The care plans are reviewed monthly and are signed and dated. Those residents who are able are encouraged to be involved in the review of their care plan. Health care needs were available in the care plans. Care staff support residents with oral hygiene and know how to identify thrush in the mouth. A dentist from Ventnor will visit the home on request. There are procedures to identify those residents who might be at risk of pressure sores. There were no residents with pressure sores at the time of the inspection. The home operates a key-worker system. Records of medical visits were available. The Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 11 inspector spoke briefly with the district nurse who has regular contact with the home. Residents’ health is monitored on a daily basis with the use of health charts. All residents are registered with a general practitioner. Residents moving to the home from outside of the Ventnor area would have to change general practitioner. There are two practices in Ventnor and they can choose which one to use. A chiropodist visits the home on a monthly basis, or to attend to emergencies. Any resident requiring access to hearing and sight tests would be referred by their GP to the ear, nose and throat department of St Mary’s Hospital. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents are provided with well presented nutritional meals in pleasant surroundings. EVIDENCE: The home’s menu is planned weekly. The menu offers residents a varied choice of meals throughout the week. The meals offered are nutritional. The inspector spoke with the cooks who stated that the majority of the vegetables provided were fresh or frozen and that tinned vegetables are never used. The inspector was present in the kitchen as the lunchtime meal was being served, and noted that that meals were well presented and portion sizes were appropriate. A small whiteboard displayed what was available for lunch. The whiteboard did not display the date. Care staff also ask residents individually what they would like for lunch and tea. A choice of cereals is generally offered at breakfast. A cooked breakfast is available on request. Most meals are eaten in the dining room but a number of residents prefer to eat in their bedrooms and this is catered for by the care staff. Drinks/snacks are served between meals and a tea trolley is taken up to the communal areas and residents’ bedrooms where they can make a choice of drink. Specialist dietary needs are catered for. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above key standards were assessed at the previous inspection and both met the standard with one exceeding the standard. EVIDENCE: Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26 The home is generally well maintained but there were areas for improvement. Communal areas are safe and comfortable indoors, there are some unsafe areas in the garden. There are sufficient lavatory and washing facilities within the home. Residents have access to specialist equipment to maximise their independence. Individuals’ bedrooms are well furnished and residents are able to have their own furniture. There is adequate heating, light and ventilation to the home. In general the home is kept clean and hygienic, however attention must be paid by all staff to prevent the risk of spreading infection. EVIDENCE: A tour of all communal areas was undertaken and the internal areas were found to be safe and provided residents with warm, comfortable homely surroundings. In the grounds the paving is starting to break-up in some areas and could be a health and safety risk. There were cigarette stub ends at the end of the ramp leading from the dining room, which looked unsightly. A number of pieces of garden furniture were unsafe and the majority were covered in lichen and moss. The garden pond has a safety barrier. The fire escape routes from the upper floors were found to be covered in leaf debris Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 15 and moss and could be a serious health and safety risk. The kitchen cupboard doors have missing door handles and the paintwork is showing visible signs of wear and tear. Internally the cupboards have wooden shelves, which have become rough, and pose a health and safety risk. The utensil drawers are sticking and one member of staff stated that they had incurred an injury due to this. The fire exit from the kitchen has a sticking door. The fly nets are ripped. The window frames are rusted and a pane of glass was cracked. There is an extractor fan and windows can be opened, however the cooks stated that the temperatures in the kitchen become unbearable throughout the summer. There is no routine programme of works for the home, the managerial staff present work requests to Islecare. Where inspection requirements have been made with regard to the physical environment compliance is usually good. The home has two large ground floor sitting rooms, which provide sea views. The rooms were well furnished and decoration was in good repair. The rooms were equipped with televisions and there were ornaments and pictures. There was sufficient lighting and ventilation. There is also a large dining room, which is split into two sections. The dining room was clean and free form hazards. The gardens can be accessed by the dining room and one of the sitting rooms. Access to the gardens is ramped. The ground floor bathroom is not being used as such and is used for storing large pieces of equipment and wheelchairs. There is one bathroom on the first floor, which is fitted with a ceiling hoist track. The wallpaper in this bathroom is beginning to peel off. On the second floor there are two bathrooms. One is fitted with a Parker bath whilst the other has a Mermaid chair hoist. All bedrooms are fitted with hand-basins and there are toilets situated close by. All bedrooms also have commodes. There is a separate sluice room. The home is fitted with grab rails throughout. Residents were observed using walking aids and wheelchairs. The home provides two portable hoists and two standing aids; one standing aid has been out of commission for several weeks which staff had found difficult. Documents were viewed to evidence that all equipment is regularly serviced. All bedrooms are fitted with call systems. A number of bedrooms were inspected and were found to be well furnished and personalised. The base of the bed in room 20 was very worn, with stains, and was unsightly. Bedroom 22 was found to have a very strong odour. All bedrooms are fitted with locks and there are lockable cabinets installed within the wardrobes. The bedrooms that were viewed were seen to be fitted with covered radiators and residents were able to control the temperature in their room. The home was seen to be well lit throughout and there is emergency lighting. Which is checked monthly. The home has infection control policy and procedures to inform staff in the prevention of spreading infection. One member of staff was observed not to Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 16 follow this policy and management was informed. The laundry is situated in the basement and clothing is not carried through food preparation areas. The laundry floor is impermeable. Items for washing are brought down in plastic bags. All residents clothing is labelled. The person undertaking the washing was seen to be wearing protective clothing. The laundry is fitted with three washing machines and all comply with the appropriate temperatures for cleaning laundry thoroughly. All communal toilets were fitted with liquid soap and paper towels. