CARE HOMES FOR OLDER PEOPLE
Stennards (Kn) 150-152 Middleton Hall Rd Kings Norton Birmingham West Midlands B30 1DN Lead Inspector
Brenda O`Neill Unannounced Inspection 20th October 2005 10:15 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 Stennards (Kn) DS0000016786.V257002.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. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Stennards (Kn) Address 150-152 Middleton Hall Rd Kings Norton Birmingham West Midlands B30 1DN 0121 458 3311 0121 459 0467 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) Mrs Dawn Lee-Harris Mr Peter David Lee-Harris Ms Philomena Malanaphy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That one named person, who is diagnosed as having Dementia at the time of admission can be accommodated and cared for in this Home. 15th March 2005 Date of last inspection Brief Description of the Service: Stennards Kings Norton is located on Middleton Hall Road which is a mainly residential area. The home is close to both the shopping centres of Cotteridge and Northfield where there are various local amenities available. The home has easy access to local bus and train services. Formerly two separate houses the property has been converted and extended to offer care and accommodation to 25 older people. Accommodation is offered over two floors and comprises of nineteen single and three double bedrooms some of which have en-suite facilities. There is a shaft lift and stair lift for ease of access to the first floor. The home has two interconnecting lounges, a large dining room and a conservatory all located on the ground floor. One of the lounges and the conservatory overlook the large, well maintained rear garden. Also located on the ground floor is the kitchen, laundry, office and staff room. Throughout the home there are three bath/shower rooms two of which allow for staff assistance. There are numerous toilets located within close proximity of the communal areas and the bedrooms. The home aims to provide residents with the opportunity to participate in a variety of leisure activities both within and outside of the home such as music, progressive mobility, reminiscence and trips out to a church centre once a week with transport provided by ring and ride. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day in October 2005 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 residents’ files were sampled as well as other care and health and safety records. The inspector spoke with the proprietors, the manager, one visitor and seven of the twenty five residents. What the service does well:
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. The visitor spoken with stated he was always made welcome by the staff regardless of what time he visited. At the time of the inspection the residents had varying degrees of confusion and physical care needs and the home appeared to meet these well. There was a lot of detail on care plans indicating a great deal of thought had gone into what was important for each resident, what their abilities were and how staff were to meet their needs. Staff ensured the residents were as safe as possible by detailing how any risks would be reduced. Staff were able to identify any health care needs of the residents and these were followed up and monitored. The residents spoken with were satisfied their health care needs were being met. There did not appear to be any rigid rules or routines in the home. The residents spoken with were very content and confirmed they were able to spend their time as they chose. 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. They confirmed they were given choices, food was plentiful and well cooked. The home had little staff turnover and many of the staff had worked there for a considerable amount of time which was very good for the continuity of care of the residents. All the residents spoken with were very positive in their comments about the staff team and there were friendly relationships evident. The home was well maintained and the residents appeared to be very comfortable. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 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. Stennards (Kn) DS0000016786.V257002.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 Stennards (Kn) DS0000016786.V257002.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): 2, 3, 4, 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 and ensured staff knew the needs of the residents prior to admission. EVIDENCE: The resident’s files sampled evidenced that social workers had undertaken assessments prior to the admission of the residents and drawn up the initial care plans. The staff at the home carried out their own assessment on the preadmission day and once admitted numerous other assessments were undertaken these included physical, mental health and falls assessments. All the files sampled included a statement of terms and conditions of residence at the home or third party agreements provided by the local authority. The residents and the visiting relative spoken with confirmed that were able to visit the home prior to admission. At the time of the inspection the residents had varying degrees of confusion and physical care needs and the home appeared to meet these well. There was a lot of detail on care plans indicating a great deal of thought had gone into
Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 9 what was important for each resident, what their abilities were and how staff were to meet their needs. There was evidence on daily records of personal care needs being met, a variety of leisure activities and health care needs being identified, followed up and monitored. Stennards (Kn) DS0000016786.V257002.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, 8, 9, 10 The systems for care planning and undertaking risk assessments in the home were comprehensive ensuring staff knew how to meet the needs of the residents and how to minimise any identified risks. The system for medication administration needed to be improved to ensure the resident’s were not put at risk. EVIDENCE: The care planning system in the home was good 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, clean dentures at night but keeps them in overnight, ensure the light is left on and what to offer if the resident did not eat lunch. There was also an emphasis on what the residents were able to do for themselves and where they were to be offered choices, for example, will pin up her own hair and
Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 11 must be consulted even though she may not be able to contribute. Reviews were being carried out monthly and indicated that the residents were consulted about their care. All the required risk assessments were in place on the files sampled. Manual handling risk assessments that indicated the use of hoist needed to detail the sling size to be used. There was 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 and district nurse as required. The district nurse visited the home on the day of the inspection. 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. There was evidence in the home that where necessary pressure relieving equipment had been obtained. Medication was being administered via a 28 day monitored dosage system and was generally well managed. All medication was being acknowledged when received into the home, copies of prescriptions were being kept and all medication was auditable. Two discrepancies were noted when checking the amounts of painkillers for two of the residents and it appeared that on one occasion staff may have administered painkillers to one resident from another residents supply. The manager needed to undertake regular drug audits before and after medication rounds to ensure the competence of the staff. It was also noted that medication was being dispensed into small plastic containers with names in for all residents prior to administration and then taken around on a tray. This was dangerous practice as medication could easily become mixed up if any containers fell over and an immediate requirement was left at the home in respect of this. 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. There were glass panels in the bedroom doors however these had been obscured by screening. Staff were seen to knock on doors and wait for a response before entering. Stennards (Kn) DS0000016786.V257002.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): 12, 13, 14, 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: There did not appear to be any rigid rules or routines in the home. The residents spoken with were very content and confirmed they were able to spend their time as they chose. On the day of the inspection one resident attended a day centre and another went out to visit her sister via transport from ring and ride which was frequently used by the home. Several residents attended 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. The residents spoken with who attended this commented it was always a very enjoyable day and that the same week as the inspection they had all had a trip to Tewkesbury. One resident stated she saw the priest on a weekly basis which was very important to her. There were regular visitors to the home to facilitate activities such as, sing a longs, watching DVDs, reminiscence sessions, quizzes and organ playing. There were also board games, table football, a croquet lawn and numerous books available in the home. On the day of the inspection residents were observed to be chatting in small groups, reading magazines and
Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 13 newspapers, having their hair done and spending time quietly in the conservatory. There did not appear to be any restrictions on visitors within reasonable hours and visitors were seen to come and go during the course of the inspection. The inspector spoke with one of the visitors to the home during the course of the inspection. He commented that he had visited at varying times and had always been made welcome and that he was very impressed with the level of care offered at the home. 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. All the residents spoken with were very happy with the catering arrangements at the home. They confirmed they were given choices, food was plentiful and well cooked. The menus seen evidenced a varied and nutritious diet that offered choices at all meals. Food records were being kept but these needed to be further developed to ensure they evidenced the choices residents were making at all meals and that any medical diets were being catered for. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 14 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): 16 There was a robust complaints procedure at the home that was issued to all residents. EVIDENCE: The complaints procedure was not viewed during this inspection however it met with the requirements at the last inspection. All residents were issued with a complaints procedure in the service user guide. The home had not had any complaints lodged with them since the last inspection. When discussing this with the proprietor it was evident that this was because if anything was raised by residents or relatives they acted on it immediately before it became an issue. There had been one complaint lodged with the CSCI that a resident had allegedly had a fall which was not recorded anywhere and then was in pain for a number of days before admission to hospital. This was not upheld and the two requirements resulting from the investigation in relation to documentation had been met. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 15 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, 25, 26 The home offers residents a safe, well maintained, comfortable and homely place to live. 