Inspection on 23/01/07 for Stobars Hall

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Stobars Hall 04/11/08

Stobars Hall 31/01/06

Stobars Hall 03/08/05

Stobars Hall 25/01/05

Stobars Hall 31/10/04

Stobars Hall 04/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOMES FOR OLDER PEOPLE Stobars Hall Kirkby Stephen Cumbria CA17 4HD Lead Inspector Jacqueline Southern-Leigh Unannounced Inspection 23rd January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stobars Hall DS0000022660.V324205.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. Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stobars Hall Address Kirkby Stephen Cumbria CA17 4HD 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) 017683 71291 The Franklyn Group Ltd Mrs Hilda Brittleton Care Home 38 Category(ies) of Dementia - over 65 years of age (7), Learning registration, with number disability (1), Old age, not falling within any of places other category (37), Physical disability (1) Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 38 service users to include: up to 37 service users in the category of OP (Older people, not falling within any other category) up to 7 service users in the category of DE(E) (Dementia over 65 years of age) 1 person over 18 years of age with a learning disability (LD) and a physical disability (PD). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 31st January 2006 2. Date of last inspection Brief Description of the Service: Stobars Hall is a residential care home registered with the Commission for Social Care Inspection to provide accommodation for up to thirty-eight people. Stobars Hall is owned and carried on by The Franklyn Group Ltd and Mrs Hilda Brittleton is the registered manager of the home. Stobars Hall is a large period property on the outskirts of Kirkby Stephen set in large attractive grounds. The home is a detached two-storey building which has been adapted for use as a residential care home. Accommodation for residents is provided in the form of twenty-four single bedrooms and seven double rooms which two people can choose to share. All the bedrooms have a private bathroom equipped with a bath or shower, toilet and wash hand basin. There are appropriate toilets close to all areas used by residents and the home provides assisted bathing facilities. Shared space is provided in the form of two smoke free sitting rooms and a dining room. A separate smoking lounge is provided on the ground floor of the home. The home has passenger lifts and a stair lift to assist residents to access accommodation on the first floor of the property. There is a pleasant patio area with level access and seating for residents at the front of the property. Stobars Hall provides accommodation to residents referred by the local social services department and to individuals who purchase their care privately. The home offers respite care when accommodation is available. Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key Inspection starting at 10.00am and finishing at 2.30pm. The inspection included a tour of the premises, meeting with residents and staff and looking at the homes policies and procedures. Information was also gathered prior to the inspection in the form of a PreInspection Questionnaire that was completed by the home and questionnaires that were completed by residents and their relatives. The current fees for the home are between £400 to £500 per week. What the service does well: What has improved since the last inspection? The home has continued to improve its plans of cares for the residents and has developed and trained the staff to provide the residents with a high level of care and support. Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 6 The home has introduced a new seven-bedded unit that cares specifically for residents with dementia care needs. The staff on the unit are receiving specialised training and are developing new care pathways. 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. Stobars Hall DS0000022660.V324205.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 Stobars Hall DS0000022660.V324205.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): 1,2,3,4,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that it can meet the needs of prospective residents and provides them with relevant information regarding the home. EVIDENCE: The home provides prospective residents with written information about the home in the form of a Statement of Purpose, there is also a relatives and representatives guide which is issued to the families of all new residents. Prospective residents and their families are welcome to come and look around the home, however the manager does prefer that appointments are made to ensure that there is a member of staff available to show them around. All residents have a copy of the homes terms and conditions which is part of the Statement of Purpose. It is essential that all residents are given a copy of the terms and conditions of the home and the manager should ensure that all Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 9 the current residents have a copy and are aware of the contents, as well as new residents to the home. All prospective residents are assessed by the manager prior to admission; this is also undertaken if the residents are coming directly from hospital or another home. The manager will make a careful assessment of the prospective resident to ensure the home can meet their needs, a resident will not be admitted if the manager feels the home would not be a suitable or safe environment. All new residents have a six-week trail period; this allows both the resident and the home the opportunity to see if the resident is happy in the home and whether the home can meet their care and personal needs. Comments received from residents and their relatives suggest that the home is meeting the needs of its current residents. Since the last inspection the home has created a seven-bedded dementia care unit, this is as a result of the high demand for specialised care for residents with dementia needs. The home does not offer intermediate care. Stobars Hall DS0000022660.V324205.