CARE HOMES FOR OLDER PEOPLE
Stocks Hall Nursing Home Stocks Hall 50c Whitemoss Road Skelmersdale Lancashire WN8 8BL Lead Inspector
Vivienne Morris Unannounced Inspection 23rd February 2006 09:30 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 Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 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 Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Stocks Hall Nursing Home Address Stocks Hall 50c Whitemoss Road Skelmersdale Lancashire WN8 8BL 01695 555234 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 Susan King Care Home 60 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (24), Physical disability (1) of places Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of 60 service users to include: Up to 24 service users in the category of OP (Old age not falling within any other category). Up to 36 service users in the category of DE (Dementia) One named service user in the category PD (Physical Disability under 65 years of age) may be accommodated within the overall number of registered places. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 21st July 2005 5. 6. Date of last inspection Brief Description of the Service: Stocks Hall is a purpose built establishment, providing nursing and personal care for up to 60 elderly persons, including people whos care needs are associated with Dementia. The home is set in pleasant, well maintained grounds. A patio area with garden furniture is available for those wishing to spend some time outdoors. Private accommodation is located on two levels, the first floor being accessible by passenger lift or stairs. The majority of bedrooms are single with a high percentage having en suite facilities. Two companion rooms are available for married couples, friends or those preferring to share facilities, both having en suite facilities. A number of lounges, quiet rooms and dining areas are available throughout the home, where a variety of activities may take place. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day during February 2006. The inspection focused on the outcomes for people living at the home. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documents were examined and a tour of the premises took place, when a selection of private accommodation was viewed and all communal areas and service areas were seen. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which was in relation to care practices, cleanliness of the service user’s bedroom, medical intervention and pressure care. The complaints were referred back to the provider to be investigated using the home’s complaints procedure. Some elements of the complaints were found to be upheld, others were found to be not upheld and others unresolved. What the service does well:
The privacy and dignity of those living at the home was promoted to ensure that they were respected at all times. Activities were provided in accordance with the preferences of those living at the home to ensure that they were supported to maintain their hobbies and leisure interests. The routines of daily living were flexible, allowing those living at the home to have some control over their lives. A good variety of nutritious food was available at the home and special diets were catered for, as required. The policies and procedures of the home ensured that those living at Stocks Hall nursing home were adequately protected from abusive situations. The home was found to be pleasant smelling and maintained to a high standard of cleanliness, providing a nice environment for service users. Good recruitment procedures were adopted by the home, which adequately protected service users. A great amount of training was provided for those working at Stocks Hall nursing home. This was given by a specifically employed full-time training manager and key members of qualified staff to ensure that all staff received adequate training to enable them to carry out the job for which they were Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 6 employed. The company is a recognised training centre, which shows a commitment to staff training. Those living at the home were able to manage their own finances if they so wished and if they had the ability to do so which showed that service users were able to have some control over their lives. Any money or valuables deposited at the home for safekeeping were safeguarded by the home’s policies, procedures and practices. The registered manager ensured so far as possible the health, safety and welfare of service users and staff by ensuring that, in general all systems and equipment requiring to be serviced had been appropriately checked. One service user commented, “The staff look after me very well” and a relative stated, “ I cannot complain about the care provided for my relative”. What has improved since the last inspection? What they could do better:
Although meals were provided in a relaxed environment the management of meals times should be reviewed to ensure that service users are given the opportunity to choose what they preferred to eat in advance of the meal being served and those requiring assistance with their diet should receive individual attention to ensure that adequate nutritional status is maintained. Some bedrooms were still in need of refurbishment in order to bring all private accommodation up to a high standard of decoration and furnishing. The ratio of care staff to service users should be determined in accordance with the dependency of those living at the home.
Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 7 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. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 8 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 Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were assessed from this section on this occasion. EVIDENCE: There were no outstanding requirements or recommendations relating to this section at the time of this inspection. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10. The privacy and dignity of those living at the home was respected. EVIDENCE: The inspector observed that the privacy and dignity of service user was respected when personal care was being delivered. Staff were seen to be knocking on bedroom doors before entering and were instructed during induction on how to treat service users with respect at all times. The service users’ plans of care showed that privacy and dignity was an important aspect of the care planning process for those living at the home and the service users’ guide supported this information. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. Service users were supported to maintain their hobbies and interests whilst living at the home. Meal times could be better managed. EVIDENCE: Detailed personal profiles had been developed for each service user on admission so that those working at the care home had a clear picture of what people enjoyed doing whilst living in the community. Evidence was available to demonstrate that service users’ identified interests were taken into consideration when organizing activities, so that those taking part would find the activity of some interest. Planned activities were displayed, demonstrating that service users were provided with up to date information about leisure activities and entertainment. Records were maintained of individual participation, including one to one activities, showing that those who were less able were also stimulated and those who had individual hobbies were supported to maintain their interests. The inspector noted that freedom of movement within the home was encouraged and service users spoken to informed the inspector that there was some flexibility in relation to the general routines of the home so that those
Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 12 living there were able to exercise choice and were able to have some control over their lives. A new chef had been appointed at the home since the previous inspection, who had recently revised the menu, which showed that a good variety of nutritious food was on offer. The menu demonstrated that choices were available at each mealtime and the inspector observed alternative choices to the menu being provided as requested. However, these choices were only offered as the meal was being served. This did not allow for service users to select their dietary preference in advance of the mealtime and did not allow for them to request an alternative to the menu without having waiting for their choice to be prepared. Lunch was served in a relaxed environment, with tables being pleasantly laid, which provided a comfortable atmosphere for dining. Staff were seen to be assisting service users with their meals as was required in order to ensure adequate dietary intake. However, it was evident that a high number of service users required assistance with their meals. One member of staff was seen to be assisting two service users at the same time and two staff members were seen to be chatting together whilst assisting service users with their meals, which did not promote individuality. The inspector noted that pureed diets were not presented in an appealing manner in order to maintain appetite and nutrition. Specialized cutlery and adaptations were available where necessary to promote independent eating. One service user commented, “ I enjoyed my lunch, it was very good” and another stated, “ I am quite happy living here”. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The policies and procedures at the care home protected those living there from abusive situations. EVIDENCE: Policies and procedures were in place at the home, which included ‘whistle blowing’ and which were in accordance with the Department of Health guidance ‘No Secrets’ to ensure that those living at the care home were protected, as far as possible, from abusive situations. The home’s policies and practices regarding service users’ money and financial affairs ensured service users’ access to their personal financial records, safe storage of money and valuables, and precluded staff involvement in assisting in the making of or benefiting from service users’ wills to ensure that service users’ money and valuables were safeguarded, as far as possible. A recent allegation of theft had been appropriately reported to ensure that the allegation was thoroughly investigated by the relevant authorities. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26. Some bedrooms were furnished to a high standard, providing pleasant accommodation for those occupying these rooms. However, the furniture in other bedrooms needed to be renovated or replaced in order to provide a homely atmosphere for all the people living at the home. The home was maintained to a high standard of cleanliness, providing a pleasant environment. EVIDENCE: A lot of redecoration and refurbishment had taken place since the previous inspection, which enhanced both the general environment and the private accommodation for those living at the home. A good percentage of bedrooms had been refurbished to a high standard. However, some bedrooms were still in need of upgrading in relation to the furnishings in order to enhance the private accommodation for those occupying these rooms. This recommendation had been partially met since the last inspection. The remainder of this standard was not assessed on this occasion. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 15 Laundry facilities were appropriately sited within the home, providing a selection of suitable machinery to ensure that clothing and linen were adequately laundered. Detailed policies and procedures were in place at the home to ensure that the control of infection was promoted. The home was found to be pleasant smelling and maintained to a high standard of cleanliness, providing a nice environment for service users. One service user told the inspector “the home is always clean and tidy”. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The number and skill mix of staff on duty met service uses needs. Care staff where appropriately trained to meet the needs of those living at the home. Staff were appropriately trained and competent to do their jobs. EVIDENCE: A recorded staff rota was maintained, which demonstrated the number of staff on duty at any time during the day and night. Although, the home routinely determined and recorded the dependency needs of those living at Stocks Hall, it was not evident that these results were considered when calculating staffing ratios at the home. However, the number of care staff allocated to the dementia care unit had been increased since this unit were admitting people with more challenging behaviour. The home was found to be clean, tidy and free from unpleasant odours, providing a nice environment for those living there. Comments received included “ the staff team are very enthusiastic” and “ the staff are all lovely and very approachable”. At the time of the inspection there were 39 care staff employed at the home, 21 of whom had achieved a National vocational qualification at Level 2 or above and the remainder were in the process of undergoing this training, which demonstrated that a high percentage of care staff were appropriately trained to meet the needs of those living there.
Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 17 The records of two newly appointed staff members were examined which demonstrated that the home operated a thorough recruitment procedure in order to protect the people living at the home. The company employed a full-time training manager and key members of qualified staff were identified as designated trainers, who were responsible for ensuring that all staff had received appropriate training in accordance with individual needs, the needs of the service users and the needs of the home. The company had been accredited as a training centre and therefore a great variety of training was provided to ensure that staff were kept up-to-date with current legislation and good practice guidelines. A matrix was in place at the home demonstrating that the service was committed to staff training and development. New employees had received a detailed induction period followed by a period of foundation training to ensure that all those working at the home were competent to adequately meet the needs of service users. A great amount of training was provided for all staff, including core training and training specific to the category of service users admitted to the home. Staff spoken to confirm that they received plenty training in accordance with their need for personal development and the needs of the people living at the home. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38. Service users’ money and valuables were protected by the policies and procedures of the home. The health, safety and welfare of service users and staff as adequately protected. EVIDENCE: The inspector examined the service users’ personal allowance accounts and found that these were very clear records showing any credit or expenditure, supported by the retention of relevant receipts so that an audit trail could easily be conducted. Secure facilities were provided at the home for the retention of money and valuables handed over by service users for safekeeping. The registered manager, in general ensured so far as was reasonably practicable the health, safety and welfare of service users and staff. All
Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 19 systems and equipment requiring to be serviced were found to have had the appropriate checks, except the maintenance of the electrical installation, which was due to be serviced in January 2006. Appropriate policies and procedures were in place in relation to safe working practices, which had been regularly reviewed and updated as necessary to ensure that current legislation and upto-date good practice guidelines were being followed. A variety of risk assessments had been conducted for safe working practice topics and strategies were implemented to eliminate or minimise any identified hazard to ensure the protection of those living at and those working at the home. All accidents, injuries and incidents were clearly recorded and appropriate action had been taken when necessary in accordance with the Data Protection Act 1999. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 (4) (a) Requirement The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. This includes evidence of servicing of the electrical installation. Timescale for action 31/03/06 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 OP15 Good Practice Recommendations Systems in place at meal times should be reviewed to ensure that service users are given the opportunity to select their preferred choice of diet in advance of the meal being served. Individualized care should be promoted by staff assisting service users with their meals, as required on a 1:1 basis. Liquidized and puréed diets should be presented in an appealing manner in order to promote service users
Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 22 2. 3 OP24 OP27 appetite and nutrition. The registered person should continue to replace or renovate the remaining bedroom furniture, which is in poor condition. The ratios of care staff to service users should be determined according to the assessed needs of residents, and a system operated for calculating staff numbers required. Stocks Hall Nursing Home DS0000025581.V280335.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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