CARE HOMES FOR OLDER PEOPLE
Stennards 123 Frankley Beeches Road Northfield Birmingham B31 5LN Lead Inspector
Brenda ONeill Unannounced 16 August 2005
th 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 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. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Stennards Address 123 Frankley Beeches Road, Northfield Birmingham B31 5LN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 477 5573 0121 477 5573 Rhonda Macey (acting) Peter David Lee- Harris Care Home 18 Category(ies) of Old Age (18) registration, with number of places Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 22nd February 2005 Brief Description of the Service: Stennards Frankley Beeches Road is located along Frankley Beeches Road, a short distance from shops and other local amenities in the Northfield area. The home is registered to provide care and accommodation for eighteen older people. The home provides residents with the opportunity to participate in communal activities and to go out for daytime activities at a church centre. The home is a large detached house with ten single bedrooms eight of which have en suite facilities and four double bedrooms all of which have en-suite facilities. The remaining single rooms have wash hand basins. Off road parking is available at the front of the building. To the rear of the house is a large wellmaintained garden. This has many attractive features such as a fountain and there are several secluded areas where people can sit and talk privately with friends or visitors. The garden is laid out so that it is possible to walk round the back of the building on paving passing through various parts of the garden. There is a large sitting room, a separate dining room and two conservatory areas, one of which joins the lounge area to the rear bedroom corridor and the other leads off the dining room. There are good views of the garden from both conservatories. The home does have an entrance at the front of the building for people with mobility difficulties. There are two chair lifts.
Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day and was the first of the statutory inspections for the home for 2005/2006. During the visit a tour of the premises was carried out, one staff and three resident’s files were sampled as well as other care and health and safety records. The inspector spoke with the proprietors, the acting manager, one member of staff and six of the eighteen residents. What the service does well:
The home had a very relaxed, welcoming atmosphere and was very comfortable. All the residents spoken with were very happy with the service they were receiving. Without exception they were happy with the staff group stating they were always ready to help and friendly relationships were evident. Comments from the residents included: ‘The staff are lovely.’ ‘There’s always something going on.’ ‘I was surprised when I saw my room it’s really nice.’ ‘The food’s much better than in the hospital.’ ‘I’ve settled in really well.’ Care plans and risk assessments were good with lots of detail about the resident’s preferences, likes and dislikes. Staff ensured the residents were as safe as possible by detailing how any risks would be reduced. Staff were aware of the small things that made a difference to the residents and made their lives more enjoyable. There was a lot of evidence that staff were able to recognise the health care needs of the residents and then would follow these up and ensure they were monitored. The residents spoken with were all happy that their personal and health care needs were being met. There were no rigid rules or routines in the home and residents were encouraged to choose what they would like to do. There was the opportunity to join in with organised activities both within and outside the home if they wished. All the residents spoken with were very happy with the catering arrangements at the home commenting the food was good and plentiful. The home was well managed and retained a core group of staff who had worked there a number of years and this was very good for the continuity of
Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 6 the residents’ care. The owners of the home were frequent visitors and had good relationships with the residents. The home offered a good standard of accommodation that is safe, well maintained and comfortable. 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. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 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 standard(s) 2, 3 and 5. Prospective residents were able to visit the home prior to admission to assess the quality, facilities and suitability of the home. The assessment procedures in the home were good but the manager needed to ensure that where applicable copies of the social work assessments were obtained to ensure staff knew the needs of the residents prior to admission. EVIDENCE: The resident’s files sampled evidenced that where applicable social workers or other professionals had undertaken assessments and drawn up the initial care plans for the residents prior to admission to the home. One of the care plans seen gave very little detail of the individual’s needs. The manager needed to obtain a copy of the social worker’s assessment so that staff knew the needs of the individual prior to admission. The staff at the home carried out their own assessment on the pre-admission day and once admitted numerous other assessments were undertaken these included physical and mental health and falls assessments. All the files sampled included a statement of terms and conditions of residence at the home. The residents spoken with confirmed that they were able to visit and spend time at the home prior to admission if they wished.
Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8, 9 and 10. The systems for care planning and undertaking risk assessments in the home were comprehensive ensuing staff knew how to meet the needs of the residents and how to minimise any identified risks. The system for medication management needed to be improved to ensure the resident’s medication needs were being met safely. EVIDENCE: The care planning system in the home was being changed and books entitled ‘Assessments for good care planning’ were being used. These included a lot of information about the individual including, a personal profile, assessments for physical and mental health, falls, pressure care, manual handling and personal risks as well as personal preferences and social needs. There was very good detail included in these of how the care needs of the residents were to be met including such things as oral, hair and nail care. From the booklets a daily profile was drawn up which detailed each individual’s daily routine and the included their preferences and where staff were to offer assistance, for example, communicate whilst feeding, likes to spend time with night staff, prefers to have drinks in a lidded beaker. There was also an emphasis on what the residents were able to do for themselves and where they were to be offered choices.
Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 10 All the required risk assessments were in place on the files sampled. Reviews were being carried out monthly and where appropriate the residents had been involved. There was good documented evidence of the health care needs of the residents being identified, followed up and monitored including foot care and continence needs. There was evidence that residents were able to see the doctor, district nurse, psychiatrists and opticians as required. The residents spoken with were satisfied that their health care needs were being met. The weights of residents were being monitored and tissue viability and nutritional screenings had been undertaken. The medication was being administered via a 28 day monitored dosage system. Only the manager and staff who had undertaken accredited training were administering medication. Some issues arose whilst checking the medication system which needed to be resolved to ensure the system was safe. These were: - There were some gaps on the medication sheets and the tablets were not in the blister packs therefore it was assumed these had been given. Staff needed to ensure they signed for medication as it was given. - Not all medication had been acknowledged as being received into the home on the medication sheets. - The tablets remaining in some of the boxes and bottles did not correspond with the amounts received and the amounts that had been administered. The acting manager needed to undertake regular staff audits to ensure the medication was administered and recorded correctly to address the issues raised. The privacy of the residents was generally well maintained and respected. Residents could lock their bedroom doors if they wished, a lockable facility was available if required, there was portable screening for use in the double bedrooms and medical consultations took place in the privacy of the individual’s bedroom. To further enhance the privacy of the residents screening or curtaining needed to be fitted to the glass sections in the bedroom doors, as although the glass was opaque the occupant of the room was visible from outside the door. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 14 and 15. There were no rigid rules or routines in the home and residents were encouraged to exercise choice and control over their lives. There were activities on offer that appeared to meet with the needs of the residents. The meals in the home were good with choices available. EVIDENCE: On the day of the inspection several residents had gone out to a day centre at a Baptist church, which was a weekly event, and where they had the opportunity to meet with other residents from the other care homes also owned by the proprietors. Other residents were seen to spend time quietly in their rooms reading or resting, chatting in small groups, watching television and interacting with staff. Residents spoken with stated there were no rigid rules or routines in the home and they could spend their time as they wished. Documented activities included such things as bingo, exercise and trips out. One of the residents spoke of being taken shopping by a staff member to the local shopping centre. The home also had visiting entertainers and a church service. Residents appeared to make choices wherever possible. They confirmed that they could get up and go to bed when they wished, chose what they wanted to eat, how they wanted to spend their time and how they personalised their bedrooms. There were details on those care plans sampled of what choices residents were able to make.
Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 12 All the residents spoken with stated the food at the home was good, plentiful and there were choices available. The menus sampled were varied and nutritious and offered choices. Although food records were being kept this needed to be more detailed to ensure they evidenced the choices residents were making and that any medical diets were being catered for. Lunchtime at the home was relaxed and staff were at hand to assist where necessary. The dining room was nicely furnished and decorated. If residents wanted to eat in the lounge or their bedroom this was not an issue. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 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 standard(s) These standards were not assessed during this visit but were met at the last inspection. EVIDENCE: Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 24, 25 and 26. The home offers residents a safe, well maintained, comfortable and homely place to live with only minor issues being raised. EVIDENCE: There had been no changes to the layout of the home and it was comfortable, safe and well maintained. The home had complied with the two minor requirements made by the fire officer at a recent visit. There are a variety of communal areas in the home which include a smoking area for the residents. All the areas were nicely decorated and all furniture and fittings were domestic in character and varied throughout. The garden area was very pleasant, well maintained and was accessible to the residents with furniture available for their use. There were adequate toilets and bathrooms throughout the home. Several of the bedrooms had en-suite facilities of toilet and wash hand basin. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 15 There are three bathrooms and one fully assisted shower room in the home. One of the bathrooms had a motorised bath seat for ease of access for the residents. In two of the bathrooms the call facility was not accessible from the bath and this needed to be rectified so that residents who wished to be on their own whilst in the bath could summon assistance if necessary. It was also noted that some of the framed toilet seats had very badly rusting feet, which needed to be replaced. The aids and adaptations throughout the home appeared to meet the needs of the residents and included a floor level shower, hand and grab rails, emergency call system and stair lifts. Bedrooms varied in size, were comfortable and adequately furnished and decorated. All were appropriately personalised to the occupants choosing and all residents spoken with were very happy with their rooms. It was noted that two carpets were badly marked and in need of replacement. The home was warm, well lit and appropriately ventilated. All radiators had been covered and thermostatic mixer valves had been fitted to the hot water outlets to ensure residents would not scald themselves. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. The appropriate staffing levels were being maintained by a long-standing staff team who were able to meet the needs of the residents. Recruitment procedures were robust and ensured the protection of the residents. EVIDENCE: The home maintained a core group of staff that had been employed at the home for a considerable amount of time which was very good for the continuity of care of the residents. Staffing levels were being maintained at three care staff throughout the waking day (one of whom was a senior) and two staff throughout the night. There was no cook employed at the home and this was done by staff on duty. There was also a domestic assistant employed. The proprietors also attended the home virtually every day. All the residents spoken with were very positive in their comments about the staff team and there were friendly relationships evident. The recruitment records for the most recent employee were sampled. All the required documentation was in place including, a completed application form, POVA first check and 2 written references. Although training was not fully assessed there was evidence that this employee had had some preemployment induction and there was a signed induction checklist after commencement. The inspector was informed that staff then move onto a full induction programme as detailed by the Learning Skills Council. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38. The manager ensured the smooth running of the home in a competent manner with regular input from the proprietors. The health and safety of the residents and staff was well managed. EVIDENCE: One of the proprietors was the registered manager for the home however the deputy manager had just been successfully interviewed by CSCI for registration as the manager and the registration process was in the final stages. She was running the home on a daily basis with support from the proprietors and had worked there for many years. Throughout the inspection she demonstrated a very good knowledge of the needs of the residents and the running of a care home. The residents thought very highly of the acting manager and their relationships with her were very good.
Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 18 Residents were confident that if they approached any of the staff group or the proprietors with any concerns they would be addressed. Health and safety of the staff and residents was very well managed. There was evidence on site of all the required checks being made on the fire system, fire drills and fire training were up to date. All the equipment on site was regularly serviced and the premises was well maintained. Accident and incident recording and reporting were seen to be appropriate. Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2
COMPLAINTS AND PROTECTION 3 3 2 2 x 2 3 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x 3 Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? No requirements were made. 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 3 Regulation 14(1)(b) Requirement Where applicable the manager of the home must obtain a copy of the social workers assessment prior to admission of a resident. All medication must be signed for when it is administered. All medication must be acknowledged on the medication sheet when it is received into the home. The balances of medication held in the home must correspond with the amounts received and those administered. Regular staff drug audits before and after a drug round must take place to confirm staff competence in medicine management. To add to the privacy of the residents curtaining/screening must be fitted to the glass sections in the bedroom doors. There must be a record of foods served to residents in sufficient detail to evidence that the diet is nutritious, varied and that any special diets are being catered for. Any rusting feet on the toilet frames must be replaced. Timescale for action 01/10/05 2. 3. 9 9 13(2) 13(2) 17/08/05 17/08/05 4. 9 13(2) 19/08/05 5. 9 13(2) 01/09/05 6. 10 12(4)(a) 01/10/05 7. 15 17(2) schedule 4(13) 01/10/05 8. 21 23(2)(c) 01/10/05
Page 21 Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 9. 10. 11. 22 24 23(2)(n) 16(2)(c) The emergency call point must be accessible from all bathing facilities. The two bedroom carpets identified during the inspection must be replaced. 01/10/05 01/10/05 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 Good Practice Recommendations Stennards E54_S16785_StennardsFB_V240380_160805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor , Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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