CARE HOMES FOR OLDER PEOPLE
Stocks Hall Nursing Home Stocks Hall 50c Whitemoss Road Skelmersdale Lancashire WN8 8BL Lead Inspector
Vivienne Morris Unannounced Inspection 8th March 2007 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.V323025.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 Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 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) sueking@stockshall-care.co.uk 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 (2) of places Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 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) Two named service user in the category PD (Physical Disability under 65 years of age) may be accommodated within the overall number of registered places. 23rd February 2006 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 people, including those 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 partners, friends or those preferring to share accommodation, 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. The fees at the time of the site visit ranged from £482 - £570 per week. Additional charges were being incurred for hairdressing, chiropody, magazines/newspapers, toiletries, private medical care, dry cleaning, cable television/satellite, telephone rental and calls, A la carte menu services, dental care, optical care, residential group outings and taxi fares. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two regulatory inspectors from the Commission for Social Care Inspection conducted an unannounced site visit to this service over one day in March 2007, which formed part of the key inspection process. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from twelve people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the preinspection questionnaire has also been taken into consideration when writing this report. The inspector ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which were referred back to the provider to investigate and which was looked into by the inspectors at the time of the site visit. What the service does well:
The information gathered before admission was extremely detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be adequately met. The plans of care were extremely well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. One comment card received from a relative stated, “ The family have nothing but praise for the care given to our relative in the home and another commented, I can only praise the staff at Stocks Hall for the level of care given to my relative and also for the support given to the family”. A variety of external professionals had been involved in the care of people living at Stocks Hall Nursing Home to ensure that their health care needs were being appropriately met. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 6 A range of risk assessments were in place to ensure that systems were implemented to protect the health and safety of anyone on the premises. Relatives spoken to were happy about how visitors were received into the home and they informed the inspectors that the staff were all very respectful, friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the community. The routine of the home was fairly flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. Service users were provided with a choice of nutritious and well-balanced meals to ensure adequate dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how did they could make a complaint should they so wish. The policies and procedures in relation to safeguarding adults were in accordance with the Department of Health guidance ‘no secrets’, so that people knew the procedure to take should an allegation of abuse be received by the home. The finances of residents were adequately protected by the policies, procedures and practices of the home. The home was tastefully furnished and in general pleasantly decorated to a good standard and the premises, both internally and externally were well maintained providing those living at Stocks Hall Nursing Home with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling and effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that adequate care was delivered. Recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Stocks Hall Nursing Home were adequately protected. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 7 A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet people’s assessed needs. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents were protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. The home was well managed by a competent person and a team of skilled senior staff, who together had completed a wide range of training so that they were able to deliver the care required by the individual residents. What has improved since the last inspection?
The management of meal times had improved since the last inspection and people were being assisted with their meals in a dignified and individualised manner. However, one recommendation remained outstanding from the last inspection, which is identified in the next section ‘what they could do better’. There had been several improvements to the premises since the last inspection, such as decoration and new furnishings. A jaccuzi and snoozalon had been installed. There was a new walk in shower room on the ground floor and an air conditioning unit had been installed in the treatment room. A ramp had been erected from the ground floor day room, providing those needing a wheelchair to get about with the same opportunity as the more mobile to access the grounds of the home. The electrical installation had been appropriately serviced to ensure that the safety of the people living and working in the home was protected. The percentage of care staff having achieved a National Vocational Qualification at level 2 or above had increased significantly since the last inspection, showing that a high percentage of care staff were appropriately trained. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 8 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. Stocks Hall Nursing Home DS0000025581.V323025.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 Nursing Home DS0000025581.V323025.