Inspection on 01/02/07 for Stonebow House

This inspection was carried out on 1st February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stonebow House 11/06/08

Stonebow House 22/03/06

Stonebow House 16/12/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stonebow House Peopleton Pershore Worcestershire WR10 2DY Lead Inspector Nic Andrews Unannounced Inspection 03:40 1 , 2 and 6 February 2007 st nd 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 Stonebow House DS0000065939.V328981.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. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonebow House Address Peopleton Pershore Worcestershire WR10 2DY 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) 01905 840245 01905 841020 ambercareltd@yahoo.co.uk Amber Care Limited Mrs Rosemarie Jean Hoskins Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is primarily for people whose care needs are related to old age, but the home may also accommodate a maximum of three people with dementia illnesses, above 65 years of age. 22nd March 2006 Date of last inspection Brief Description of the Service: Stonebow House is a large, period property that has been converted and extended in order to provide accommodation for a maximum of 30 older people, three of whom may also have a dementia illness. The home stands in its own extensive grounds in a corner position off a main road in a rural area within a few minutes driving distance of Pershore. The home is accessible to people who use wheelchairs. The home provides space for car parking at the front of the premises. Most of the service users are accommodated on the ground floor. There are 5 bedrooms i.e. 3 single bedrooms and 2 double bedrooms on the first floor of the original part of the building. The home does not have a passenger lift. However, a stair lift has been installed on part of the stairway to enable service users to have easier access to the bedrooms on the first floor. Although the home has two double bedrooms, all of the bedrooms were being used as single rooms. The stated aim of the home is to ‘provide a homely, comfortable and caring environment for elderly people, for long and short stays, encouraging the highest possible standard of life which reflects each individuals dignity and independence’. The fees ranged from £1540.00 to £1904.00 per month. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of three days. The home was inspected against the key National Minimum Standards and time was spent with the registered manager assessing the home’s response to the requirements and recommendations that were made as a result of the previous inspection. Various records and a number of different policies and procedures that the home is required to maintain were inspected. A tour of part of the premises was also made. Individual discussions were held with four service users and four members of staff. As part of the inspection Comment Cards were also issued to the relatives/visitors of service users. A total of eleven Comment Cards were completed and returned. The majority of the responses to the questions that were asked in the Comment Cards were positive. The additional comments provided are reflected in this report. What the service does well: What has improved since the last inspection? Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 6 The registered manager said that, since the previous inspection, a number of rooms had been decorated and the front door security had been improved. Record keeping and activities for the service users had also improved. The level of service user consultation had increased following the introduction of regular monthly meetings. Information about the meetings was circulated before and after the meetings. A trolley shop had also been introduced. 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. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 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 Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Prospective service users were provided with information to enable them to make a choice about the home. Their needs were assessed and they were given a contract that clearly tells them about the service they will receive. However, some aspects of the information provided and assessment form needed to be written in more detail. EVIDENCE: The home’s statement of purpose contained clear and relevant information. It was pleasing to note that it placed an emphasis on the rights of the service users. However, it did not include all of the details referred to in Regulation 4, Schedule 1 and Standard 1.1. The statement of purpose must be amended so that it includes, • The number, relevant qualifications and experience of the staff working at the home. • The organisational structure of the home. • The range of needs that the home is intended to meet. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 9 • • The emergency procedures associated with the outbreak of fire e.g. the arrangements made for the care and accommodation of the service users in the event of a temporary closure of the home. The number and size of all the rooms i.e. the physical environment standards referred to in Standard 1.1. The service users’ guide also contained clear and relevant information. However, the service users’ guide should also include, • The number and size of all the rooms i.e. the physical environment standards referred to in Standard 1.1 and, • Information about how to contact the local social services and health care authorities. The registered manager confirmed that the requirement that was made as a result of the previous inspection regarding the provision of a standard form of contract with the service users’ guide had been implemented. The registered manager also confirmed that a copy of the service users’ guide had been issued to all of the service users. A record was maintained to show that all of the service users had been given a copy of the service users’ guide. The service users with whom discussions were held also confirmed that they had been given a copy of the service users’ guide. A copy of the statement of terms and conditions