Inspection on 03/09/08 for Stilecroft (MPS) Ltd TA Stilecroft Residential Home

This inspection was carried out on 3rd September 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

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOMES FOR OLDER PEOPLE Stilecroft (MPS) Ltd T/A Stilecroft Residential Home 51 Stainburn Road Workington Cumbria CA14 1SS Lead Inspector Liz Kelley Unannounced Inspection 09:30 3 September 2008 rd 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 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.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. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stilecroft (MPS) Ltd T/A Stilecroft Residential Home 51 Stainburn Road Workington Cumbria CA14 1SS Address 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) 01900 603776 Stilecroft (MPS) Limited VACANT Care Home 44 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (30) of places Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender:- Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 30) Dementia - Code DE (maximum number of places 14) The maximum number of service users who can be accommodated is: 44 NA New Service 2. Date of last inspection Brief Description of the Service: Stilecroft residential care home is registered with the Commission for Social Care Inspection to provide accommodation for up to forty-four older people. Stilecroft is run by MPS Care Homes Ltd and the Registered Provider is Mr Paul Gray. The home is on the outskirts of Workington in a quiet residential suburb. The property is a large, extended older building that has been adapted for use as a care home. The home is surrounded by attractive grounds with car parking facilities. Accommodation for residents is provided over three floors and there is a stair lift to help residents to move freely around the home. The home provides shared accommodation in the form of two large lounges, and two dining rooms. A separate wing for people who have dementia has a combined lounge/dining room that incorporates a conservatory. The majority of bedrooms have a wash hand basin and bedrooms in the newer part of the building have ensuite toilet facilities. The home has sufficient accessible bathrooms and toilets available close to all the accommodation used by residents. The home has a range of aids and equipment to assist residents to maintain their independence. The home has the use of a people carrier. The current scale for charging is £363 per week, for both private fee payers and through social services referral. Social services financially assess individuals to determine the level of contribution. Newspapers, magazines and personal toiletries are not included in the fee. A pamphlet is available for prospective residents, and a summary of the latest Commission for Social Care Inspection report is made available on request. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.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. This was the first Key Inspection since new owners took over the home in April 2008. This included a visit to the home and surveys and interviews of residents, relatives and health and social services professionals. The visit to the home was carried out over a full day by two inspectors, Liz Kelley and Nancy Saich. The pharmacist inspector carried out an inspection the week prior to this visit. Staff were also interviewed and observed carrying out their duties. Documents examined included sampling care plans, daily notes and safety and maintenance records. The pharmacist inspector assessed the handling of medicines on the 26/08/08, through inspection of relevant documents, storage and meeting with the designated manager, staff and residents. The inspection took four and threequarter hours. What the service does well: What has improved since the last inspection? People are being given increased opportunities to exercise choice and control over their lives. This is being helped by each persons care plan being reviewed and through the increase in staffing levels which allows staff to be more responsive to people’s needs and requests. A resident said “I have noticed a tremendous difference recently, I have been given more choice about things and the owners have asked me what I would like to do or see happen in the Home.” Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 6 Staffing levels have been improved all-round with approximately 1000 more hours per week being employed. A resident spoken to said they had noticed that more staff where available and she didn’t have to wait for assistance. For example the hours for the cooks have been increased recently and when interviewed they said they were pleased to be given more time to bake and prepare home cooked food using good quality ingredients. Residents said, “The food is all home cooked and we have fresh cakes, its wonderful”. The home has improved aids and equipment to assist in personal care, for example electric profiling beds have been purchased by the new owners, additional hoists, and two dozen new commodes, and moving and handling equipment is bought as it is needed. This helps to promote people’s comfort, independence and dignity. The Company’s Senior Nursing Officer has introduced the organisations Quality Assurance System. Areas for development have been identified and a plan of action with timescales set out. This is good practice and will help the home to offer a quality service to its residents. What they could do better: The service must make sure that all records for medication are complete and accurate to protect people from errors. Medicines should be administered as prescribed from the original dispensed container. All containers must be checked to make sure they are labelled with the correct person’s name and list of medication to prevent them getting the wrong treatment. Care plans for administration of “when required” medication should be more detailed so that staff have clear instructions to follow to make sure people get appropriate treatment. Care plans for people who look after and take their own medicines should also contain risk assessments to ensure that this is done safely. A suitable cabinet for the storage of medicines liable to misuse must be obtained. Regular audits of medication should be done to monitor the management of medicines and to keep people safe. Immediately after the pharmacists inspection the senior nursing officer took responsibility for medications, which included an audit, and training senior staff in the safe handling of medicines. And in addition to this the Company’s Senior Nursing Officer and General Nursing Officer are spending time in the home setting up new systems to monitor and manage people’s health and personal care needs. We