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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The preadmission process was very thorough so that the staff team were confident that individual needs could be met and that the independence of people could be maximised. EVIDENCE: At the time of the site visit the inspectors ‘tracked’ the care of four people living at the home. The care records seen showed that the needs of people had been very thoroughly assessed before they moved into the home and that a lot of information had been considered prior to the admission process commencing. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 11 The detailed assessments had been retained on residents’ files so that those working at the home were confident that the staff team were able to deliver the care required in order meet individual needs. The assessed needs of those admitted to the home were consistently recorded within the care plan, providing staff with detailed information as to how service users’ needs were to be met. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. Stocks Hall Nursing Home DS0000025581.V323025.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 Excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were being consistently met and their privacy and dignity was always respected. EVIDENCE: The care of four people living at the home was ‘tracked’ during the course of the site visit. All four plans of care had been developed from the information gathered prior to admission and were found to be extremely detailed and well-written documents. This enabled staff to have a clear picture of people’s assessed needs and how these needs were to be appropriately met. Residents or their relatives had been given the opportunity to be involved in the care planning process, so that they could have some in put into the care provided. The plans of care had been consistently reviewed every month to show that the needs of
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 13 people were being regularly assessed so that their current needs were accurately reflected. All comment cards received from six relatives showed that they were satisfied with the overall care provided to the people living at the home. The registered manager and staff team are to be commended on the consistently high standard of care planning adopted by the home. The pre inspection questionnaire and the care records showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care needs were being appropriately met. Comment cards received from four General Practitioners (GP’s) showed that they were satisfied with the overall care provided to their patients. One GP indicated that when a visit was requested by the home it would be helpful if the surgery was informed which unit of the home the resident was living in, so that on arrival the GP could proceed directly to the appropriate unit. One resident said that a GP had been called when she was unwell and that staff were polite and sensitive to her needs. One visitor spoken to was very happy with the care provided to their relative and said, “everyone does their best”. A specialised nurse was at the home at the time of the site visit, providing health care support. Comment cards received showed that everyone was treated equally and that people felt that they received medical support when needed. Appropriate pressure relief was being delivered and specialised equipment was provided to make the lives of people living at the home as comfortable as possible. A wide range of assessments were in place so that the health and safety of people living in the home were protected within a risk management framework. The pre inspection questionnaire showed that the medication policies and procedures had been reviewed and up dated this year so that staff were aware of current regulations and guidelines in relation to the safe administration of medications. Clear medication records were maintained to ensure that a thorough audit trail was evident and photographs were retained of each resident on their Medication Administration Records for identification purposes. The management of medications was good. However, although ‘as and when required’ medications were clearly recorded on the charts, it is recommended that written guidance be provided for staff so that they are aware of possible triggers, which may indicate the administration of these medications is required.
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 14 Although any refusals of medications were clearly recorded on the medication charts it is recommended that strategies be implemented for when a resident refuses medication and that when someone consistently refuses prescribed medication, then this is recorded within the residents’ care records. The inspector observed staff speaking to residents in a respectful manner and knocking on bedroom doors before entering to ensure that privacy and dignity was consistently maintained. A written policy was in place and available to staff, which demonstrated that those living at the home were supported to maintain their privacy and dignity at all times. Induction records showed that staff had been instructed to treat service users with respect and care records demonstrated that the wishes of people were respected in relation to maintaining privacy and dignity when giving personal care. Residents spoken to stated that the staff treat them well and respect their privacy and dignity at all times. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and recreational activities were provided in accordance with residents’ expectations and the rights of people were upheld. Residents received a wholesome diet, although liquidised meals were not well presented. EVIDENCE: Both residents who submitted comment cards said that there were usually activities arranged which they could take part in. Residents spoken to said that the routine of the home was relaxed and that people were able to get up and go to bed when they wanted to. One resident said that people can have their meals in their rooms if they wished to do so and that there was always a choice of menu offered. Staff were seen offering people a variety of choices in relation to daily living and residents spoken to said that staff were very helpful. Activities organisers were employed by the home who were responsible for the planning of social activities both in the home and within the community. A small group of people were involved in craft activities on the day of the site visit, which they seemed to be enjoying. Records were retained about people’s