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 one minor requirement made by the fire officer at the most recent visit which was in relation to the fire risk assessment. There was ample communal space at the home which comprised of two interconnecting lounges, a dining room and conservatory. The lounges were equipped with televisions, DVD players and there were music systems also available. The conservatory was used as a quiet area where residents could take their visitors if they wished. There was a large well maintained garden that was accessible to the residents. All the communal areas were well furnished and decorated. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 16 There were adequate numbers of toilets and bathrooms throughout the home with toilets that were easily accessed from the communal areas and bedrooms. Some of the bedrooms had en-suite toilets and one of the double bedrooms had an en-suite floor level shower. One of the bathrooms had a rise and fall bath seat the other had a bath with a door on it making it more accessible for the residents, however, residents did still have to negotiate a step into this. There was also a floor level shower on the ground floor of the home. The aids and adaptations at the home appeared to meet the needs of the residents and included, assisted bathing facilities, hand and grab rails, ramped entrance, stair and shaft lift and emergency call system. It was noted that calls made on the emergency call system could be cancelled on a panel in the staff room. This is not good practice as staff could cancel a call and not attend the location. This was discussed with the proprietor who was to explore ways of addressing this. There were several wheelchairs in use that did not have the footrests attached. This issue was discussed with the manager and the proprietor and there was a risk assessment in place for this however it was strongly recommended that this was done on an individual basis for residents rather than en masse. 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. Residents could have keys to their rooms if they wished and lockable facilities were available. 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. The premises were found to be clean and tidy and generally odour free. The proprietor discussed with the inspector a new product he was trialling to ensure all the residents rooms remained odour free. The product was eco friendly and had had good results up to the time of the inspection. The laundry was appropriately located and there was a separate sluice facility. It was recommended that when the washing was replaced one with a sluice cycle was purchased. Stennards (Kn) DS0000016786.V257002.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 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 rotas sampled during the inspection evidenced that there were three or four staff on duty during the morning and three staff during the afternoon and evening, one of whom was a senior care, and two waking night staff. The home also employed domestic staff and a cook. The manager’s hours were supernumery to the rota. The proprietors also attended the home virtually every day to offer their support. Several of the staff team had worked there for a considerable amount of time which was very good for the continuity of care of the residents. 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. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 18 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): 31, 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: The manager of the home had recently been registered with the CSCI and had worked at the home for a considerable amount of time. She had completed her NVQ level 4 in management and was aware that she would need to complete the necessary modules of the NVQ level 4 in care in order to complete her qualification. Throughout the inspection she demonstrated a good knowledge of the residents in her care and the running of a care home. As this was a relatively new role to her she was receiving regular support from the proprietors, one of whom was the former registered manager. The residents appeared comfortable in the presence of the manager and there were evident friendly relationships.
Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 19 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 were well maintained. Accident and incident recording and reporting were appropriate. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 3 2 X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 3 Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 13(5) Requirement Where the use of a hoist is detailed on a manual handling risk assessment the size of the sling to be used must be included. Staff drug audits before and after a drug round must be undertaken to confirm staff competence in medicine management. The secondary dispensing of medication into other containers prior to administering must stop. Medication must be administered from the containers in which it was dispensed. 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. The emergency call system should be of a type that the call can only be cancelled from the point where it was made. The registered manager must be qualified to NVQ level 4 in care and management or the
DS0000016786.V257002.R01.S.doc Timescale for action 01/12/05 2 OP9 13(2) 01/12/05 3 OP9 13(2) 20/10/05 4 OP15 17(2) Sch 4(13) 01/12/05 5 OP22 23(2)(n) 01/06/06 6 OP31 9(1)(a) 31/12/05 Stennards (Kn) Version 5.0 Page 22 equivalent. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP22 OP26 Good Practice Recommendations It is strongly recommended that individual risk assessments are undertaken when footrests are not used on wheelchairs rather than a general risk assessment. It is strongly recommended that when the washing machine is replaced one with a sluice cycle is purchased. Stennards (Kn) DS0000016786.V257002.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Birmingham 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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