of residence (contract) was made available for inspection. The contents of the contract were satisfactory. The registered manager confirmed that a contract had been issued to all of the service users. A record was maintained of the dates when the contracts were issued. The service users’ files that were inspected contained a copy of the contracts. A copy of the form that was used for assessing the care needs of prospective service users was made available for inspection. The assessment form was called ‘Prospective Resident Initial Assessment Record’. A requirement was made as a result of the previous inspection that the form used by the home to assess the care needs of prospective service users must be amended so that it includes a reference to history of falls, mental state and cognition and personal safety and risk. It was noted that the assessment form contained a reference to all of the aspects of care referred to in Standard 3.3 except for religious and cultural needs and carer and family involvement and other social contacts/relationships. Therefore, the wording of the previous requirement has been amended and is repeated in this report. It was stated that a copy of the assessment form was issued to prospective service users for them and/or their relatives to complete prior to admission. It was also stated that a senior member of staff i.e. usually the deputy manager, checked the contents of the form thoroughly with the prospective service user and/or their relatives prior to admission. An assurance was given that an assessment form was always completed prior to admission. However, not all of the assessments that were inspected were signed and dated. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 10 It was confirmed that an opportunity was provided for all prospective service users to make pre-admission visits to the home. The details of the visits as described by the registered manager enabled prospective service users to make an informed choice about the home prior to admission. The first four weeks following admission were regarded as a trial period. Service users were not normally admitted in an emergency. The service users’ guide contained clear and relevant information about the admission process including the preadmission visits, trial period and emergency admissions. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 11 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users’ health and personal care was based on their individual needs. The principles of respect, dignity and privacy were put into practice. However, more attention needed to be given to aspects of care relating to reviews and medication. EVIDENCE: It was confirmed that all of the service users had a care plan based on an assessment of their care needs. It was also stated that a risk assessment had been carried out in respect of all the service users in regard to nutrition, personal hygiene, mobility, sleep and social activities. The contents of the care plans that were inspected were well written and contained clear instructions to enable the staff to meet the service users’ needs. The requirement that was made as a result of the previous inspection that the service users’ care plans must include all of the aspects of care as set out in Standards 7.2 and 3.3 had been implemented. It was noted, however, that the care plans were not reviewed during December 2006. The service users’ care plans must be reviewed every month. It was also stated that a care plan was only written ‘if there is an identified problem’. However, an assurance was given that the care plans would include all of the aspects of care covered in Standard 3.3 in order to promote the service users’ wellbeing and independence. In the case of one Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 12 service user it was noted that the assessment included a reference to the need for an ophthalmic appointment for an eye test and a new pair of glasses. However, there was no reference in the care plan to confirm whether any action had been taken in regard to this issue and/or the outcome. All of the service users were registered with the GPs at two local practices. None of the service users had pressure sores. However, the district nurse visited the home to change dressings and provide equipment as necessary. One service user was using a pressure-relieving mattress. The staff were aware of the signs to observe and the action to take to prevent skin breakdown. The continence adviser assessed new service users and provided appropriate support. The home responded promptly to any signs of deterioration in the service users’ healthcare. An opportunity was provided for the service users to undertake physical activity each week. The staff had followed the instructions of the physiotherapist in the past as part of the service users’ plan of care. Nutritional screening was undertaken at the time of admission. The service users’ food and fluid intake was monitored when necessary. The service users’ weight was recorded. The chiropodist visited the home every two weeks. A file was kept of the visits and relevant information was transferred to the service users’ individual care plans. Dental and ophthalmic care was provided as necessary. Hearing tests were arranged via the GPs. The Comment Card from one of the visiting professionals stated that the staff were ‘very vigilant about the health of the residents’ feet’. The same respondent also stated that the staff had contacted GPs or the district nurse whenever concerns had been raised ‘enabling appropriate medication and care to be given’. The Comment Card from the relative of one service user stated, ‘On rare occasions staff were unaware of mobility issues and have used wheelchairs when the resident could be encouraged to exercise’. The service users with whom discussions were held felt that their healthcare needs were being met. The home had suitable arrangements in place to ensure that medication could be stored securely. The home had a controlled drugs cupboard that complied with the Misuse of Drugs (Safe Custody) Regulations 1973. The book in which the administration of controlled drugs