CARE HOMES FOR OLDER PEOPLE
Stone House Union Street Bishops Castle Shropshire SY9 5AJ Lead Inspector
Pat Scott Unannounced Inspection 09:55 5 January 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stone House DS0000020656.V253920.R01.S.doc Version 5.0 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. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Stone House Address Union Street Bishops Castle Shropshire SY9 5AJ 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) 01588 638487 01588 638582 Coverage Care Shropshire Limited Care Home 40 Category(ies) of Dementia (9), Learning disability over 65 years registration, with number of age (3), Old age, not falling within any other of places category (28) Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The number of persons for whom personal care is provided shall not exceed 40. The number of adults with a learning disability over 65 years of age may not exceed 3. The number of older persons accommodated in the home shall not exceed 40 of whom up to 9 may have dementia. Pauline Tremellen must complete NVQ 4 by the required date. Date of last inspection 15th June 2005 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. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 5th January 2006 and commenced at 09.55am for the duration of one and a half hours by one inspector. 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. 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 a representative of 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. The commission does not have any concerns with this home. What the service does well:
The home provides for the needs of elderly people including those with dementia through small group living. Service users were seen to be treated in a respectful and dignified way. Coverage Care provides training to a level that creates a trained and experienced staff team that is well managed. Service users living in care are often vulnerable both physical and emotionally and staff have been recruited with the ability to carry out personal services for people sensitively and tactfully. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection EVIDENCE: Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 9 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): 9 The procedures and policies for medication at this home give clear direction to staff in order to promote good health but are not consistently followed. EVIDENCE: The morning drug round on one unit was being concluded during this visit and 2 staff were observed to administer controlled medication to a service user on another. Staff were observed to give the medication in professional manner but not fully complying with the procedures of the home i.e they signed the controlled drug register before administration and did not cross reference the MAR chart with the medication in the controlled drug cabinet. Gaps were noted on the MAR charts which suggests the medication has not been administered. Liquid medicines had not been dated on opening in one drug trolley seen. The manager stated that the tablets of one service user are put in her food as she sometimes refuses to take them. The care plan was seen for this individual that contained a plan relating to their medication on days when their behaviour may not be so compliant. Coverage Care’s medication policies state that this area must be discussed and agreed by the manager, social worker, GP and
Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 10 service user. There was a stated agreement with the GP in the care plan that tablets could be administered by crushing them and placing them in the diet but no signed authorisation by the GP or other party. This area was discussed with the care manager who stated that all areas had been discussed with the GP but not any others. This person’s last review by social services was February 2005 where it was recorded that the service user was happy to take medication. It is strongly recommended that if this method is in the service users ‘best interests’ that this agreement is formally reviewed and authorised to avoid possible allegations of covert medication. Service users spoken with stated that they receive their medication at the right times and that they are treated with respect. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection EVIDENCE: Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 12 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): 16,18 The home’s complaints procedure is clear and residents are protected from abuse of any kind. EVIDENCE: The complaint log was examined. One complaint received in the home had been appropriately dealt with through the homes procedures and the multiagency adult protection procedures. On the whole, all service users spoken with were very happy with life at Stone House. They said they knew to whom they could speak to if they were worried about anything which they all stated they were not. The service users on Oak unit were very vocal about this and had nothing but praise for the way in which they were cared for and how staff listened to them. A staff training portfolio showed that adult protection training has been provided and is due again soon. Incident reports are sent to the CSCI as required by legislation. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 13 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): These standards were not assessed at this inspection. A recommendation from the inspection of June 2005 regarding flooring in communal bathrooms has been carried over. EVIDENCE: Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 14 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): 29 The home has robust recruitment procedures to ensure as far as possible that only suitable people are employed to work with vulnerable adults. EVIDENCE: Examination of the file of a new recruit demonstrated that the home’s recruitment procedures are thoroughly carried out. Service users commented that they feel safe with the staff caring for them. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 15 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): 33,35 Service users views are regularly sought and they perceive them as having an effect in changing how the home is run Service users personal monies are well managed so that their financial interests are safeguarded. EVIDENCE: The previous manager, Mrs Tremellion, has recently transferred to another Coverage Care home. The deputy manager has taken up the post. Residents’ valuables and sums of money lodged with the home for safe keeping were accounted for satisfactorily. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 16 The annual quality survey was carried out in March 2005 and will be due again in the coming months. Residents meetings take place regularly and service users stated that staff are always asking them if ‘everything is alright’. Staff interaction with service users was very professional. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 17 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 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 18 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 OP9 Regulation 13(2) Requirement Staff should adhere to the home’s medication procedures regarding administration of medicines. Care files should contain appropriate signed authorisation regarding administration of medication to service users who cannot give consent. Timescale for action 05/01/06 2 OP9 13(2) 28/02/06 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 OP26 Good Practice Recommendations Replace the floor covering in the communal bathrooms. Stone House DS0000020656.V253920.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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