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 16 leisure interests and hobbies, including religious needs so that staff were aware of individual social care needs, and could therefore plan activities accordingly, showing that those who were less able to participate were given the same opportunities as others by the provision of 1:1 activities. A sensory room was available for those requiring periods of relaxation. Residents said that outside entertainers visited the home and occasional trips out were arranged, which they enjoyed. A variety of notices were displayed informing people about what activities were available and one relative said that visitors are encouraged to become involved. Information about the provision of activities was included within the statement of purpose and service uses guide, so that people were aware of what activities were provided. The pre inspection questionnaire showed that policies were in place in relation to equal opportunities. This included an explanation of the six principals of care, including rights, fulfilment, independence and choice, showing that all those living at the home were given the same opportunities to make decisions and informed choices about their daily lives. The plans of care showed that people’s choices had been taken into consideration and they included information about the leisure interests of residents so that staff were able to provide activities in accordance with people’s preferences. The care plans recorded people’s social histories well so that staff could get a clear picture of each person’s life, interests and hobbies. One service user confirmed that religious ministers visited the home regularly to conduct services and the statement of purpose supported this information. A visiting policy was in place at the home and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. Relatives were seen to be visiting people in private and visitors spoken to felt that they were made to feel welcome to the home at any time and that a friendly environment was provided for both residents and visitors. The comment cards received supported this information. Personal possessions adorned individual rooms, where appropriate to create a homely environment and audits of service users’ belongings had been conducted on admission to protect the safety of individual’s personal possessions. People living at the home were able to manage their own finances, if they so wished and if they were capable to do so, showing that they were able to have some control over their lives. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 17 The four weekly menus were examined and were found to provide a choice of well-balanced meals to ensure that those living at the home received a nutritious dietary intake. The menu of the day was clearly displayed, so that people were aware of the choices they had been given for lunch. Staff were seen offering people choices of meals and a resident confirmed that there were alternatives to the menu available if required. The pre-inspection questionnaire showed that residents were offered a choice of menu and that special diets were provided as required. The food served at lunchtime was nutritious, but not consistently well presented, as the separate flavours for those requiring liquidised meals had been mixed together. The inspector noted that specialised utensils were provided to aid in independent eating, but that people were also supported with their meals in a dignified manner as needed. The catering staff were aware of individual dietary needs, preferences and any special diets required so that people were receiving meals, which fulfilled their expectations. The dining rooms were found to be relaxed areas for people to eat in, with well-presented tables and unhurried atmospheres, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings. Residents spoken to were all happy with the quality and quantity of meals served. One resident said, “I always enjoy my meals. We are asked what we want to eat and the staff help me if I need”. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were well managed and people living at the home were adequately safeguarded. EVIDENCE: A detailed complaints procedure was in place at the home, which was displayed prominently and which was included within the service users guide, showing that people were given enough information about making a complaint should they wish to do so. Five of the six comment cards received from relatives indicated that they would know how to make a complaint, should they wish to do so. Of the two comment cards received from residents, one said that they would know who to speak to if they wished to make a complaint and the other said that they wouldn’t know what to do to make a complaint. Residents spoken to at the time of the site visit said that they would know what to do if they were not happy about something at the home. A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. The pre-inspection questionnaire showed that the home had received six complaints since the last inspection, which had been dealt with according to the home’s complaints procedure. The Commission for Social Care Inspection had received one complaint about this service since the last inspection, which
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 19 was referred back to the provider to investigate under the home’s complaints procedure. However, the inspectors looked into the concerns raised at the time of the site visit and found that a thorough investigation had been conducted. Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. Staff spoken to confirmed that they had received training in relation to safeguarding adults and the training matrix seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home provided a safe and generally well-maintained environment for people to live in, which was clean, pleasant and hygienic. EVIDENCE: The pre-inspection questionnaire showed that there had been a significant amount of decoration to bedrooms since the last inspection and that more was planned for the future. A programme of routine maintenance demonstrated that the up keep of the premises, both inside and out was an ongoing process, so that the home was in general well maintained, providing a safe and pleasant environment for people to live in.
