Inspection on 11/12/07 for Stocks Hall

This inspection was carried out on 11th December 2007.

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

Stocks Hall 26/01/07

Stocks Hall 24/03/06

Stocks Hall 19/10/05

Stocks Hall 24/02/05

Stocks Hall 13/05/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stocks Hall 76a Nursery Avenue Nursery Lane Ormskirk Lancashire L39 2DZ Lead Inspector Val Turley Unannounced Inspection 09:15 11th and 18 December 2007 th 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 Stocks Hall DS0000005909.V352213.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. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stocks Hall Address 76a Nursery Avenue Nursery Lane Ormskirk Lancashire L39 2DZ 01695 579842 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) Stocks Hall Care Homes Limited Mrs Ann Elizabeth Williams Care Home 45 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (18) of places Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 45 service users to include: Up to 18 service users in the category OP - (Old age, not falling within any other category) needing personal care only. Up to 27 service users in the category DE (E) Dementia (service users who are over 65 years of age) needing personal care only. Date of last inspection 26/1/07 Brief Description of the Service: Stocks Hall care home provides 24-hour personal care and accommodation for the elderly and people who have care needs associated with dementia. Stocks Hall is owned by Stocks Hall Care Homes Limited and is one of four homes managed by the company. The home is situated in a quiet area of Ormskirk, close to the town centre, near to shops, pubs and post office. Car parking is available at the front entrance with garden areas and a larger garden at the rear of the home. The premises are a two storey purpose-built property. Bedroom accommodation is on both floors. All bedrooms are single and several of these rooms have an en-suite facility. Lounge and dining rooms are also located on both floors. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedroom and living rooms. Charges at the home range from £396 - £464 per week. There are additional charges for chiropody, optical care, dental care, outings and hairdressing, toiletries, papers and magazines, transport and private telephones. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection that took place over an eleven-month period and culminated in a site visit to the home over two days in December 2007 by two regulatory inspectors. The inspection involved discussion with people living at the home where this was possible, discussion with staff, observation of staff supporting the residents and an examination of records, policies and procedures. Every year the registered persons are asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. We use this information, in part, to focus our inspection activity. Information was also provided through surveys recently completed and returned by 2 residents living at the home and 3 relatives. As part of the inspection, the inspector used ‘case tracking’ as a means of assessing some of the National Minimum Standards. This process enabled the inspectors to focus on four of the people living at the home. Records relating to those individuals were inspected and discussion took place with them where possible and with the staff team in relation to their support needs. Just over 1 hour of the inspection was used to undertake a SOFI (short observational framework for inspectors) exercise. This meant that four residents were observed in their daily routines along with the care practices of staff. The SOFI observations are a way of assessing the wellbeing of residents who live in the unit. What the service does well: Stocks Hall presents as a generally clean, tidy and comfortable home. Improvements are continually being made to the environment and the home has recognised areas it can further improve. Most systems and equipment are serviced appropriately to help ensure that the environment is safe. The home has a good approach to assessing residents before they are admitted to the home. This enables the home to determine if they are able to provide the support that each individual needs. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 6 The relationship between the staff and the residents is generally positive and the atmosphere in the home is calm and relaxed. The staff are interested in the residents and are aware of their support needs. They are courteous in their approach to residents and are sensitive to their needs. One relative wrote ‘the care staff are in general pleasant and friendly and have a great deal of patience and understanding.’ The staff are positive in their approach and are looking forward to new consistent management arrangements being introduced so that improvements can be made to the way the home is being run. The home welcomes the input and support from a range of social care and health professionals. The home employs recreational therapists who organise activities in the home and trips out for the residents. Representatives from local churches also visit the home to attend to the residents spiritual needs. There are good training opportunities for the staff and they have taken advantage of these providing them with a range of skills and experience. Over 60 have achieved a nationally recognised qualification in care. The home is hoping to extend the training opportunities for staff still further over the next twelve months. Resident’s monies are well managed with records being accurately kept. Policies and procedures in relation to resident’s money and financial affairs protect the resident as far as possible. The home has recognised that it must improve in many areas and it has already started to work towards making these changes. The home has a number of quality assurance monitoring systems in place which are carried out to identify any concerns, these plus meetings with staff have helped identify where the home needs to improve. What has improved since the last inspection? Since the last inspection the home has improved the way it recruits staff and now staff only start to work when all of the necessary checks have been undertaken. Training for staff has also improved with staff now attending all mandatory training courses. Improvements have been made to the homes general environment with improvements in lighting having been made, much of the furniture in the communal areas has been replaced and the curtains in these areas have also been renewed. The kitchen and laundry areas have been screened off, making the patio and garden area safe for the residents. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 7 The home has recognised that it has areas that are underused and some thought is being given to how better use may be made of the premises to give the residents more choice of living space. What they could do better: The home has had a disappointing year mainly because of inconsistent management arrangements and as a result improvements are needed in most areas. The care and support it provides to residents is poorly organised and records of the care given must be better recorded and organised. This will help ensure that residents receive effective care consistently. Care plans and risk assessments are not reviewed on at least a monthly basis so that residents changing needs can be recognised and met. The way the home manages and administers medication is very poor and needs to be thoroughly reviewed with changes being made to help ensure that the health of the residents is monitored closely and that they receive all medication that is prescribed for them. Some changes are needed to the way food and drinks are managed on the dementia unit. It has no facilities to make drinks, snacks or reheat food, and staff have to physically leave the unit to undertake any of these tasks. There are concerns over the hygiene arrangements, as food that is brought up to this floor is sometimes not covered. Additionally food brought up to the unit cannot be kept warm until residents are ready to be served. Soft diets and liquidised meals should have the flavours served separately to allow residents to enjoy the different tastes and textures. Coffee tables should also be provided on the dementia unit to allow residents to put their drinks down at the side of their chairs. Inconsistent management input over the year has resulted in complaints and protection issues being poorly handled. The home has co-operated with a number of agencies as these matters have been investigated and it has recognised where changes need to be made to protect and ensure the safety and well being of the residents. However, a lack of consistent management has made it difficult for changes to be made and maintained. Some improvements should be made to the standard of cleanliness in the home in certain areas. These include the small kitchen area on the dementia unit and the offices around the home. Infection control measures in the home need to be strengthened to ensure all of the staff are aware of their responsibilities. Stocks Hall DS0000005909.V352213.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. Stocks Hall DS0000005909.V352213.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 Stocks Hall DS0000005909.V352213.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): 3 and 6 Quality in this outcome area is good. Residents are assessed before they are admitted to the home, enabling the home to determine if they are able to give them the support that they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the site visit to the home we looked at the files of three residents in detail to see if their support needs had been thoroughly assessed before they moved into the home. For two of these residents a full assessment had been undertaken by the care manager before the resident was admitted to the home. There was no evidence of an assessment having been completed for the third resident prior to admission, although the acting manager said that the home Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 11 had undertaken the assessment and that the document must have been mislaid. Two of the residents had a care plan that had been developed at the time of admission with the plans reflecting the information provided in the assessments. The third resident had a care plan in place that had also been developed at the time of admission and the acting manager stated this would also have been based upon the assessment that the home had undertaken. The home has an intermediate care unit that provides short-term intensive rehabilitation to its residents to enable them to return to their own homes. The unit has its own dedicated space and staff team. It has equipment and facilities to promote everyday activities of living and enjoys good working relationships with relevant health and social care professionals who provide additional support to the residents in the unit. We spoke to three people in the unit who were happy with the support that they were receiving. None of these residents anticipated staying in the unit for very long. One said a physiotherapist visited regularly to work with them and there was written evidence that other health professionals visited the unit. Stocks Hall DS0000005909.V352213.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 and 10 Quality in this outcome area is poor. The care planning process has some strengths but is not consistent enough to ensure that residents receive a good standard of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recognised that it needs to improve the way in which it supports residents and improve the records about the care it provides to them. A reorganisation of files has begun and the files of the more recently admitted residents were more detailed and better ordered. On the day of the site visit we spent time in each of the three small offices in the home, one on each of the units. Two of these were very disorganised and documentation in respect of the residents was not always filed or stored away. Information could not be easily accessed, checked or any concerns picked up. There are some potentially good systems in place to enable staff to monitor Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 13 and check the well being of the residents, but these had not always followed as they should have be. It was therefore impossible to determine in some cases if residents had received all of the care that they needed. On one file night records had not been kept for several months, fluid intake records had been started but lacked any consistency, the care plan and risk assessments had not been updated for almost six months. Another care plan did not include specific guidance for staff regarding one resident’s health care needs and the protocol staff needed to follow when giving her personal care. There were no risk assessments in place in relation to the use of bed rails although bed rails were observed to be positioned safely. There was good written evidence that the home welcomed the input and support from a range of social care and healthcare professionals including GP’s, a continence advisor, optician, district nurses and a chiropodist. Residents spoken to confirmed the involvement of health professionals. Residents were also supported to attend outpatient appointments. The staff spoken to were reasonably well informed about the individual backgrounds and needs of the care needs of the residents and residents spoken to were happy with the care that they received. One relative wrote that her mother was supported