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): 7,8,9,10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good assessment procedure that meets the needs of the service users and ensures that health, personal and social care is well maintained. EVIDENCE: All residents have comprehensive plans of care that look at all aspects of the individual’s life at the home. The plans identify specific care needs of the individual residents, the staff then use these plans to ensure that the health and personal needs of the residents are met; the plans are reviewed on a regular basis. The care given by the staff is of a good standard, however the staffing levels are just adequate to meet the needs of the current residents any increase in occupancy or dependency would require an adjustment in the staffing levels to ensure the standards remain at an acceptable level. The home supports residents who wish to self-medicate; there is an appropriate system in place that safeguards these residents. The general Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 11 medication system is of a good standard, with policies in place for the safe handling, storage, administration and disposal of drugs. On the day of the Inspection residents were asked if the staff at the home treated them with respect and dignity, one resident said that the staff ‘always treat me with kindness, they respect my privacy and always allow me to chose what I want to do, when I want to do it’. Another residents said that ‘the staff always knock on the door before coming into my room and asked me what I wanted to be called’. The home asks residents and their families about their end of life wishes and records these in the plans of care. Stobars Hall DS0000022660.V324205.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports the residents to maintain a balanced lifestyle with options for choice. EVIDENCE: The home does not employ an Activities Coordinator, therefore any recreational activities provided for the residents are either via outside entertainers or are organised when the care staff have time available. This is an area of weakness for the home, it is apparent from the comments made by residents and their families in the questionnaires and from speaking to residents that although they appreciate the efforts of the staff they would like more variety and choice. Family and friends of the residents are made welcome at any time; there are no restrictions in visiting. The home keeps a room available for the use of guests, relatives or friends of the residents can book the room directly with the home, and the cost also includes all meals. Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 13 Residents commented on the day of inspection that they were able to make there own lifestyle and personal choices. The residents generally have breakfast in their own rooms; lunch is the main meal of the day, with the choice of two or three starters, two main meals and a variety of desserts on the sweet trolley. The evening meal is a lighter meal with four or five choices and a choice of desserts. Lunch and the evening meal can be taken in the dining room or in the resident’s own room, the lunch that was served on the day of inspection was well presented and appetising. Residents commented that the meals at the home were ‘very good’, one resident commented that she was a fussy eater and the home always provided her with different options, ‘if I didn’t like something they will always do something else for me’. As well as the main kitchen there is also a smaller kitchen area that visitors are welcomed to use, the manager said that ‘relatives can come and help themselves’. Stobars Hall DS0000022660.V324205.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints process that protects the rights of the residents. EVIDENCE: The home has a formal complaints procedure, a copy of which is available to all the residents and visitors. There have been no formal complaints since the last inspection. Residents are aware of who to speak to if they have a complaint, and had no hesitation about discussing any issues they had with the manager. Stobars Hall DS0000022660.V324205.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): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home is clean, warm and safe; it meets the needs of its residents. EVIDENCE: Stobars Hall is a converted period property on the top of a hill overlooking the market town of Kirkby Stephen. There are beautiful views of the surrounding countryside including the Pennines and the Howgill Fells. Most of the residents have lovely views from their bedrooms, this certainly adds to the charm of the home. There are nice ground surrounding the home, some residents have motorised scooters to allow them independent access to the grounds. There are twenty-four single bedrooms and seven double rooms; all the bedrooms have en-suite or attached bathrooms. The double rooms are only Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 16 used at the resident’s request, for example for married couples. The bedrooms are all different sizes and shapes; this gives many of the room’s their own character, which the residents appreciate. The en-suite bathrooms are now very dated, they all have baths and many of the residents are unable to use these for various reasons. It is recommended that the home undertake to start to up-date the bathrooms, replacing the baths with level deck showers that residents may access independently or with minimal assistance. There are three