was recorded contained the signatures of two staff. The home had a dedicated fridge for medication that required cold storage. However, the fridge was not locked. Therefore, the requirement that was made as a result of the previous inspection in regard to this issue still stands. An up to date daily record of the fridge temperatures was being maintained. The home also maintained an accurate record of the signatures of the staff who were involved in the administration of medication. The requirement that was made as a result of the previous inspection that the receipt of all medication entering the home must be recorded had been implemented. The requirement regarding the recording of the date of opening of medication containers had also been implemented. The dates of opening of medication were written on the outside of the containers. Two further previous requirements regarding the recording of medication using an appropriate code Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 13 and the amount of medication administered where the dose is variable had also been implemented. The recommendation that was made as a result of the previous inspection that staff should ensure that they obtain written confirmation of changes made to warfarin doses wherever possible had been implemented. It was stated that a fax was now sent to the home by both Health Centres to confirm any changes that were made to the service users’ medication. It was also stated that the staff see all of the prescriptions before they are sent to the pharmacy for dispensing. Access to the medication was restricted to senior staff. The senior member of care staff on duty was responsible for the keys to the medication storage. Some of the staff had received training in medication and further training was being arranged for February 2007. However, the training provided was not accredited. The home’s policy and procedure for the administration of medication must be amended to include the action to be followed in the event of an administration error. The policy should also state that when a service user dies, medicines will be retained for a period of seven days in case there is a coroner’s inquest. The Medication Administration Record (MAR) charts were inspected. It was noted that there were gaps in the record for the administration of medication at the beginning of the day in respect of two service users. It was stated that the medication had been administered and that the MAR charts would be checked and any omissions rectified at the end of the afternoon shift. MAR charts must be completed at the time of administration of medication. It was also noted that two members of staff were not always checking and signing the MAR charts when the details of the medication were being written on to the MAR charts by hand. The staff with whom discussions were held understood the importance of upholding the service users’ privacy and dignity. The responses that were given by the staff to the questions that they were asked reflected good practice. A requirement was made as a result of the previous inspection regarding the provision of a mobile handset. It was confirmed that the home now provided a mobile handset to enable service users without their own personal telephone to make and receive calls in private. It was confirmed that mail was given to the service users unopened. The exception to this practice occurred when relatives had asked the home to retain ‘official’ mail that was to be dealt with by them. The service users wore their own clothes. However, it was stated that the home kept a supply of nightclothes for use in an emergency. The staff induction included instruction on how to treat service users with respect. The privacy of the service users was enhanced by the provision of all single room accommodation. The service users with whom discussions were held confirmed that they were treated with respect by the staff and that their privacy was maintained. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The home promoted the service users’ quality of life by seeking their views, offering choice and encouraging them to remain as independent as possible. EVIDENCE: One requirement and one recommendation were made in regard to Standard 12 as a result of the previous inspection. The requirement was that the service users must be consulted about the programme of activities arranged by or on behalf of the home and appropriate social, recreational and religious facilities and activities provided according to the service users’ interests, preferences and needs. The requirement had been implemented. The registered manager stated that regular monthly meetings had been recently introduced in order to ascertain the views of service users in regard to social and other activities. Two meetings had been held so far on 5 December 2006 and 12 January 2007 respectively. The recommendation was that a record of the social, recreational and religious activities provided by or on behalf of the home including the dates and the names of the service users that participate should be maintained. The recommendation had been implemented. The record of activities was made available for inspection. These included hairdressing, music for health and Communion once a month and keep fit every week, flower arranging, manicures, Bingo and sing-a-longs. Prior to Christmas, the service users had been involved in making lavender bags, cards Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 15 and chocolate bags. An ‘entertainment afternoon’ had also been introduced as a regular weekly event. A summer fete had been held on 1 July 2006 that was well supported by the service users’ relatives and friends. The registered manager hoped to repeat the event during 2007. A monthly activities programme and a daily events poster were displayed to enable the service users and their families to see what activities had been arranged. The number of outings was limited. The home did not have access to a dedicated vehicle to enable the staff to take the service users on individual or small group outings. A vehicle provided specifically for this purpose would enhance the