to keep her dignity at all times. Observations made throughout the day confirmed that staff made arrangements for the dignity of residents to be respected. Two of the residents said that the staff were kind and attended to their needs promptly during the night. A letter of thanks sent to the home described the staff as being dedicated and compassionate. The two survey returned by residents at the home stated that the staff listened to them and acted upon what they said. There is a need to improve the way medication is managed in the home to help ensure the safety and well being of the residents. Records were poorly maintained and there were many instances were no record had been made of medication being administered. No consistent records were kept of any creams and food supplements being administered and there was also one instance of no records being kept of the medication brought into the home by a resident on respite care. Where antibiotics were administered it was not always clear if the resident had been given the full course and there were no guidelines in place for medication that should be given ‘as required’ (PRN). Medication for one resident had stopped because there was no stock and there was no evidence to suggest that a new prescription had been ordered. Not all of the medication administration records included a photograph of the resident to allow them to be identified correctly. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 14 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 adequate. Residents are given opportunities to make choices and decisions about their daily life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs recreational therapists who work during the week organising activities within the home such as arts and crafts, quizzes and board games and trips out to places of interest including the Imperial War Museum. On the day of the site visit a group of residents were involved in a quiz. There was a lively atmosphere and there was friendly banter between the staff and the residents. The recreational therapists were encouraged to meet with therapists from the other homes in the group to look at different ideas for activities and outings. The activities organised in the home have recently been moved to a more prominent area of the home so that residents may watch even if they do not wish to take part. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 15 There had been an improvement on the way resident’s interests and hobbies are recorded for new residents being admitted to the home, enabling the staff to support the residents more effectively to pursue their chosen interests. However surveys returned by two relatives stated that they felt that the home should do more to encourage residents to become involved in meaningful exercise including being taken out for walks, especially for those residents who are very mobile. It was noted that the home does not have a specific budget for recreational activities/supplies. There are limited possibilities for raising money and it was recommended that the home look at the possibility of providing a dedicated budget for activities that would possibly extend the range of activities the staff are able to provide. The acting manager stated that a sensory room is planned for the home and that this will provide the residents with more choices about how they would like to spend their day. Representatives of the local churches also visit the home to attend to the residents spiritual needs. Visitors are able to visit the home at any reasonable time and may visit the residents in the privacy of their own room. Just over one hour of the inspection was used to undertake a SOFI (short observational framework for inspectors) exercise. This meant that four residents were observed in their daily routines along with the care practices of staff. The exercise took place in the main dining room on the dementia unit and enabled the lunchtime period to be observed. This observation noted that interactions between staff and residents were generally good with staff being positive in the way they spoke and responded to residents. Staff were seen to be courteous, encouraging and ready to have a laugh over a shared experience. During the period of observation none of the residents were seen to in any discomfort or distress. Throughout the site visit staff were observed to give residents choices and encourage them to make decisions about their daily lives. The home has links with the local advocacy agency for those residents who may need independent advice and support. Residents were also encouraged to bring personal possessions into the home to help make their rooms and living areas more comfortable. The meals appeared to be satisfactory. A choice was offered to residents and staff were observed asking staff what they would like for lunch. The staff spoken to were aware of the individual dietary needs of the residents and were observed to provide sensitive support to the residents who needed some help Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 16 at meal times. There was a determination on the part of the catering staff to provide meals that the residents enjoyed. There were some concerns regarding the meals served. Meals were observed to arrive on the trolley uncovered at the dining room on the first floor. There were concerns over the hygiene arrangements in respect of these arrangements. Additionally on this floor, there are no arrangements to keep food warm until residents are ready to eat. Although there were dishes in the kitchen that enabled staff to serve flavours separately for those residents needing soft diets and liquidised foods, we noted that a soft diet meal was served with all of the flavours mixed together. This looked unappetising and did not allow the resident to enjoy the different tastes and textures. One resident had said that there was a long wait in the dining room before meals were served. On the day of the site visit there was no evidence that residents had a long wait before the meals arrived. The menu was changed regularly with the home taking into account the needs and preferences of the residents. Snacks and drinks are available at all times. It was also recommended that some thought be given to developing a safe kitchen area on the dementia unit. This would enable staff to make drinks and snacks for the residents without having to leave the unit. Stocks Hall DS0000005909.V352213.