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The staffing complement has sufficient numbers and skills mix to meet the needs of the residents. The home endeavours to support and protect residents through its recruitment and selection process. The staff team are well trained are competent to do their job. EVIDENCE: The home currently employs thirteen care staff, two are full time with eleven part time. There are two care staff vacancies. A modern apprentice is also insitu. The home also employs two cooks, a housekeeper/cleaner and cleaner. The vacant posts are temporarily being covered by a pool of staff from Slovakia, recently employed by Islecare. Staff rosters covering the period from the 4th to the 24th September were viewed and indicated that five care staff are rostered to work in the morning with this number reducing to four in the afternoon. There are two wakeful night staff and one manager (sleeping in) working at night. On a weekend the care staff on duty in the morning is reduced from five to four. In conversation with staff it was the general feeling that there should be five staff on a morning throughout the whole week and they did not understand why the numbers reduced. Care staff felt that they managed to undertake their work but did not feel they always had quality time to spend with residents, as they are kept busy. Early mornings until after breakfast, and after tea, were considered by care staff to be busy times. Islecare have policies and procedures in place for the recruitment of staff. Seven staff files were viewed and were found to contain two references. There Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 18 was no evidence of Criminal Record Bureau (CRB) checks or Prevention of Adult Abuse checks (POVA). The assistant manager did have a copy of her CRB disclosure available for inspection. None of the staff files had evidence that identification had been supplied. There was not a staff file available for the member of pool staff. The assistant manager explained that these documents are held at the head office. The inspector interviewed four staff who confirmed they had been through a thorough recruitment process and completed application forms, attended interviews and received terms and conditions of employment. Islecare have a staff induction programme for all new employees, with staff attending a weeks office based training. Induction training meets with TOPPs training standards. Training certificates were available in staff files. A number of care staff have completed National Vocational Qualifications at level 2 or 3 in care. Training needs are identified through supervision and annual appraisal. Care staff interviewed all confirmed that they had received mandatory training, which is regularly updated. One member of the morning staff had left the home after breakfast to have training. Care staff training records were seen on staff files. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 34 The ethos within the home is one of strong leadership, with both staff and residents and their families being able to approach management. The home is run with the best interests of the residents as its main focus. Islecare are responsible for the finances of the home and residents are safeguarded by it being a larger organisation. EVIDENCE: The management team is constructed of the registered manager and two assistant managers with two senior support staff. Information is shared in the daily handover book, verbally and through team meetings. Members of the care staff team highly praised the manager and described her as being very approachable and supportive both to them and to the residents. The atmosphere within the home seemed very friendly with staff engaging positively with residents and amongst each other. Islecare provide care staff with a code of conduct. Care staff are encouraged to undertake training. There Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 20 are two offices situated in the home; one is the general office, which is open to the staff, residents and visitors. The manager has a separate office located near to the dining room. The home provides opportunities for residents to express their views by way of residents’ meetings. Residents are consulted with on a daily basis and are also able to view their opinions through the residents’ meetings, which are held every three months. Islecare undertake an annual survey with the use of resident questionnaires. Each resident is provided with a statement of purpose and service user guide. CSCI leaflets and stamped addressed envelopes are available in the lobby. The manager has completed NVQ level 4 and the Registered Managers Award. Islecare are responsible for the reviewing and updating of policies and procedures. Islecare provide a budget for the home for which the registered manager is responsible. The home has Insurance Liability cover of up to £5 million, certificates on display. The home employs a financial clerk, and all financial transaction details are held on the home’s computer systems. A business meeting is held annually. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 21 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 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 3 x x x x Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP 3 Regulation 14(1)(a) & 2(a) 23 (2)(b) 23 (4)(iv) 23 (2)(b) Requirement The needs of service users must be assessed prior to admission. Needs assessments should be reviewed. Damaged pathways to be repaired or replaced. Removal of leaf debris from fire escapes and walkways. Kitchen cupboard and utensil drawers to be re-painted and missing handles replaced. Utensil drawers to be lubricated to enable easy access. Kitchen door to be repaired or replaced. Replace broken glass in kitchen window. All documents listed in schedule 2 should be available for inspection. Timescale for action 15/09/05 2 3 4 OP 19 OP 19 OP 19 30/12/05 15/12/05 30/12/05 5 OP 29 19 (1)(b) 30/12/05 Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 23 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 OP 19 Good Practice Recommendations Islecare to consider complete refit of the kitchen as existing kitchen has been fitted for over thirty years. Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 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 Steephill DS0000012539.V250471.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!