have had two complaints from relatives about how the manager has handled the death of their relative. This highlighted that the manager requires training in this area and, as identified at the last Random Inspection the care Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 7 of people who are dying needs to be better co-ordinated, recorded and managed. This includes the procedure on how relatives are informed and supported at this difficult time. People’s nutritional needs require more focus, starting with a thorough nutritional assessment through to giving staff training and instructions, including the kitchen staff. This will ensure that people’s needs are identified and they are given the correct support and diets to stay well and healthy. Care plans are nursing focused and the inspectors felt that more work was needed in making them more person focused to include peoples background, life histories, and what interests people now. This would be particularly beneficial to people who have dementia and a training need was identified in assisting staff in meeting the needs of people with dementia and the more specialist approaches to use. Links with external agencies are adequate but there is a lack of understanding of safeguarding procedures and how they work. The organisation needs to consider how they rectify this to ensure people are protected and lessons are learnt to prevent reoccurrences of similar complaints and concerns. When the Fire logbook, fire checks, drills and instructions were checked we found they had not been done at the required frequency. No one in the home had completed the fire warden training and staff fire training was inadequate. There is a risk that fire safety is being compromised and this needs to be rectified as soon as possible. We (Commission for Social Care Inspection, CSCI) have concerns about the manager’s lack of experience in running a care home for older people. The home is of a considerable size, has a large staff team, and complex operational requirements. The current manager has either no experience, or very limited experience in these areas and has demonstrated a lack of knowledge of her legal responsibilities since being appointed. The registered Provider has a legal duty to appoint an individual who has the qualifications, skills, experience and competence necessary for managing the care home. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 8 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. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 9 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 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 10 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): 1,3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are given the opportunity to make an informed decision about the choice of home, and the correct processes are followed to make sure their needs can be met by the home. EVIDENCE: The new owners have introduced new paperwork right across all the procedures in the home, and this included a new admissions form and procedure. A blank admissions form was examined and the operations manager for the organisation described how the manager would use this during a visit to the person’s home or while they were in hospital. All those wishing to move in are invited and encouraged to visit the home to meet the staff and other residents and to enjoy a meal and spend some time in the home. One resident described the introduction, which included a visit to Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 11 the home prior to making a decision. A number of people also said they had used the respite service and this had allowed them to test the home out before moving in permanently, and others said they chose the home because it has a good reputation in the local area. One respite admissions file was examined and a new style care plan made reference to the persons needs as assessed by a social worker and this went onto describe how staff in the home would meet these needs. These measures ensure that admissions to the home only take place if the service is confident in meeting the assessed needs of the prospective resident through the right equipment, facilities and trained staff. More detail would improve the Statement of Purpose Guide for the home; in particular reference should be made to how the care of people with dementia is approached. The home does not offer intermediate care referred to in point 6 above. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Medicines and healthcare have not been well managed and this places peoples health at risk. EVIDENCE: On the 26.8.08 the CSCI Pharmacy Inspector stated that medication records were poor and put peoples’ health at risk from errors. Many records of administration of medicines had not been signed so we could not tell the treatment people had received, and some were signed when no medicines were given. Sometimes medicines were not given but the reasons for this were not clear. Most records were printed by the pharmacy however some records were written or changed by staff by hand. These were inaccurate or unclear so that medicines may not be given as the doctor intended. They were also not dated so we could not tell when medication had changed. We checked medicines against records and this showed that they were not always given in the prescribed dose. For example a number of courses of antibiotics were checked and this showed that people frequently did not Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 13 receive the full course that could result in infection not being treated properly. Other medicines that must be given on an empty stomach were given with other medicines so that they would not provide effective treatment. People were able to look after and take their own medicines and this helped them to remain independent. We spoke to one person who said he had asked to look after his own medicines and was able to do so. He said that staff often asked him if he had taken his medicines. We looked at two care plans for people who took their own medicines. One had a risk assessment to ensure that this was done safely and risks had been managed properly but the other did not. We also checked care plans for people receiving “when required” medication and these did not provide staff with clear instructions on their use. This may result in people receiving inappropriate or inconsistent treatment. For example we did not see any care plans for the use of “when required” medication to treat chest pain and there were no instructions for staff to follow or what to do if treatment did not work. Most regular medicines were packed into weekly cassettes. We checked these cassettes made up by the manager and found two that