Inspection on 29/01/07 for Stirlings

This inspection was carried out on 29th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stirlings 09/01/06

Stirlings 11/05/05

Stirlings 20/01/05

Stirlings 21/10/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Stirlings Garston Lane Wantage Oxfordshire OX12 7AX Lead Inspector Chris Sidwell Unannounced Inspection 29th January 2007 11:00 29/01/07 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 Stirlings DS0000028949.V317417.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. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stirlings Address Garston Lane Wantage Oxfordshire OX12 7AX 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) 01235 762444 01235 763995 manager.stirlings@osjctoxon.co.uk www.oxfordshire.gov.uk The Orders Of St John Care Trust Mrs Maggie Knowles Care Home 40 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (3), Dementia - over 65 years of of places age (4), Old age, not falling within any other category (40), Physical disability over 65 years of age (20) Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 40. 9th January 2006 Date of last inspection Brief Description of the Service: Stirlings is a care home providing personal care and accommodation for forty older people, five of whom need help with rehabilitation (intermediate care). The care home is managed by The Orders of St John Care Trust, which is responsible for many care homes in Oxfordshire that were formerly provided by the County Council. Stirlings is located near to the centre of Wantage, close to local amenities. The property is a two storey building with a lift fitted and divided internally into five areas. All bedrooms are single and there are no ensuite facilities. The home has well maintained grounds that are easily accessible. The fees range from £491 -£596 per week for residents who are sponsored by Oxfordshire Social Services and £550 - £625 fro those who are privately funded. Information about the home can be obtained by contacting the home or visiting in person. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of three days and included an unannounced one-day visit to the home. Prior to the visit all previous information about the home was reviewed. Comment cards were sent to the home for distribution to residents and their families and to other professionals who have contact with the home. Three residents responded. The care of four residents was case tracked. Residents, family members, staff, the manager and visiting healthcare professionals were spoken to on the day of the unannounced visit and care practices were observed. The home’s approach to equality and diversity was observed. What the service does well: There is information available to residents and their needs are assessed prior to them moving to the home, to help them decide whether the home can meet their needs. Residents were pleased that they had the opportunity to visit the home and stay for the day before deciding to move for a trial period. The personal, healthcare and medication needs of residents are met in a timely way and in a manner, which promotes their dignity. The visiting general practitioners were happy with the care that was given to residents and said that staff call them promptly and had a good understanding of resident’s care needs. The atmosphere in the home is friendly and supportive. Residents have a choice as to how they spend their day promoting their dignity and wellbeing. Resident’s nutritional needs are met and mealtimes are a sociable occasion. One resident said ‘the food here is always good and plenty of it’. Special diets are available to meet resident’s health and cultural needs. There are complaints and safeguarding procedures in place to protect residents from harm arising from their care. The Commission for Social Care Inspection has not received any complaints about the home nor has it been notified of any allegations of abuse. The home is well maintained, residents rooms are homely and the standards of hygiene and infection control are adequate, giving residents a comfortable and safe place in which to live. Many residents had chosen to personalise their rooms by bringing items of furniture and personal pictures and ornaments with them when they moved. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 6 There is a stable staff team, which has the necessary attitude, skills and knowledge to meet resident’s needs. Recruitment procedures are thorough and there are good training programmes in place for all staff. The home is well managed, with good quality assurance systems in place, for the benefit of residents. Resident’s views are sought and the home is flexible in meeting their needs. The St John’s Care Trust service managers monitor standards in the home on a regular basis. There are health and safety policies and procedures in place and staff have had training in manual handling, first aid, food hygiene and infection control. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. There is information available to residents and their needs are assessed prior to them moving to the home, to help them decide whether the home can meet their needs. EVIDENCE: The home has a Statement of Purpose and Service Users guide, as well as a small brochure which is available to service users prior to their moving to the home. One of the service users spoken to said that they could remember receiving this although the others said no indicating that their families or social services may have received information. The information pack made available to people who enquire about the service does not contain the service users guide nor a copy of the statement of purpose. It was not clear when the service users would receive a copy of these and the manager should clarify this with the Trust. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 9 The care of four residents was ‘case tracked’. All had been visited before they moved to the home and their needs had been assessed. A copy of the care manager’s assessment was on file where appropriate. The residents spoken to said that this had happened. One said that she had had the opportunity to visit the home for a day before she moved in for a trial period. She said that visiting for the day had helped her feel ‘less anxious’ than she might have done. This is good practice. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal, healthcare and medication needs of residents are met in a timely way and in a manner which promotes their dignity. EVIDENCE: The care of four residents was case tracked and they were met on the day of the unannounced inspection. All had been helped with their personal care needs and spoke highly of the carers. All had care plans, which had been updated and reviewed on a regular basis. There was evidence in the care plan that residents had been seen by the doctor regularly and had the appropriate referrals to secondary care when necessary. Risk assessments had been undertaken to assess the risk of residents developing pressure damage and the appropriate care plans had been drawn up. Nutritional risk assessments had been undertaken and residents were weighed regularly. One had lost weight and the appropriate action had been taken promptly. There were falls risk assessments and the manager has arranged training for staff in falls prevention from the local Primary Care Trust falls prevention team. The residents spoken to said that the doctor was always called promptly. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 11 Two visiting General Practitioners were spoken to on the day of the inspection and both confirmed that the homes care staff called them promptly and had a good understanding of the residents care needs. The daily entries for one resident stated that the resident could be ‘quite aggressive’. There was no care plan relating to his or identification of possible triggers to this behaviour. The staff spoken to were very aware of his needs and knew how to minimise any outbursts of aggression. This is an aspect of care planning that could be developed. There are medication policies and procedures in place. The care leaders administer medication and all have had training. Records are kept of medication entering and leaving the home. There were no gaps on the medication administration charts with the exception of some creams, which are prescribed as a skin lubricant and which are kept in resident’s rooms. There is a medication refrigerator and temperatures are monitored regularly. No residents are prescribed controlled drugs at present although there are policies and procedures in place should this be necessary. The residents spoken to said that they were happy at the home and that all their personal needs were met in their room. The staff were observed to take residents to their rooms to see the general practitioners when they visited. All residents were wearing their own clothing. The laundry was well organised and clothing was kept in a good state of repair. Staff were observed to treat residents with respect and to go up to them when they spoke to them. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The atmosphere in the home is friendly and supportive. Residents have a choice as to how they spend their day, promoting their dignity and wellbeing. Resident’s nutritional needs are met and mealtimes are a sociable occasion. EVIDENCE: The residents spoken to said that they had a choice as to how they spent their day. Some preferred to stay in their own room, others to join other residents in the lounges. A range of activities is provided. One resident had been enabled to maintain contact with the day centre that she had attended before moving to the home. Residents can see relatives in private. There statement of purpose states that visitors are welcome. Residents confirmed this. The residents spoken to said that there was a choice of activities available which they enjoyed although there was no compulsion to join in if they did not wish to. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 13 The meals are varied and the residents spoken to said that they enjoyed them. Menus are on display. Special diets are available to meet resident’s health and cultural needs. The meal on the day of the unannounced visit was of a high standard. Tables are laid attractively and mealtimes are a sociable occasion. Staff were observed to assisting those who required help sensitively and discretely. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are complaints and safeguarding procedures in place to protect residents from harm arising from their care. EVIDENCE: There are complaints, protection of vulnerable people, whistle blowing and restraint policies and procedures in place. A complaints record is kept. The staff spoken to said that they had had protection of vulnerable adults training and this was confirmed by the training records. The residents spoken to said that the staff were kind and that they had never been treated badly. Those who returned the comment cards said that the staff were always kind and that they knew who to complain to if they were unhappy. The Commission for Social Care Inspection has not received any complaints about the home nor has it been notified of any allegations of abuse. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, residents rooms are homely and the standards of hygiene and infection control are adequate, giving residents a comfortable and safe place in which to live. EVIDENCE: The building is well maintained and a programme of routine maintenance and decoration is evident. It has been refurbished over the last two years. There are now no double rooms. None of the rooms however have ensuite facilities. The grounds are tidy and accessible to residents. Residents rooms are homely and had been personalised. One resident said that she had been pleased to be able to bring some of her own furniture and her ornaments with her when she gave up her home. Most residents had small items of their own furniture and photographs to personalise their rooms. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 16 There are sufficient bathing facilities and bathrooms and toilets are adapted to meet the needs of the elderly. The beds are an old-fashioned divan type although the residents spoken to said that they were comfortable. The organisation should consider a rolling programme to replace some of the older beds. Residents rooms were clean and there were no offensive odours. There are infection control policies and procedures in place and the staff training records showed that staff had had training in infection control. Staff were observed to wash their hands. Not all rooms have soap and paper towels for use by the staff. The staff said that they had to go to a nearby bathroom or the sluice if they wished to wash their hands after assisting a resident. It is recommended that the organisation review their infection control policies in line with guidance published by the department of Health in June 2006. There are good systems for separating and washing soiled laundry and washing machines with programmes to disinfect soiled laundry. There are contracts in place to dispose of clinical waste and staff were aware of these. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a stable staff team, which has the necessary attitude, skills and knowledge to meet resident’s needs. EVIDENCE: There is a stable staff team. Five members of staff have moved since the last inspection, three of whom were attached to the local army base and were relocated. The residents spoken to said that the staff were always available to help them. The staff spoken to said that they felt that they had time to help residents although were sometimes very busy and had to prioritise whom to help first. The three residents who returned the questionnaires said that they ‘always’ received the support that they needed although two said that staff were ‘usually but not always’ available to help them. There are sufficient catering and housekeeping staff to meet service users needs. The home was clean and tidy on the day of the visit and the meals were served promptly and to a high standard. The home has an active programme to support staff to obtain the National Vocational Qualifications in Care. There are twenty seven Care staff, fourteen of whom hold the national vocational Qualifications in Care at Level 2 and a further nine are registered. The home meets the standard that fifty percent of staff hold this qualification. The care leaders hold the National Vocational Qualification in Care at level 3. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 18 Four staff recruitment records were selected and examined. All had the required documents to show that staff member’s identity had been verified and appropriate checks had been undertaken before they commenced work. All had references and full Criminal Records Bureau disclosures. Interview records were kept. There is an in house induction programme. The training programmes are well organised and records are kept showing that most staff have had the required mandatory training. The staff spoken to said that they felt well supported to undertake training and that most was done in work time. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, with good quality assurance systems in place, for the benefit of residents. EVIDENCE: There is an experienced manager who has had significant experience of managing a care home. She holds the National Vocational Qualifications in Care and Management at Level 4. The staff were supportive of her and said that she created an open and supportive atmosphere. She was knowledgeable about the needs of the individual residents living in the home. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 20 The St Johns Care Trust has a quality assurance programme in place. Service managers visit the home regularly and monitor standards, including examining care plans, fire log training procedures and other health and safety issues. They speak to residents and families. Complaints (and compliments) are recorded. Residents meetings are held and minutes kept. Annual surveys are undertaken and analysed. The manager said that the last survey had revealed that some residents felt that some of the furniture was shabby. Money has been allocated in this year’s budget to replace the older furniture. Quality assurance visits are undertaken in line with Regulation 26 of the Care Home’s Regulations and records are kept. The home does not act as agent or manage monies on behalf of residents. A small amount of personal allowance may be kept at the home for residents and records were seen to verify that receipts are given for receipt of money and for any expenditure made on behalf of the resident. The pre-inspection questionnaire showed that regular servicing and maintenance of equipment takes place. There are health and safety policies and procedures in place and generic risk assessments have been undertaken to promote safe working practices. The staff spoken to had had manual handling training and the training matrix showed that a programme was in place to ensure that all staff had mandatory health and safety training with annual updates where required. The fire log was checked and showed that fire training and checks of equipment are undertaken on a regular basis. All staff have basic food hygiene training. There are control of infection policies and procedures in place. It is recommended that the organisation consider providing liquid soap and paper towels in service users rooms where they have hand-washing facilities for use by staff and should review and update the organisations Infection Control policies in line with guidance published by the Department of Health in 2006. Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 21 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered manager should ensure that residents have a copy of the home’s statement of purpose and service users guide. Timescale for action 31/03/07 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 OP8 Good Practice Recommendations It is recommended that care plans are further developed to identify the triggers that may lead to resident’s behavioural problems and that strategies to cope with this are described in the care plan. The organisation should consider a rolling programme to replace some of the older beds. It is recommended that the organisation review their infection control policies in line with guidance published by the Department of Health in June 2006. 2 3 OP24 OP38 Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Stirlings DS0000028949.V317417.R01.S.doc Version 5.2 Page 24 - 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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