CARE HOMES FOR OLDER PEOPLE
Stone House Union Street Bishops Castle Shropshire SY3 5HJ Lead Inspector
Pat Scott Unannounced 15th June 2005 09:30 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 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. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Stone House Address Union Street, Bishops Castle, Shropshire, SY3 5HJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01588 638487 01588 638582 Coverage Care Shropshire Limited Pauline Tremellen Care Home 40 Category(ies) of Old age (28)Dementia (9)Learning Disability registration, with number over 65 years (3) of places Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The number of persons for whom personal care is provided shall not exceed 40. 2. The number of adults with a learning disability over 65 years of age may not exceed 3. 3. The number of older persons accommodated in the home shall not exceed 40 of whom up to 9 may have dementia. 4. Pauline Tremellen must complete NVQ 4 by the required date. Date of last inspection 4th October 2004 Brief Description of the Service: Stone House care home is managed by Coverage Care (Shropshire) Ltd, a nonprofit making organisation. The home provides personal care and accommodation for up to 40 older people who have a range of different needs. Situated near the centre of Bishops Castle the home is adjacent to Stone House Community Hospital. The homes kitchen supplies meals to the hospital and the laundry provides facilities for the hospital. Accommodation is arranged into five separate units each containing single bedrooms, toilet and bathing facilities, lounge/dining area and kitchen facilities. The units are well decorated with comfortable furnishings, which creates a homely atmosphere. There is also a day centre and the comings and goings of groups of service users adds to the air of community involvement.Mrs Pauline Tremellen, who has a great deal of past experience in the provision of residential care for older people, manages Stone House on behalf of Coverage Care. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on the 15th June 2005 between the hours of 10.00 and 12.00 and was unannounced. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s objectives to be able to meet service user requirements and expectations were being met. Reports regarding an overview of the conduct of the home are sent to CSCI on a monthly basis by the Head of Operations for Coverage Care. These, as well as the risk assessment from the last inspection were taken into account to determine the core standards focused on and depth of inspection. What the service does well:
The home provides for the needs of elderly people including those with dementia through small group living and a wide variety of activities. Service users were seen to be treated in a respectful and dignified way and some of those spoken with stated that they were well cared for at Stone House. After appropriate risk assessment, service users are not discouraged or unduly restrained from undertaking activities solely for fear that for example, they may hurt themselves. (see below, what they could do better). The home is not purpose built and service users on the ground floor dementia unit are unable to access other parts of the home. Inevitably, service users come to a ‘dead end’ when walking around their unit. The experience and training of staff with dementia needs is such that this aspect is well managed. Coverage Care provides training to a level that creates a trained and experienced staff team that is well managed as examination of files and in discussion with staff and the deputy manager showed. The home provides
Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 6 useful literature on dementia for staff to refer to. Service users stated that the staff always “know what they are doing”. Outside contact is encouraged and the home has links with the local community. The deputy manager stated that they would like to increase community contact in the home. The home is a known resource in the small community of Bishops Castle and many service users and their families are known to each other. So contact already goes on to a large degree as the public are invited to activities in the home. This is an area which they already do well in but state they want to continue to improve upon. Service users were very complimentary about the daily life within the home. They stated that they could spend their day where they liked and have visitors when they wished to. The Commission does not currently have any concerns regarding this home. What has improved since the last inspection? What they could do better:
Two of the communal bathrooms are carpeted on the flooring and the bath sides. In such areas the recommendation is to use hard flooring. One of the two facilities did have a stained area around the toilet which is both unsightly and unhygienic. The deputy manager stated that these are in the long term plan for refurbishment. It is strongly recommended that this be completed as soon as possible. This has been carried out in other Coverage Care homes. It is acknowledged that these areas are thoroughly cleaned every day. Following on from ‘what they do well’: Bed rails, also known as cot sides and bed guards are used in the home to protect vulnerable service users from falling out of bed. Employers should ensure that all employees who are responsible for selecting, fitting and checking bed rails have received appropriate training. Other staff, such as care assistants and support workers who make beds and help service users in and out of bed, also may remove and replace bed rails. These employees should be
Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 7 given information and instruction in the correct fitting and adjustment of bed rails. This topic was discussed with the Deputy Manager (who is the health and safety representative for the home) who agreed to include the management of this area in the general maintenance of equipment records, health and safety audits and training in the home. Implementation of this would improve health and safety for both service users and staff. 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. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 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 standard(s) 1,3 The homes statement of purpose and service user guide is good providing service users and prospective users with details of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: The information provided to service users gives details of needs assessment to be conducted prior to admission and examination of care plans on the units confirmed that this process had been carried out. The deputy manager stated that all new people receive a copy. The statement of purpose and service users guide were on display in the foyer. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 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 standard(s) 7,8,10,11 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Personal support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life as well as at the end of life. EVIDENCE: Care plans looked at for 4 service users were consistently completed and had all the useful information in them that is necessary to enable a care worker to provide the right care for that individual in a way that meets their wishes and preferences. Ascertaining such information can be difficult when an individual has dementia or mental health problems and records provide evidence of consultation with families and other supporters. The information that was read showed that individuals receive the level of care which their own situation requires. All care plans seen had been signed by the service user. Visits by other health care professionals are documented e.g. GP, CPN (Community Psychiatric Nurse). Regular monitoring and review of a service user’s condition takes place to ensure that the correct treatment and care is being given. A service user was particularly unwell during this visit and staff had contacted the GP, obtained
Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 11 medication and carried out frequent monitoring of this person’s condition which was relayed back to the GP. A number of service users had been unwell recently and files showed that staff had taken appropriate action. One of these service users stated that she felt a little better and that the staff had been marvellous. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. Links with the community are good which support and enrich service users’ social and psychological well being. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: There is no imposition of rules or routines within the home. Service users who wished to remain in their room were able to do so and staff were seen to pop in from time to time and were not left for long periods. Service users have their own rooms, places to withdraw to from busy active communal areas, opportunities to prepare food and drink for themselves and choice over when they get up and go to bed. Standards 12 and 14 have been exceeded because of the importance placed on people retaining contacts and continuing to be part of the ‘local scene’ as they had prior to living at Stone House. It is the staffs’ intention to enhance this community spirit further. Staff are to attend an activities for dementia course. Staff work with the Shropshire Reminiscing Society and a local volunteer visits the home.
Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 13 Forthcoming social events are displayed on the notice board of each unit. The minutes of the most recent residents’ meeting held are also on display. The content of these demonstrate that service users opinions are sort and acted upon. There is a min-shop in the foyer and a table on display for a prize draw in support of the Air Ambulance. Menus are on display on the dining tables which offer a varied and nutritious diet. Service users spoken with stated that they liked the meals and that they can have other choices if their appetite is ‘off’. Care plans detailed special diets to be catered for such as for coeliac disease. Nutritional risk assessments are conducted and referral made to the Speech and Language Therapist as required. Some service users had been taken on a holiday to Llandudno with one to one staff support. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24,26 The standard of the environment within this home is very good providing service users with an attractive and homely place to live. The type of flooring in two communal bathrooms is inappropriate and if stained by soiling detracts from the homely, dignified atmosphere that service users are entitled to. It could potentially harbour bacteria. EVIDENCE: A general tour of some bedrooms and communal spaces demonstrated that the home is purposely designed into small group units each with its own lounge/kitchenette and dining area. These were all in a good state of repair and comfortably furnished. It is easy for service users, elderly frail or those with dementia to find their way around their unit. Due to the layout of the home there are some ‘dead ends’ particularly on the ground floor dementia unit. Staff manage this appropriately and were seen to interact well with service users that would ‘wander’ about. The monthly report on the overview of the home details routine decoration and maintenance of the building due to be carried out.
Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 16 Two communal bathrooms have carpet flooring. There is a potential here to harbour bacteria from accidental soiling of urine and faeces. One area around a toilet was stained through such soiling which did not look at all pleasant for service users using this facility. Although it is regularly cleaned the present stain did not give this impression. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 There is a good match of well-qualified staff offering consistency of care within the home. EVIDENCE: The home demonstrated that its recruitment procedures are carried out through two staff files examined. These were in good order with the exception of one where the support worker has commenced work prior to the criminal records bureau check being received. Relevant training has been provided and staff spoken with confirmed this. Staff observed carrying out their duties were seen to be responsive and understanding of individuals wishes and needs. The staffing establishment and rota are arranged so that there are enough senior staff and are deployed to give the cover required to meet the home’s stated aims. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 The manager is supported well by the deputy manager in providing clear leadership in her absence and demonstrating an awareness of her roles and responsibilities. EVIDENCE: The safety of service users is covered by the Health and Safety as Work Act and by the general risk assessment requirements of the Management Regulations. A service user was using an electric bed with bed rails incorporated into the design and a generic assessment had been completed regarding the use of the bed. Risk assessments were seen for the use of bed rails with individuals with the exception of this one. The deputy manager stated that this would be completed immediately. She also stated that district nurses make the assessment of the type of rail to be used for the bed. Thus staff do not receive specific training on this matter.
Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 19 The report into the conduct of the home for the month of May 2005 stated that all health and safety checks are in place and up to date, such as; fire book, water temperatures, accident book. The deputy manager is the health and safety representative for the home and carries out quarterly audits for which records were seen. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 N/A 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4
COMPLAINTS AND PROTECTION 3 N/A N/A N/A N/A N/A N/A 3 STAFFING Standard No Score 27 3 28 N/A 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A N/A N/A N/A N/A N/A N/A 3 3 Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 21 no 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 29 Regulation 19(4) Requirement To obtain a CRB check prior to employment or at least a POVA 1st check followed by supervision until CRB check cleared. Timescale for action Immediate 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. Refer to Standard 38 37 26 Good Practice Recommendations Be mindful of Regulation 18(1)(a). Provide training appropriate for staff who who are responsible for selecting, fitting/using and checking bed rails Include maintenance of bed rails in the records for routine checks of equipment and health and safety audits. Replace floor covering in the two carpeted bathroom as soon as possible. Stone House E56 S20656 Stone House V230963 UAI 150605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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