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 poor. The home needs to be more effective in the way it responds to complaints and allegations if it is to improve the care provided for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has good policies and procedures in place that give clear information as to how complaints can be made and how they will be addressed. Similarly policies and procedures that deal with the protection of vulnerable adults are clear. Staff have received training in this area and those spoken to knew who to speak to if they had any concerns. The home recognise that they have not kept detailed enough records about the concerns that they had received. The acting manager told us they planned to make improvements and monitor concerns and complaints more closely. This will help them to identify any trends and help ensure that all concerns and complaints are dealt with effectively. One resident told us in a returned survey that they did not know who to approach if they had any concerns about the home. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 18 Since the last site visit, four safeguarding adult issues have been raised relating specifically to the support and care that the residents in the home receive. In each case the home has co-operated with a number of agencies as these matters have been investigated. They have recognised where changes need to be made to protect and ensure the safety and well being of the residents. Two of these concerns have been dealt with promptly and efficiently. A lack of consistent management has made it difficult for other changes and improvements to be made. The families of two residents have told us that they have not been satisfied with the way the home has responded to the concerns they have raised. Although the home has some good policies and procedures in place, there can be a lack of attention to detail either in the care provided or in the record keeping in the home. Residents are therefore at risk of not receiving the care that they need. Stocks Hall DS0000005909.V352213.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 and 26 Quality in this outcome area is adequate. Improvements could be made to the environment to give residents a cleaner home with more choice of living space. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Stocks Hall presents as a home that is generally clean, tidy and comfortable and appears to be reasonably well maintained. Some improvements have been made since the last site visit. The laundry and kitchen areas have been screened off from the garden to help keep the residents safe. Inside the home, curtains in all of the communal areas have been replaced, as has much of the furniture. New lighting has also been installed and the home is much better lit. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 20 Bedrooms are personalised with residents being able to bring in some of their own possessions. Those bedrooms seen were clean and comfortable. There were some areas that could have been cleaner and tidier. The floor of the small kitchen area on the dementia unit was sticky and two of the offices were so untidy they could not be cleaned properly. The floor of one office was sticky from medication spills. Some work has been identified as needing to be attended to. This includes the installation of a new nurse call system throughout the home and plans to install a sluice downstairs. A replacement bath has been ordered for one of the bathrooms and picture frames have been purchased to enable residents on the dementia unit to personalise these and so recognise their bedroom doors more easily. The heating in the dining room on the dementia unit wasn’t effective but a member of staff said that it had been reported and it was expected to be to be attended to. It was recommended that the home provide coffee tables in the dementia unit to enable residents to put their drinks down at the side of their chairs. The home has recognised that it has areas that are underused including the dining room upstairs, and some thought is being given to how better use may be made of the premises giving the residents more choice of living space. The home has been visited by the Environmental Health Officer following the outbreak of an infection and also by the Fire Service since the last site visit and had taken action to act on their requirements and recommendations. On the day of the site visit a member of staff was observed not to take necessary precautions to prevent the spread of infection, by continuing to wear protective gloves as he walked through the home, after assisting a resident with personal care. Stocks Hall DS0000005909.V352213.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): 27, 28, 29 and 30 Quality in this outcome area is good. Staff are safely recruited and are provided with a range of training opportunities to enable them to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the site visit staff appeared to be calm and relaxed and the residents were happy in their company. Those staff spoken to said that there were generally enough staff on duty when there was a full complement of staff. Surveys completed by two residents said that staff were only ‘sometimes’ available when they needed them while the residents spoken to praised the staff for the support that they provided. One problem highlighted by the staff spoken to was the frequent use of agency staff that often creates extra work for regular staff and inconsistent care for the residents. The acting manager said that there were signs that the use of agency staff was being reduced as more staff were being appointed and that it was hoped that the staff team would soon be more settled. The information provided before the site visit stated that over 60 of the staff team had achieved a nationally recognised qualification in care. Training records also showed that had staff received mandatory training in all of the Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 22 necessary areas. The staff who were spoken to during the site visit confirmed this. The home also planned to encourage staff to attend additional and specialist training courses to help them meet the needs of the residents. The home were careful about the way they appointed staff and ensured that all the necessary checks and references were taken up before any one started work at the home. The acting manager also stated that the home usually checked with staffing agencies to ensure that any staff they provided had the necessary experience to work in the home. These steps help to ensure that the residents are protected, being supported by staff who have been fully vetted. Stocks Hall DS0000005909.V352213.