lounges for the resident’s use and a separate dining room, all the rooms are decorated in a style that matches the house. The overall standard of the décor of the home is good, providing the residents with a pleasant environment. The home is kept clean and tidy; there were no unpleasant odours. All laundry is done in-house, laundry staff are employed to deal with the washing and drying, the night care staff are expected to do ironing. The home also has a separate bathroom with hoist to allow the staff to help bathe residents with mobility difficulties; this is very nice and is newly decorated. Hoists and mobility aids around the home are maintained by an external specialised company, as are the main lifts and the stair lift. The home will provide all furniture for the bedrooms, however residents may choose to bring their own furniture, residents are encouraged to bring in their own possessions to personalise the room. Stobars Hall DS0000022660.V324205.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): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A staff team that has been recruited, inducted and trained adequately to give a good standard of care meets the service users needs. EVIDENCE: The home is currently registered to care for 38 residents, on the day of inspection there were 25 residents living at the home. The staffing levels are adequate to meet the needs of the current residents, however should there be a change in the dependency levels of any of the residents or if anymore residents are admitted to the home, these staffing levels would no longer allow the home to provide the current good standard of care for the residents. The residents are happy with the care they receive from the staff, one residents said ‘the staff are great, they are very good’, this resident went on to say that she had tried several homes and they were ‘not up to my standards’, however she is very happy at Stobars Hall mostly because the staff are ‘so good’. Another resident said that ‘I can’t speak highly enough of the staff’, there were also positive comments about the staff in the questionnaires. Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 18 The home has a recruitment policy in place that is followed for all new staff, staff files that were checked on the day of inspection contained relevant information. The home has an induction programme that new staff work through over the first two to three weeks. Nearly 60 of the staff have National Vocational Qualifications (NVQ) in Care at level II or above, the manager encourages and supports staff to undertake higher-level courses as well. The staff have undertaken other relevant training over the last year including moving and safe handling, spine awareness, first aid, managing and handling of medication, basic food hygiene, fire evacuation procedures and several staff are currently undertaking NVQ III in care. Stobars Hall DS0000022660.V324205.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): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home safeguards the rights and best interests of the residents. EVIDENCE: The home is managed by Hilda Brittleton; she has undertaken the Registered Managers award and has gone on to gain higher qualifications in care and management to enable her to support the residents and staff at the home. All the residents and staff spoken to on the day of inspection spoke of Ms Brittleton’s role as the manager in a positive way, one resident said ‘Hilda is lovely, she really does manage, if I have any complaints or worries Hilda sorts them out’. Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 20 The administration and paperwork system of the home was extremely well organised, the manager was able to supply me with all the documentation I required, it was stored and organised in a logical manner, policies and procedures were laid out in the order of the National Minimum Standards. Ms Brittleton told me that she was well supported by the organisations management structure, however I did note on the duty rota that there is only one team leader on days and one on nights and none on the EMI unit. As these roles are ‘hands on’ and work as part of the care staff numbers this does not leave any time for these staff to ‘support’ Miss Brittleton on a day-to-day basis as stated in the pre-inspection questionnaire. Ms Brittleton did explain that one of the team leaders had recently left and she was working with her manager to look at a more suitable system of management support. The staff receive regular supervision from the manager, this is recorded appropriately, the manager is also an NVQ Assessor and therefore has regular clinical contact with the staff undertaking NVQ’s. The home has a policy in place for the safeguarding of residents money that is kept in the home, there is a double check system in place and the manager keeps good records. There are no current Health and Safety issues at the home, a maintenance schedule is in place with all relevant servicing and checks being undertaken. Stobars Hall DS0000022660.V324205.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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 3 3 3 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 3 3 3 3 3 3 3 Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations Consideration should be given to employing an activities coordinator or an alternative system should be implemented to provide the residents with a more varied choice in recreational activities. Up-date the en-suite bathrooms and replace baths with level deck showers for independence and safety. 2 OP21 Stobars Hall DS0000022660.V324205.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Stobars Hall DS0000022660.V324205.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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