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 21 One bath had been converted into a Jacuzzi and a walk in shower room had been installed on the ground floor. There was evidence of changes to the use of some administrative rooms on the first floor and a snoozalon had been installed on the ground floor. An air conditioning unit had also been installed in the treatment room so that the shelf life of medications would be maintained. The pre inspection questionnaire showed that a ramp had been provided from the ground floor day room into the pleasant and safe garden area. This allowed people easier access to the grounds of the home, which showed that people requiring the use of a wheelchair to get about were given the same opportunity as the more mobile to access the gardens. A tour of the premises took place during the site visit when the home was found to be, in general, tastefully decorated and furnished to a high standard, providing a very homely and comfortable environment for people to live in. However, some areas were still in need of minor decoration, but it was evident that this was an on going process and plans for these areas to be addressed were in hand. One resident said, “I am very happy with my bedroom, it has recently been decorated and I was able to choose my own decoration and fabrics. Don’t you think it is lovely?” The bedrooms were found to be bright and individualised and photographs of the residents were displayed on each bedroom door to aid in orientation. The communal lounges and dining rooms were pleasant and comfortable for people to sit during the day, providing a homely environment for those living at the home. The building was fit for purpose and was maintained to a good standard of repair so that people living at the home were provided with a safe and homely environment. The home was found to be clean and odour control was effective so that the home was pleasant smelling. However, the staff toilet adjacent to the kitchen was in a dirty condition and in need of a thorough clean. Out of the two comment cards received from residents, one said that the home was always fresh and clean and the other said it was fresh and clean in the morning, but not always later on in the day. Residents spoken to were satisfied with the standard of private and communal accommodation provided. The laundry department was suitable for the needs of the residents and it was well organised, providing sufficient equipment, so that laundry was completed in a timely fashion. Detailed policies were in place at the home to ensure that the control of infection was being adequately met so that the health and safety of people living there was appropriately safeguarded. The inspectors noted that the laundry door was unlocked when vacant, which allowed residents easy access to the laundry equipment and domestic products kept in this area. However, due to the category of people living in the home it would be unlikely that residents could access the laundry of their free will. Therefore, it is
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 22 recommended that a risk assessment be conducted and strategies be put in place based on the outcome of the assessment. The inspectors observed that a relaxed and happy environment was provided for those living at the home, so that they were comfortable and so that they felt safe. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 23 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. This judgement has been made using available evidence including a visit to this service. Staff working at the home were appropriately trained and in sufficient numbers to meet changing needs of residents and the recruitment procedures adequately safeguarded those living at the home. EVIDENCE: At the time of the site visit there were 57 people living at Stocks Hall Nursing Home. The number of staff on duty was being calculated in accordance with the assessed needs of people living at the home, using a bench marking system and records showed that a good skill mix of staff made up the staff team so that residents’ needs were being met. The inspectors noted that additional staff were brought on duty so that one to one supervision could be provided, when necessary. The pre-inspection questionnaire showed that agency staff were used as required, provided by the company’s registered agency so that continuity of care was maintained. Of the two comment cards received from residents one said that there were always staff available when needed and the other said that there were usually staff available when needed. Staff spoken to felt that they were not under pressure to complete work as in general there were enough staff on duty to meet the needs of people living in the home.