had the wrong persons name and list of medication on it. This is very dangerous and could lead to people getting the wrong medicines. The home also did not have a medicines trolley, although there was one on order, so medication could not be moved safely around the home. Staff described how they packed medicines down into smaller packs so they can be carried easier. This is very risky and errors could again result in people receiving the wrong medicines. New regulations state that all care homes must have a suitable cabinet for safe storage of medicines liable to misuse, called Controlled Drugs. The service did not have a suitable cupboard and one must be obtained. The receipt, administration and disposal of controlled drugs was not recorded accurately in the register. We were told that all staff that administer medication had started a course in safe handling of medicines. The service must undertake regular checks, or audits, of medication so that problems can be identified and corrected promptly to keep people safe. A senior nursing sister and the organisations General Nursing Officer are spending time in the home setting up new systems to monitor and manage people’s health and personal care needs. Immediately after the pharmacists inspection the senior nursing officer took responsibility for medications, which included an audit, and training senior staff in the safe handling of medicines. The organisation made the decision to use a more robust medications system whereby the majority of medications come prepacked. A medications trolley had also been provided and staff felt this already improved the way they gave out medications. The medications room was now kept locked with only senior staff having access. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 14 The inspectors were satisfied that the organisation had taken the concerns of the pharmacy inspector seriously and acted quickly to rectify many of the deficiency’s found. A programme of improvements has begun based on the requirements made by the pharmacy Inspector to ensure they comply with good practice in future. The Care Planning system has also had an overhaul by the senior nursing officer in the last few weeks with the majority of plans now in the organisations style as used in their nursing homes. This has been done in conjunction with relatives and the resident, and as this is a time consuming process there are some still being developed. These plans are nursing focused and the inspectors felt that more work was needed in making them more person focused to include peoples background, life histories, and what interests people now. This would be particularly beneficial to people who have dementia and a training need was identified in assisting staff in meeting these peoples needs and the more specialist approaches to use. Another area for development was around people’s nutritional needs, starting with a thorough nutritional assessment through to giving staff training and instructions including the kitchen staff. This will ensure that people’s needs are identified and they are given the correct support to stay well and healthy. Although care plans need to be strengthened, the overall healthcare of residents was met by working in partnership with District Nurses, GPs, and other visiting professionals. A visiting District Nurse interviewed stated that she had seen a dramatic improvement in pressure relief care since the new owners had taken over. The recording of GP visits and other healthcare professionals needs to improve as often no reason was given as to why they were called out and what the follow up instructions from their visits were. The provision of aids and equipment to assist in personal care has improved. For example the new owners had purchased electric profiling beds, additional hoists, two dozen new commodes, and other equipment is bought as it is needed. This helps to promote people’s comfort, independence and dignity. We have had two complaints from relatives about how the manager has handled the death of their relative. This highlighted that the manager requires training in this area and that as identified at the last Random Inspection the care of people who are dying needs to be better co-ordinated, recorded and managed. This includes the procedure on how relatives are informed and supported at this difficult time. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 15 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): All the above Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are being given increased opportunities to exercise choice and control over their lives. EVIDENCE: Residents’ choice and control over their lives is respected by staff and they are supported to make informed decisions. This is being helped by each persons care plan being reviewed and through the increase in staffing levels which allows staff to be more responsive to people’s needs and requests. Residents are also encouraged to manage their own financial affairs and to retain interests and contacts that they had prior to living at the home. For example residents spoke of choosing when to get up and go to bed. Residents are supported to maintain and develop relationships with the community and are in contact with community groups such as churches and schools. The home invites volunteers and visitors into the home for music sessions to enrich residents’ lives. Family and friends reported that they feel welcome and know they can visit the home at any time. Relatives stated that they are always given a warm Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 16 welcome, and this contributes to one of the positive features of the home. There are always numerous visitors in the home which leads to a warm, and friendly atmosphere. Residents said of the home “Food is all home cooked and we have fresh cakes, its wonderful”. “I have noticed a tremendous difference recently, I have been given more choice about things and the owners have asked me what I would like to do or see happen in the Home.” “We are given more choice at meal times”. The home has recently increased the hours for the cooks and when interviewed they said they were pleased to be given more time to bake and prepare home cooked food using good quality ingredients. All five kitchen staff had completed a food hygiene course recently. While the cooks had a good general knowledge of peoples likes and dislikes the inspectors felt they need more written documentation based on peoples assessed nutritional needs and any specialist dietary requirements. A record also needs to be kept of what people are eating to ensure a balanced diet is in place and to alert staff to the need for any specialist professional input. The home now has a people carrier and the post of activities co-ordinator has been advertised in an attempt to offer more varied activities for people living in the home. Again a special focus on how this can happen in the dementia unit is needed particularly as space in the communal living room area is quite limited and one person said they would like to get out more. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The day-to-day handling of both safe guarding issues and complaints needs to be strengthened to ensure consistency of approach and satisfactory outcomes across these important areas. EVIDENCE: The organisation has a corporate complaints procedure which has been handed out to residents in the home. There have been two formal complaints, one was upheld and the other is currently being investigated. Timescales are adhered to. The two complaints were of a similar nature and suggested that the necessary changes identified from the first complaint had not been fully implemented by the manager and led to similar mistakes. The organisation and manager need to ensure that the complaints procedure is managed in a way that leads to actions that bring about improvements in the service and that complainants are satisfied that their complaint has been investigated fully. Residents spoken to felt that they could speak up if they had any concerns or worries. One resident said “They listen and make changes, if they can, and always sort out any problems”. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 18 Staff have received basic training on keeping people safe from harm and abuse. When interviewed staff could demonstrate that they knew the steps to take to safe guard people. The home has up to date literature on the local multi-disciplinary procedures for reporting abuse. When first in post the manager was unsure of the procedure to follow in reporting and managing safeguarding incidents. The outcomes from any referral are not always adequately managed. For example a multi disciplinary meeting recommended one person’s care plan be reviewed and up dated but weeks later this had not been carried out. Links with external agencies are adequate but there is a lack of understanding of safeguarding procedures and how they work. The organisation needs to consider how they rectify this to ensure people are protected and lessons are learnt to prevent reoccurrences of complaints. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 19 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): 19,20,22 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Stilecroft provides a safe, clean and comfortable environment for residents to live-in and residents had been pleased with recent consultations and improvements. EVIDENCE: The Operations Manager and manager told us of the improvements since they took over in April this included equipment such as two new hoists, and two profiling beds, pressure relief mattresses and cushions, sit-on scales and 24 new commodes to assist in the personal care of people. A new fridge for the kitchen, and a hot trolley for meals taken to the dementia care unit has also improved the quality of the provision offered to residents. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 20 Additional hours had been invested in cleaning staff and residents commented that the home had received “a good spring clean and a de-clutter” and another said, “Bathrooms and toilets are spotless”. A handyman has recently been employed to work 20 hours per week to keep on top of general maintenance jobs. The inspectors identified that some bedrooms required new flooring. The Operations Manager agreed that a full environmental audit would be carried out to prioritise improvements, and they had already identified that a new call bell system was needed as well as refurbishment of a number of bedrooms. In line with current best practice when working with people with dementia the home needs to review its provision of facilities, for by example exploring appropriate sensory stimulation, layout and resources. Consideration also needs to be given on how signs and prompts around the home can be used to maximise people’s opportunities to remain independent. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 21 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): All the above Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are beginning to benefit from increased staff hours and a better trained work force. EVIDENCE: Staffing levels have been improved all-round with approximately 1000 more hours per week being employed. A significant number of improvements have been implemented in staffing. For example: a third night care assistant on every night of the week and an increase of 21 hours per week on the dementia care unit; increases to the domestic hours, including 12 more hours to cover laundry. Cooks hours have been increased in the kitchen and they now offer cooked breakfasts three days per week, and can attended more training as a result. Staff deployment has also been examined after an audit of the shift patterns and changes have included more delegation, extra weekend cover, and more senior staff on duty at weekends, including the manager. Staff have been provided with walkie-talkies so they can communicate with each other in different parts of the home. The aim is to provide between four and five staff during the day and a senior carer is on each shift and they give a hand over to the next shift. Notice boards around the home had basic workflow instructions. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 22 Staff felt all these measures had made them better organised as a staff team and able to help residents more. A resident spoken to said they had noticed that more staff where available and she didn’t have to wait as long for assistance. Staff training has also had a significant investment with areas such as Moving and Handling, Safe guarding from abuse, Health and Safety and medications been given a priority. The Senior Nursing Officer seconded to the Home said she had been working with staff to increase their awareness of dignity and care practice issues, and was working towards a less institutional approach. The organisation has carried out a training audit for the staff team to identify gaps and future training needs, and each person has an individual training file. Staff recruitment practices follow the organisational procedures inline with good practice guidelines to ensure that people are suited to the role and are carefully vetted. However the manager when first employed demonstrated that she was not familiar with these and employed a person without the necessary checks being carried out. Fortunately this was noticed by the senior person seconded to help run the home and the manager was informed of the correct procedures to follow. A new induction programme has also been introduced for new members of staff, and new staff reported that they felt well supported and equipped to carry out their roles. Staff were observed being respectful and professional in their duties and interacting with people in a pleasant and appropriate manner. While a number of staff have received training in dementia care awareness the Inspectors identified that to fully meet peoples needs staff who work in the dementia care unit would benefit from a more in-depth training course. The Operations manager said that the organisation has a specialist trainer who they will be using to fill this gap. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. The current manager lacks experience to successfully run a large care home, however the home is currently being run in a satisfactory manner due to the high level of senior input from the organisation. EVIDENCE: The organisation that runs the home MPS Ltd has put in a considerable amount of additional hours and support to help the manager run the home. We (Commission for Social Care Inspection, CSCI) have concerns about the manager’s lack of experience in running a care home for older people. The home is of a considerable size, has a large staff team, and complex operational requirements. The current manager has either no experience, or very limited Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 24 experience in these areas and has demonstrated a lack of knowledge of her legal responsibilities since being appointed. The registered Provider has a legal duty to appoint an individual who has the qualifications, skills, experience and competence necessary for managing the care home. The home is however running efficiently at the present time due to two senior nursing officers being seconded to the home for a temporary period, and through the support of another care home manager. The manager is responsible for fire safety in the home. When the Fire logbook, fire checks, drills and instructions were checked we found they had been done up until March 2008 and had not been done again until August 2008. The fire risk assessment had last been done on 16/06/07 and had not been updated. No one in the home had completed the fire warden training. Staff fire training was inadequate. For example a nighttime carer had only had one session of fire training and had received no instruction or drill but had worked consistently at night since June. There is a risk that fire safety is being compromised and this needs to be rectified as soon as possible. Infection Control needs to have a higher profile in the home and the inspectors recommended using the “Essential Steps Guide”, assessment and training material designed for Care Homes available through Environmental Health Officers. The Home had a sickness outbreak in May that was not reported to us. The Senior Nursing Officer had introduced the organisations Quality Assurance System and on examination this looked a very effective tool for monitoring and ensuing the quality of the service. Part of this audit had been to send out questionnaires to everyone involved in the home. Areas for development had been identified and a plan of action with timescales set out. This is good practice and will help the home to offer a quality service to its residents. Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 25 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 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 x 3 x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 x x 2 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 15 Requirement Care plans must be kept up-todate to give staff the latest instructions to be able to meet peoples needs This was to have been met by 31/07/08 Administration of peoples medication must be accurately recorded and non administration accounted for This was to have been met by 20/06/08 Medicines must be administered as prescribed so that people get safe and effective treatment. All medicines cassettes must be labelled with the correct residents name and list of medication to reduce the risk to them from receiving the wrong treatment. A legally compliant controlled drugs cupboard must be used to store controlled drugs to help ensure they are not mishandled or misused. DS0000071717.V367538.R01.S.doc Timescale for action 30/09/08 2. OP9 13 01/10/08 3. OP9 13(2) 01/10/08 4. OP9 13(2) 01/10/08 5. OP9 13(2) 01/12/08 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home Version 5.2 Page 27 6. OP8 17 (1a) (2) Nutritional screening of people must be carried out to include an ongoing record of nutritional intake and for issues of weight loss or appetite loss to be recorded and monitored with appropriate action to be taken. The Registered Provider must appoint a suitably qualified and experienced person to manage the home with sufficient care, competence and skill to ensure people are safe and well cared for. The Registered person must ensure the safety of residents by carrying out a Fire Risk Assessment reviewing fire precautions, testing of equipment and ensure staff receive suitable training and instructions. 31/10/08 7. OP31 9 31/10/08 8. OP38 23 (4) 31/10/08 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. 2. 3. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations Regular audits of medication should be done to monitor the management of medicines and to keep people safe. All hand-written medication administration records should be double-checked for accuracy and signed. Medication should be administered from the original dispensed container and should not be packed down to prevent errors being made. Care plans relating to medicines such as for “when DS0000071717.V367538.R01.S.doc Version 5.2 Page 28 4. OP9 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home required” medicines or for people who self-medicate should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. 5. OP11 The manager should seek advise about introducing good practice pathway care plans for the end of life care for people in the home to ensure this care is co-ordinated and dignified Care Plans should be developed in a person centred way to assist in understanding people and to meet their needs more in a less institutional way The approaches to use with people with dementia should be given more consideration and staff should receive training on strategies and activities suited to their particular needs. 6. 7. OP7 OP12 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Stilecroft (MPS) Ltd T/A Stilecroft Residential Home DS0000071717.V367538.R01.S.doc Version 5.2 Page 30 - 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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