Inspection on 28/01/08 for Stella House

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Stella House 23/01/07

Stella House 15/09/05

Stella House 25/05/05

Stella House 17/01/05

Stella House 05/10/04

Stella House 23/03/04

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Snydale Care Home

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Beeches The - North Yorkshire County Council

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

CARE HOMES FOR OLDER PEOPLE Stella House Cobblers Lane Pontefract West Yorks WF8 2SS Lead Inspector Mavis Pickard Key Unannounced Inspection 28th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stella House DS0000006218.V359020.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.V359020.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 jill.stella@btconnect.com 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.V359020.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th December 2007 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. Bedrooms are located over two floors, there are 39 single bedrooms and one double bedroom. A passenger lift provides access to the first floor for those people with limited mobility. At the time of the inspection weekly bed fees for people living at the home were £380:00 weekly. The fees are annually reviewed in line with Local Authority contracts. 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.V359020.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection a site visit was undertaken by a Pharmacist Inspector who looked at all matters relating to medication whilst a Regulatory Inspector inspected the remaining key standards. The Pharmacist Inspector had undertaken a random inspection in December 2007. The reason for the earlier inspection is that the service had told us that a controlled drug had been administered in error. Other information used as part of this inspection process includes notifications sent to us about a range of subjects including any serious illnesses, accidents and incidents at the home. We also asked for the information to be provided before the visit, in a document called an Annual Quality Assurance Assessment (AQAA). This is a new self-assessment document that the home is required to complete annually. During the visit, care records and other records kept by the home were looked at and we had discussions with the manager and other staff. We also spent time in one of the sitting rooms watching and recording the care being given to a small group of people with dementia. Using this observational tool, as part of the inspection process, helped us to understand the experiences of people living in the home who aren’t able to communicate their views because of their dementia or communication difficulties. We sent out ten questionnaires to residents, their families and to staff. At the time of writing this report three had been returned. We would like to thank the people who live and work at the home along with the registered manager for their patience and help during our visit. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: They must make sure that people who need it are helped to take the drinks provided. This would make sure that people are not thirsty or dehydrated. They must make sure that prescribed medicines received into the home are recorded, stored and administered correctly and that all requirements from the Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 7 previous random inspection are fully met. safe. This will ensure that people are A survey said that, “some times staff are so busy it takes a while for the buzzer to be answered”. The response time for staff to answer call bells must be assessed and reviewed to make sure that people receive the care and support they need promptly. A survey said that “ Some meals are not what I like, but with 40 people I know that’s difficult”. There must be systems in place for people to be able to voice their opinions about the food and for the home to show what action they have taken in response to any feedback. 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.V359020.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 (Intermediate care is not provided) People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are assessed before they move in which means that they can be sure their needs will be met. EVIDENCE: Information from the AQAA and surveys show that people are generally satisfied with the admission procedure. Family and advocates stated that their relative’s needs and aspirations were fully considered when they were being admitted to the service. Although one person said that they thought they hadn’t received a contract, the records show that all people receive a contract. The deputy manager confirmed that all people do have a contract. We looked at the case file of a recently admitted person, this gave good evidence about the way they had come to live at the home. The assessment Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 10 showed that the person and their family had taken a full part in letting the service know the way that they wanted their health care, social and emotional needs met. From evidence we gathered it is clear that people’s needs are fully assessed before they are admitted to the home. The deputy manager told us that if they felt they could not meet the person’s needs they would not be admitted. The service does offer respite care but does not provide an intermediate care service. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate quality outcomes in this area This judgement has been made using available evidence including a visit to this service. 7,8,9 and 10 People are not always treated with respect and care plans are not always followed in practice. People are not fully protected by the medication practices. EVIDENCE: Following the medication error in December 2007 systems have been put in place to reduce the risk of further errors. Staff have undergone in-house medication training and the management team have done extra checks during medication rounds. However the recording and storage of medication is not always accurate. We found that the receipt of some medicines had not been recorded accurately, that some had not been stored properly and that in one instance medication had been signed for as given but had not been given. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 12 This could lead to people not receiving their medication safely and as prescribed. The management team have told us that they will continue to supervise staff when they are giving out medication and that they will make sure that medication is recorded and stored properly. This will make sure that people are safe. We received surveys from people who live at the home and from relatives that said that staff treat them well and that they are able to make decisions about how they spend their days. From our observations people who have complex needs are not always provided with such choice. We spent one and a half hours in one sitting room observing the care given to five people with more complex needs such as dementia or communication difficulties. People seemed to be relaxed and comfortable, many people slept for most of the time. The deputy manager told me later that this may be because they were catching up on sleep lost at night. Records showed that this is often the case. Staff were kind to people and spoke to them respectfully but people’s needs were not being routinely met. For example one person asked to be assisted to the toilet, their request was acknowledged, but it took 8 minutes for the person’s request to be acted upon. This could have been very uncomfortable and may have resulted in incontinence. We saw that although everyone was provided drinks, only one person was assisted to take a drink. A person who had a glass of water and a jug of juice next to them told a carer “ I can’t reach it” but the carer didn’t help and left the room. The television was on although no one was watching it. A person asked for it to be turned off and was told “I will take you to your room if you like”. I didn’t hear their reply but they stayed in the sitting room. The television was not turned off. Another person had become agitated and this seemed to be made worse by the television. This shows that some staff don’t treat people with respect. All people have a care plan that shows how care should be provided. Records show that service has an understanding about the rights of individuals and how people can be assisted to make decisions about how they spend their time. A survey received from a staff member says that staff received comprehensive training to care for the people who live at the home. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 13 However it was evidenced by our observations that the training provided does not always translate into practice. We saw that individuals with more complex needs find it harder to have their opinions listened to and their needs met. Our concerns were discussed with the manager and deputy manager who made a commitment to observe practice in the home and to work with staff to improve areas where concerns have been raised. