CARE HOMES FOR OLDER PEOPLE
Stella House Cobblers Lane Pontefract West Yorks WF8 2SS Lead Inspector
Elizabeth Hendry Key Unannounced Inspection 23rd January 2007 07:45 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 Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Stella House Address Cobblers Lane Pontefract West Yorks WF8 2SS 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) 01977 600247 01977 600247 pauline.varley@tiscali.co.uk Mr Fieldhouse Mrs J Fieldhouse Mrs Jill Fieldhouse Care Home 41 Category(ies) of Dementia - over 65 years of age (41), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (41), Old age, not falling within any other category (41) Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th September 2005 Brief Description of the Service: Stella House is a care home providing personal care and accommodation for 41 older people. The home is privately owned by Mr and Mrs Fieldhouse and is situated in a residential area outside the centre of Pontefract. Mrs Fieldhouse is the registered manager. The premises, which are mainly purpose built, are situated on the site of a former farm and house and set in well-maintained gardens with parking space for staff and visitors. Service users’ bedrooms are located over two floors, there are 39 single bedrooms and one double bedroom. A passenger lift provides access to the second floor for those service users with limited mobility. At the time of the inspection weekly bed fees for permanent residents at the home were £359. Information about the home is made available through the home’s Statement of Purpose and Service User Guide both of which are available, on request, from the home. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s annual key inspection which took place between 07.45 hrs and 13.30 hrs. As part of this inspection, CSCI have had contact with the following people residents, their relatives, the service provider, staff members, social workers and GPs. During the visit to the home records, observations and discussions with both residents and staff were undertaken. Ten resident questionnaires were sent out. At the time of writing this report, three had been returned. In writing this report, information and evidence was not only obtained by way of visiting and looking around the home but also from notifications sent to the CSCI since the last key inspection, questionnaires, and the last inspection report. The inspection has concluded that residents’ needs, both personal and recreational, are met. Residents reside in a relaxed and informal homely environment. The inspector would like to thank the residents, manager, and deputy manager and staff for their hospitality and patient co-operation throughout the inspection. What the service does well:
A strong focus is placed upon staff training and development, a large proportion of care staff are currently undertaking National Vocational Qualifications in Care levels 2 and 3. Residents spoke of receiving quality care from a dedicated staff team within a very homely, friendly environment. The registered owners have daily input into the home and are committed to delivering quality care and pursuing the development of the service. Support systems in place within the home ensure that both residents and members of staff have access to either a member of the care team or management to discuss any concerns as they may arise. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 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 Stella House DS0000006218.V325221.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users move into the home knowing that their needs will be fully met. EVIDENCE: Stella House did not have any vacancies at the time of the inspection. The registered manager confirmed that all of these service users have a contract of residence which states what is and is not included within the weekly bed fee. Information regarding the trial period, notice of termination of contract and services available within the home is also included within this contract. Of the three resident questionnaires returned to the Commission, two confirmed that they had received a contract of residence and one declined to comment. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 9 The deputy manager spoke in detail about the admission process into the home and confirmed that Social Services assessments are used to form the basis of the home’s care plan. All prospective residents are invited into the home to have a look around, spend time meeting existing residents, and to stay for a meal. A senior member of staff also conducts a needs assessment to ensure that the individual needs could be fully met prior to a place being offered. The deputy manager confirmed that the home does not offer intermediate care but, should they have a vacancy, they will provide short-term respite care. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information of residents’ health, personal and social care needs are set out in an individual plan of care. Residents are protected by the home’s medication policies and procedures. Records viewed identified that residents’ health care needs are met. Residents are always cared for in a manner that maintains their dignity and affords respect. EVIDENCE: A sample of resident care plans were viewed. While all were found to contain details relating to the circumstances surrounding the individual’s admission into the home, their personal, healthcare and social care needs, the level of information recorded varied greatly. A discussion took place with the
Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 11 management of the home regarding the benefits of making all care plans more service user specific and, in particular, how this would assist care staff in the provision of care to those residents with limited communication. The deputy manager spoke of holding regular reviews with general practitioners and social workers to ensure that residents are receiving the level of support needed. Throughout the inspection staff were observed clearly displaying knowledge of each individual resident’s needs. Of all the residents spoken with on the day of the visit, all had an awareness as to the contents of their care plan and confirmed that, should they wish to see the plan, staff would provide assistance. On the day of the site visit, the inspector highlighted the need to ensure manual handling assessments are reviewed on a regular basis and provide a consistent approach to the safe handling of a resident. All of the resident questionnaires returned to CSCI indicated that they always receive the care and support required, and that staff are always available when they are needed. Daily records contained sufficient information, detailing the individuals’ activities for the day and staff observations. All of the residents spoken to at the visit complimented the dedication of the care staff, commenting, “They are always smiling” and “If I need anything I just have to ask”. One resident said that she has been made to feel at home. A sample of medication administration records were viewed and found to have been completed correctly. The deputy manager confirmed that each resident has a medication assessment within their individual care plans which clearly details the needs and methods of administration as instructed by their GP. Medication was found to be stored in accordance with the Royal Pharmaceutical Guidelines of Great Britain. The registered manager also explained that everyone involved in the management of residents’ medication has completed a safe handling of medication training course. Of those residents spoken with, positive comments were given surrounding the standard of care given by members of staff and the positive and homely atmosphere within the home. Individual care plans and medical notes viewed indicated that any problems identified were quickly addressed.
Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 12 Throughout the site visit, staff were observed treating residents with respect and dignity whilst remaining positive and supportive. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 13 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): 12,13,15 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ daily life and activities generally meet the needs of all residents. Discussions with residents described how, on the whole, the lifestyle they experienced within the home met their expectations and preferences and satisfied their social and religious interests and needs. Residents maintained contact with family and friends and members of the local community as they wished. Family and friends feel welcome and know that they can visit the home at any time Residents are encouraged and supported to exercise choice and control over their lives. Residents receive a varied and nutritious diet within a pleasant dining environment. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 14 EVIDENCE: A variety of activities are available within the home. These include music, films, bingo, charades, card games, arts and crafts. During the visit to the home, residents were seen undertaking activities of their choice. Many residents were sitting within the communal lounges chatting to one another. Staff members were busy on the day of the site visit, however they were observed being very responsive to residents when anything was asked of them. Of the three resident questionnaires returned, two stated that there were usually activities arranged in the home that they can participate in and one declined to comment. One resident spoken with said that they are happy to watch television in their room as this is what they would be doing if they were in their own home and that they didn’t want to participate in any activities. The deputy manager spoke of organising day trips, excursions to the coast and to the local pantomime. Residents spoke of staff encouraging them to make decisions regarding activities, meals and personal care. One resident spoken with said that staff do not take anything for granted and, “even if they know what I like, they always ask”. The registered manager confirmed that resident meetings are held on a regular basis. One resident said that “the manager or deputy manager go out of their way each day to say good morning and ask how I am”. Since the last inspection, a new cook has been appointed and is already proving to be a great success. Feedback from those spoken with, and all of the surveys returned to CSCI, confirmed that the meals are of good quality and are usually or always to their taste. Residents confirmed that snacks and drinks are available throughout the day. Menus sent to the Commission prior to the site visit indicated a varied and nutritious diet. The presentation of the dining room was of a good standard with fixtures and fittings being domestic in nature. Dining tables had been arranged in a layout that encourages small groups of residents to converse during mealtimes. The deputy manager said that, for those residents who do not wish to eat within the dining room, a tray is provided in their bedroom or lounge area. It was observed that those residents requiring a greater level of care or who had speech difficulties were offered the same choices as those more able, for example regarding what clothes to wear, where they would prefer to sit and what they would like to eat. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 15 The deputy manager spoke of friends and family being encouraged to visit at any time. A resident who spoke of their family being made to feel very welcome whenever they visit confirmed this. Stella House DS0000006218.V325221.R01.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be confident that their complaints would be listened to and acted upon. The service has a complaints policy that is up to date, clearly written and easy to understand. Systems in place for the protection of service users from possible abuse are good. EVIDENCE: A copy of the home’s complaints policy is on display within the entrance hall and is also included within the Service User Guide provided to each resident upon admission into the home. The policy is easy to read and provides clear guidelines for anyone wishing to complain. Of the three resident questionnaires and two relative questionnaires returned, all indicated that they were aware of how to complain and who to speak to if they weren’t happy. Information supplied to the Commission prior to the inspection confirmed that the home holds a detailed record of complaints held within the home, with
Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 17 sufficient information regarding the nature of the complaint, timescale and the action taken. The home has an open door policy which provides residents and their families with the opportunity to discuss problems at any time with the registered manager, owner or deputy manager. Letters of appreciation and compliments were viewed, highlighting the quality of the service provided. A copy of the Wakefield Adult Protection policies and procedures was available within the staff office. The registered manager explained that all staff participate in adult protection training as part of the induction process. The inspector explored the benefits of discussing adult protection issues within staff meetings, to ensure all staff have an adequate understanding of the procedures to follow. The registered manager confirmed that, following a recent adult protection alert, all staff have been booked to attend a certified vulnerable adults training course. On the day of the inspection the home had no outstanding adult protection alerts. Enhanced Criminal Records Bureau checks and POVA First checks were in place for all of the staff files evidenced on the day of the site visit. The registered manager confirmed that only staff that have been appropriately vetted are offered a position within the company. Stella House DS0000006218.V325221.R01.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good, providing residents with an attractive and homely place to live. Infection control measures are in place which promote the wellbeing and health of both residents and staff. EVIDENCE: On the day of the visit, a tour of the home was undertaken. A good standard of decoration and furnishing was found throughout the home. The majority of fixtures and fittings were domestic in nature and of a good quality. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 19 To the rear and side of the property there are large garden areas which are laid mainly to lawn; this provides additional seating and leisure space for residents during the summer months. Car parking is available to the front and side of the property. The home has an ongoing programme of maintenance and redecoration. All residents spoken to said that their bedrooms were comfortable and that they had everything they needed. A large proportion of bedrooms viewed by the inspector had been personalised by the resident. The deputy manager spoke of encouraging residents to make their room their own by bringing in items of furniture, pictures and trinkets. Feedback from three resident questionnaires identified the home as being “always” fresh and clean. On the day of the site visit, the home was found to be clean and tidy, no offensive odours were present. Staff training records sampled indicated that all staff receive infection control training as part of the induction programme. Throughout the course of the visit to the home, all staff were seen to be adhering to infection control guidelines. The registered manager confirmed that the floor within the bathroom on the second storey was due to be replaced; on the day of the site visit evidence was seen confirming that this works was scheduled to take place. Stella House DS0000006218.V325221.R01.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are sufficiently met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are fully protected by the home’s recruitment policy and practices. Staff are sufficiently trained and competent to do their jobs. EVIDENCE: Good levels of staff were on duty during the site visit, staff rotas sent to CSCI indicated that good levels of staff were on duty at all times to ensure service users’ needs could be fully met. All of the residents spoken to commented on the staff’s patience and understanding and were very complimentary of all members of the management. Resident questionnaires returned to CSCI indicated that staff always listen and act on what they say and that they are always available when they are needed.
Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 21 Staff were observed interacting well with all residents and were seen to take a proactive role with regards to meeting individual requests in both personal care and leisure activities. The registered manager explained the recruitment procedure in detail, confirming that no member of staff works within the home without a clear enhanced criminal records bureau check. Of the staff files viewed, all were found to contain a criminal records bureau check, two written references and forms of identification. The home has a comprehensive staff induction programme which ensures that new staff do not work unsupervised until they are confident and sufficiently trained to do so; this involves the new starter shadowing an experienced member of staff. The registered manager said that only when they feel that the new starter is competent are they given separate duties. Of those staff files sampled, all contained evidence that regular supervision is undertaken. Details of identified training needs and personal development requirements are also formally discussed and recorded on a regular basis. A wide variety of training courses are accessed on a regular basis to ensure the changing needs of residents are fully met. Staff spoken to said that they just need to ask and additional support is given from both the management team and colleagues. Stella House DS0000006218.V325221.R01.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality assurance procedures within the home ensure the home runs in the best interests of the service users. The management of the home is good and records are well managed. The manager provides clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The health, safety and welfare of service users and staff are promoted. Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home places a high priority on ensuring quality care for all residents. In addition to the annual inspection from CSCI, the home regular quality audits. The owners/manager play an active part in the home on a daily basis. Should the need arise, the assistant manager is fully able to act up as manager. The manager has a clear understanding as to the goings on within the home, residents spoke of the manager and owner being a very friendly and approachable person who likes to get involved. The manager spoke of having an open door policy for staff and residents to discuss personal issues and worries. Staff confirmed that the manager and owner are approachable, understanding and that they actively encourage their personal development. Records are well maintained, accurate and regularly reviewed. No financial records relating to either the home or the residents’ finances were inspected on this occasion, however no incidents surrounding the management of residents’ monies has been reported to CSCI. Health and safety certificates viewed identified a consistent and responsible outlook being placed upon residents’ well being within the home by the management team. Records viewed, and information received prior to the site visit, indicated that regular fire safety checks are carried out and electrical appliances are tested annually. Training certificates viewed identified all staff undertake health and safety training as part of their induction process, with updates as required. Each of the residents’ care plans had risk assessments in place. The registered manager confirmed that all manual handling plans and risk assessments would be reviewed to ensure that clear, current and detailed instructions for staff to follow to ensure the safety of both residents and staff is maintained. The home has made adequate provision for the removal of clinical waste from the home. Stella House DS0000006218.V325221.R01.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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Manual handing assessments should contain clear detailed instructions for staff to follow. Staff undertaking manual handling assessments should undertake further training to ensure that assessments are completed and recorded adequately. Service user care plans should be specific to the individual, and contain detailed accounts as to the manner in which the resident would prefer care to be given. Full details should be recorded on menus detailing what each meal consists of. Staff’s understanding of adult protection issues should be reviewed on a regular basis. Risk assessments should be reviewed on a regular basis to ensure the full protection of each resident and member of staff. 2 3 4 5 OP7 OP15 OP18 OP38 Stella House DS0000006218.V325221.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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
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