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, 36 and 38 Quality in this outcome area is poor. The management arrangements of the home need to be improved to ensure that residents receive the care and support that they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has had a poor year mainly because of inconsistent management arrangements. The registered manager has unfortunately been absent from work for a large part of the year. A manager from another home in the group has been involved in the home in a caretaking role during the registered managers absences. This arrangement, although temporary, has created difficulties. The caretaker manager has introduced new procedures but these Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 24 have not always been being maintained or carried through. The overall lack of consistent management has allowed standards of care within the home to slip. During the course of the site visit the responsible individual for the service visited the home. She said she was fully aware and concerned about the difficulties the home is facing and said that the company is committed to making changes to improve the home. Some steps have already been taken to resolve the difficulties by introducing consistent management arrangements. A deputy manager has been appointed from within the home and a full time acting manager has been appointed and will take up the post at the end of 2007. All of the staff spoken to said they were looking forward to the new acting manager taking up her post and staff and thought that the home will improve when this happens. Not all of the staff had received regular formal supervision from a senior member of staff. It was recommended that this be introduced to help improve the quality of the care and support that the home provided to the residents. The home has a number of quality assurance monitoring systems in place. It has achieved the Investors in People Award which is a quality assurance award accredited by an external body. A survey of relative’s views of the home had been undertaken in November 2007. Fourteen of these had been returned and of these twelve relatives said they were generally satisfied with the service the home provided. There were no major criticisms of the home. A monthly monitoring visit is made to the home when residents, staff and any visitors are spoken to and the environment is checked and any issues are highlighted. Additional monitoring systems should be developed to ensure that the home meets its aims and objectives, including internal audits that look at the management of medication and checks that care plans are accurate and up to date. The home is aware that it needs to review all of its policies and procedures to ensure that they reflect best practice and a start has been made on this. Resident’s monies are well managed with records being accurately kept. During the course of the site visit a resident asked for some of her money and a member of staff dealt with her sensitively and efficiently. Policies and procedures in relation to resident’s money and financial affairs protect the resident as far as possible. The home is generally well maintained with all systems and equipment being checked and serviced appropriately with a view to promote the health, safety and welfare of the residents and staff. However the acting manager must ensure that the fire equipment checks are undertaken as necessary as it Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 25 appeared that no checks had been made since late November. The acting manager said that the paperwork for these checks was being revised. Records showed that the staff team had received training in health and safety, including moving and handling, food hygiene and infection control. Staff spoken to on the day of the site visit confirmed this. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 2 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 1 X 2 X 3 1 X 2 Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 12 Requirement The registered person should ensure that residents receive the care and support they need to promote their health and welfare. To protect the residents, the registered person must ensure that the home manages and administers medication safely. Complaints must be managed effectively to ensure that the care and support provided to residents is appropriate. The registered person must make arrangements to prevent residents being placed at risk of harm or abuse. The responsible individual must ensure that the home is managed with sufficient care, competence and skill to ensure that the health and well being of the residents is promoted. Timescale for action 31/03/08 2. OP9 13(2) 29/02/08 3. OP16 22(1) 29/02/08 4. OP18 13(6) 31/03/08 5. OP31 10 31/03/08 Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 28 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. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Refer to Standard OP7 OP7 OP7 OP9 OP9 OP9 OP12 OP12 OP15 OP15 OP15 OP16 OP19 OP26 OP26 OP33 Good Practice Recommendations Care plans should be more detailed to give staff more information about the service users support needs. The daily record of care provided to service user on a daily basis should be more detailed to enable the health and welfare of residents to be monitored effectively. Care plans and risk assessments should be reviewed on at least a monthly basis to enable residents changing support needs to be managed. Medication administration records should include a photograph of the service users to help ensure medication is administered correctly. The administration of all medication should be recorded including creams and food supplements. Guidance should be drawn so that staff are clear when ‘as required’ (PRN) medication should be administered. The home should look at the possibility of identifying a specific budget for recreational activities and supplies to enable the range of activities to increase. Residents should be supported to take meaningful exercise. Meals should be covered when moved around the home. A means of keeping meals warm should be introduced for those served in the first floor dining room. A kitchen should be developed on the first floor to allow staff to make snacks and drinks without leaving the unit. The registered person should ensure that all residents know how to make a complaint. The dementia should have coffee tables to enable residents to put drinks down at the side of their chairs. All areas of the home should be kept clean and hygienic. Systems should be in strengthened to prevent the spread of infection. The home should introduce additional self-monitoring systems to help ensure that home meets its aims and objectives including an internal audit of the management of medication. All staff should receive formal supervision at least six times a year to support them to develop their skills and DS0000005909.V352213.R01.S.doc Version 5.2 Page 29 17. OP36 Stocks Hall 18. OP38 experience. The home should ensure that fire equipment checks are undertaken to protect those living and working in the home. Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Stocks Hall DS0000005909.V352213.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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