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. 12-15 Generally people have control over how they live their lives, they are given choice, can keep in contact with relatives and friends and their expectations are met. Observational evidence shows that this is not always the case for people with complex needs. Meals provided are of a high standard and are provided at times that suit people. EVIDENCE: Generally daily routines are flexible to meet people’s individual preferences, however our observations showed that this is not always the case for people with more complex needs. Visitors are encouraged and we saw people visiting during our time at the home. The Annual Quality Assurance Assessment [AQAA] and surveys told us that visitors are welcome. This shows that the service is open and inclusive and is confident about the care they provide. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 15 People say that they are encouraged to be part of the local and wider community. Where that is difficult people are supported by staff to go out or to enjoy the times when entertainment comes into the home. There are set mealtimes and people usually take their meals in the dining room. However staff say that should a person want their meal at a different time to suit them, this can be arranged. Records show that this is the case. Surveys say that people enjoy their meals all or most of the time. Records show that staff consult with people about the choice of meals and likes and dislikes are catered for where possible, although one survey said that they didn’t always receive the meals they enjoyed but acknowledged the difficulties of providing meals for 40 people every day. All people are provided with hot and cold drinks and snacks if wanted in between meals. Stella House DS0000006218.V359020.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): People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. 16 & 18 People are protected from abuse and are confident that any concerns are taken seriously and acted upon EVIDENCE: The home has an appropriate complaints policy and surveys tell us that that people and their families know who to go to and how to make a complaint. We discussed with the deputy manager the procedures the home follows should they have any concerns that abuse of any type is or may have been taking place. The deputy manager and others said that robust procedures are in place to protect people. They said that they knew what to do if they had concerns and know the local central number to ring to get advice and help should such an issue be raised. The home has a whistle blowing policy and staff understand the meaning of ‘Whistle Blowing’ and how the home’s policy protects them should they need to use it. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 17 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): People who use this service experience good quality outcomes in this area This judgement has been made using available evidence including a visit to this service. 19 and 26 People live in a safe, clean, well maintained home. EVIDENCE: There are 3 sitting rooms and a dining room. All are pleasantly and comfortably furnished. The home is well decorated and bright and there is a nicely furnished conservatory where people can sit quietly or listen to music. All people have private accommodation; there are 39 single rooms and one double which is used as a single, unless two people who wish to share. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 18 On the day of our visit the home was clean, well decorated and nicely furnished. An unpleasant odour was noticed in the entrance hall and was reported to the management who dealt with it immediately. The management team tour the home and undertake regular health and safety checks and the service has an ongoing maintenance programme. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 19 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): People who use this service experience adequate quality outcomes in this area This judgement has been made using available evidence including a visit to this service. 27-30 There are sufficient staff employed to meet people’s needs and staff are regularly trained to meet their needs. However there is evidence that not all training is transferred into best practice. EVIDENCE: The home uses a sound recruitment policy and procedure, which makes sure that proper checks are made when recruiting staff. There are enough staff on duty at all times to be able to meet people’s needs. This will keep people safe. We know that the manager understands person centred planning. That the care provided is centred on each individual. However it is not clear that these theories are translated into practice in a way that all staff understand. The management team have developed high levels of training in the home. Evidence from staff surveys say that they receive high levels of training and feel confident about the role they perform. We observed staff that have developed good techniques when speaking to people with dementia who need time and patience. We observed that staff Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 20 transferring people from arm chair to wheelchair or standing positions that did so with patience, kindness and skill. We saw staff who listened and talked with people in a kind, nonconfrontational way and who tried to find a solution to complex problems. However, we also saw staff who were not listening and who walked away or seemed to ignore requests for help. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 21 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): People who use this service experience adequate quality outcomes in this area This judgement has been made using available evidence including a visit to this service. 31,33,35, 36 and 38 People live in a home run by a qualified manager who works to ensure that the interests of the people who live in the home comes first. EVIDENCE: The manager and the deputy manager show a clear understanding of the key principles and focus of the service and they work to improve services provided to people and they run the home in the best interests of people. The management team trains and develops staff that are generally competent and knowledgeable to care for people. The manager must be sure however that all staff put the interests of people first when providing support. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 22 There is evidence that some staff do not follow the training and advice given to them, as serious shortfalls have been noted regarding the storage and administration of medication and some care issues. The manager gave us assurances that she would further supervise staff closely to ensure that the type of shortfall in safety and care evidenced during this visit will not happen in the future. The providers, one of who is the registered manager, make sure that the health and safety and fire safety records are up to date and accurate. The records sampled show that this is the case. We did not inspect personal finances on this visit, however we have done several times previously and are confident that robust procedures and practices are in place to safeguard people’s money and valuables. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 23 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 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 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 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 24 Yes 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 13 Requirement A system must be in place to check the expiry dates of medicines and to add the date of opening when necessary. This makes sure medication is safe to administer. This requirement was made at the previous random inspection and found not to have been met. 2. OP9 13 All medication must be administered as prescribed and recorded on the MAR chart. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. This requirement was made of the previous random inspection and found not to have been met. 3 OP8 12(1)(a) People must be given assistance, when needed, to take the drinks provided for them. DS0000006218.V359020.R01.S.doc Timescale for action 14/03/08 14/03/08 14/03/08 Stella House Version 5.2 Page 25 4 OP8 12(3) Staff response time to answering call bells must be reviewed to make sure that people are getting the attention they need promptly. Management must ensure that the training provided to staff is successfully translated into best practice within the home. 14/03/08 5 OP30 12(3) 14/03/08 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 OP9 Good Practice Recommendations A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Stella House DS0000006218.V359020.R01.S.doc Version 5.2 Page 27 - 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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