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 24 Equal opportunity policies were in place at the home to ensure that everyone applying for work was treated the same and was given the same job opportunities. Residents spoken to felt that their needs were being fully met and that the staff were kind and caring. One resident said, “The staff are extremely helpful and will always help me out if I need it”. The pre inspection questionnaire showed that there was a total of thirty nine care staff employed at the home, twenty eight of whom had achieved a National Vocational Qualification at level 2 or above, giving a total of 71 of care staff suitably qualified, which is commendable. Formal induction processes had been adopted by the home so that staff understood their role and were able to perform the duties expected of them. . The pre inspection questionnaire showed that a wide range of training was provided for staff so that people working at the home were competent to look after the people in their care. All staff completed a variety of mandatory coretraining courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people they were caring for. Staff spoken to felt that a lot of training was provided to meet their needs, including training specific to the care of people living in the home and staff training certificates available on files supported this. Three staff files were examined at the time of the site visit. It was found that recruitment procedures were being followed in day-to-day practice and that sufficient checks had been undertaken on staff to ensure that those living at the home were adequately protected. However, it is recommended that when there is a significant delay between staff completing an application form and staff being recruited that strategies are put in place to determine if there have been any changes of circumstances so that current information is obtained. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed by a competent person, having effective systems in place for monitoring the quality of service provided. The health, safety and welfare of people living at the home were sufficiently protected. EVIDENCE: The manager of Stocks Hall Nursing Home has been in post for a number of years. She has the required qualifications and experience and is competent to run the home. During the time she has been in post she has worked hard to improve the service and to provide an increased quality of life for residents. She has the skills to operate the home efficiently and effectively for people living there. There was a strong belief of being open and transparent in all
Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 26 areas of running the home so that people were kept informed of matters involving them. The manager had completed a variety of additional training courses and was resident focused. She leads and supports the staff team who have been appropriately recruited, so that those living at the home are adequately protected. Residents and staff spoken to were happy with the management of the home and felt that they would be able to approach the manager if they had any concerns or if they wished to discuss any thing. A variety of surveys were being conducted annually so that the views of residents, their relatives and stakeholders were obtained about how the service was performing. The information gathered was put together and produced to show interested parties the strengths and weaknesses of the service. A variety of meetings were held, with minutes kept, so that people were informed of any relevant matters. The home had been accredited with a number of external awards, showing that it was audited on a regular basis by external professional bodies. The registered manager had put in place a variety of regular, detailed checks. This enabled her to identify and address any shortfalls within the systems in place at the home and closely monitor the quality of service provided. The registered person ensured that visits to the service were conducted at least every month, when a full report was made so that the service could be monitored. Of the six comment cards received from relatives, two stated that they did not have access to the inspection reports. However, it was noted that a copy of the last report was clearly available in the reception area, so that people could read it to determine how the service was performing. Systems were in place at the home to ensure that residents’ finances were adequately protected. The relatives of residents were often responsible for the management of their money. However, the provider of the home was acting as appointee for a small number of residents. Clear records were kept of any money or valuables retained at the home on behalf of service users so that the possibility of any mishandling was reduced. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. The pre-inspection questionnaire showed that all systems and equipment within the home had been appropriately checked so that the health and safety of people living at the home was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 27 had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. The environment was free from any hazards, which could pose risks to those living at the home. The registered manager had previously submitted confirmation that the electrical installation had been appropriately serviced. Therefore, this requirement from the last inspection had been addressed. Fire drills were conducted periodically to ensure that all staff were familiar with the fire procedure and evacuation plan within the home and a record was retained of staff attendance so that the home could ensure that all staff were involved in a fire drill at least annually. Policies and procedures were in place at the home in relation to Health and Safety issues, moving and handling, food hygiene and Infection Control practices, so that staff were aware of the importance to ensure that the health, welfare and safety of people living at the home was consistently protected. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 28 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 29 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. 2 Refer to Standard OP9 OP9 Good Practice Recommendations Written guidance should be provided for staff so that they are aware of possible triggers, which may indicate the administration of ‘as and when required’ medications. Strategies should be implemented for when a resident refuses medication and when someone consistently refuses prescribed medication, then this should be recorded within the residents’ care records. Liquidised and puréed diets should be presented in an appealing manner in order to promote service users appetite and nutrition. The few parts of the home which are still in need of minor decoration and refurbishment should be identified and upgraded so that these areas are brought up to the high standard of the remainder of the home. The kitchen staff toilet should be thoroughly cleaned, The registered manager should conduct a risk assessment and implement strategies in relation to the laundry
DS0000025581.V323025.R01.S.doc Version 5.2 Page 30 3. 4. OP15 OP19 5. 6. OP19 OP26 Stocks Hall Nursing Home 7. OP29 department being unlocked when vacant. It is recommended that strategies be put in place so that if there is a delay between staff completing an application form and them being recruited, any change in circumstances is determined. Stocks Hall Nursing Home DS0000025581.V323025.R01.S.doc Version 5.2 Page 31 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
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