service users’ sense of independence and quality of life. The Comment Card from the relative of one service user felt that the home could improve the standard of care by providing ‘outside trips and visits’. Another respondent felt that the home should provide, ‘more activity for the more able people’. Another respondent said, ‘Male residents are in the minority and activities are more female orientated’. The service users’ right to choose where they ate their meals and to enjoy social relationships was respected. The service users with whom discussions were held expressed their satisfaction with the social activities provided. One service user said, ‘We aren’t getting any more activities but they’re dealing with it. They do their best’. The same service user felt that the proposed introduction of a mobile trolley shop was a positive idea. There were no unnecessary restrictions in regard to visiting. The service users with whom discussions were held confirmed that their relatives and friends were always made welcome and offered a drink. The service users also confirmed that they were able to see their relatives and visiting professionals e.g. the GP, district nurse etc, in private. The service users’ guide stated, ‘It is our intention to encourage all residents’ relatives and representatives to maintain as much involvement as possible with the resident, at the time of admission and in their subsequent life at Stonebow House’. The home received visits from a group of bell ringers at Christmas and from members of the Older Peoples’ Forum approximately every three months. It was confirmed that the service users found these visits enjoyable. The Comment Card from one of the visiting professionals stated that the home had a ‘caring atmosphere and a real sense of home’. Another respondent also stated that the home was ‘like home from home’. The registered manager supported the service users’ right to exercise personal autonomy and choice. The service users’ guide contained information about the local advocacy service. A poster with similar details was also displayed on the notice board. There was evidence to show that the service users were able to bring personal possessions with them when they were admitted to the home. The service users’ guide contained information about the service users’ right of access to the records held about them by the home. The service users with whom discussions were held confirmed that they were enabled to make choices in regard to their daily routines and matters affecting their care e.g. the clothes they wore, the food provided, where they ate their meals and the Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 16 time they got up and when they went to bed. The registered manager said that the service users were ‘always asked not told’. The Comment Card from the relative of one service user stated, ‘Sometimes encouragement is needed so that residents express their needs. Equipment like chairs could be better for the disabled’. The home operated a six-week menu. The record of the food provided was varied, wholesome and nutritious. Variations to the menu or changes that were made in respect of individual service users were not being recorded. However, it was confirmed during the inspection that a book had been introduced in which a record would be maintained of any such changes. In so doing, an accurate record of the food provided which the home is required to keep, would be maintained. Breakfast is served between 8.00 and 9.00 am. Lunch is served at 12.30 pm and the teatime meal is served between 5.00 and 5.30 pm. At lunchtime a main meal is provided and an alternative is made available to service users who do not like the meal that is on offer. There is always a choice of food for breakfast. The staff consulted the service users each day about the food they would like to have at teatime. Mid-morning and mid-afternoon drinks were provided. Supper is provided between 7.00 and 7.30 pm. Drinks and snacks were available throughout the day. The service users’ individual preferences and needs including those with diabetic and vegetarian requirements were respected and catered for appropriately. A list of the service users’ food preferences was posted in the kitchen. Special occasions e.g. birthdays, were also celebrated. The daily menu was displayed on a notice board in the main corridor outside the dining rooms. The food that was sampled during the inspection was well presented and enjoyable. It was confirmed that special cutlery was available for service users who had difficulty in eating. One service user required staff assistance at mealtimes. It was confirmed that all of the kitchen equipment was in satisfactory working order. A cleaning schedule was available. A record of the temperature of the food and fridge and freezers was maintained. There were ample food stocks. The dining room facilities were satisfactory. The service users with whom discussions were held spoke positively about the food. One service user said, ‘By and large the food is very good. No complaints’. Another service user said, ‘The food is good. The staff go out of their way to help you. They take note of your food preferences. We’re not rushed at meal times’. Another stated, ‘The food is very good. It’s improved over the past nine months. The residents are consulted more about the food’. A fourth service user said, ‘The food isn’t bad. It’s improving’. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The home had a clear complaints procedure and other relevant policies and procedures to ensure that service users were protected from abuse. EVIDENCE: The home maintained two complaint folders, one for service users and their relatives and one for members of staff. Since the previous inspection the home had received one complaint by a member of staff about the behaviour of a service user. The complaint had been handled appropriately. No other complaints from service users or their relatives had been received by the home. The home had a clear complaints procedure that was included in the service users’ guide. A copy of the complaints procedure was also displayed on the notice board. The service users with whom discussions were held felt confident about making a complaint. They also felt that, if it was considered necessary to make a complaint, it would be dealt with quickly and appropriately. They all felt that the registered manager was approachable. A requirement was made in regard to Standard 18 as a result of the previous inspection. The requirement was that all members of staff must receive training on abuse and the protection of service users. The requirement had been implemented. Relevant basic awareness training had been undertaken on 22 September 2006 and further training was planned for March 2007. It was stated that all the staff had been issued with a leaflet regarding the protection of vulnerable adults produced by the Worcestershire Vulnerable Adults Protection Committee. The registered manager was advised to maintain a record of any similar information or documentation that is given to staff. A Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 18 poster alerting members of staff to the protection of vulnerable adults was displayed in the office. The home’s policy and procedure on the protection of vulnerable adults from abuse was made available for inspection. The wording of the policy needed to be amended and this was done during the inspection. The home’s ‘whistle blowing’ policy and the policy on the service users’ money and financial affairs were satisfactory. The home’s policy on ‘Managing Aggression and Violent Behaviour at Work’ had not been reviewed since 2005. The policy should state clearly that in the highly exceptional circumstances when physical restraint is deemed necessary in order to protect the service users or to prevent further harm the least amount of force necessary should be used. The registered manager confirmed that no incidents of alleged or suspected abuse had occurred or had been reported or had otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had had no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. The home had a copy of the Department of Health guidance ‘No Secrets’. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users lived in a safe, well-maintained environment. EVIDENCE: The location of the home was suitable for its stated purpose and had been extended and adapted to meet the needs of older people. The home was accessible, safe and well maintained. Two requirements were made in regard to Standard 19 as a result of the previous inspection. The first requirement was that a risk assessment must be carried out and recorded in respect of the service users who are accommodated on the first floor regarding their ability to access this part of the building. The requirement had been implemented. The registered manager stated that it was intended to install a new stair lift on the second staircase within the next four months. This would enable service users to access the five bedrooms on the first floor more easily than at present. The second requirement was that a risk assessment must be carried out and recorded in regard to the maintenance of a safe environment, including outdoor steps and pathways. The requirement had been implemented. The registered manager stated that she carried out an audit of the environment Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 20 every three months. A monitoring checklist was also completed every three months to enable the registered manager to identify any hazards. A risk assessment was carried out and recorded in respect of any high level hazards that were identified. A monitoring book was also maintained in respect of each individual room. The registered manager carried out a monitoring check every month. This enabled her to ensure that all of the service users’ bedrooms were appropriately equipped. The registered manager was, therefore, able to maintain a programme of routine maintenance and renewal of the fabric and decoration of the premises. The gardens were attractive and accessible. The home employed a part-time gardener to help maintain the grounds. On 23 December 2006 an inspection by the Environmental Health Officer had identified flaking paint on the wall adjacent to the dishwasher and on the window frame in front of the sink and a small area of damaged wall near to the floor in the kitchen. The registered manager stated that these items of work would be addressed in the near future. The last recorded visit by the Fire Safety Officer was on 2 March 2005. The registered manager confirmed that the four recommendations contained in the subsequent letter dated 3 March 2005 had been implemented. At the time of the inspection a new office was being provided for the registered manager. The Comment Card from the relative of one service user stated, ‘The home is always well maintained and the staff are always pleasant and hardworking’. Another respondent said, ‘The gardens are kept beautifully’. Standard 21 was not fully assessed on this occasion. However, the home’s response to the recommendation that was made as a result of the previous inspection was assessed. The recommendation was that the toilets available for shared use should be clearly marked. The recommendation had not been implemented and still stands. The premises were clean, tidy and free from unpleasant odours. The laundry facilities were appropriately sited and included hand-washing facilities. It was noted that there were no paper towels and no liquid soap dispenser available in the laundry. However, these items were provided during the inspection. The floor finishes were impermeable and these and wall finishes were readily cleanable. The laundry contained a large washing machine and industrial dryer. The washing machine had the specified programming ability to meet disinfection standards and a sluicing facility. The staff transported soiled linen into the laundry using portable trolleys with plastic covers. Protective gloves and aprons were available for use by staff. The policy and procedure for infection control was satisfactory and had been signed by the registered manager and dated 7 June 2006. Currently, the staff clean manually the commode pots that are used. The home does not have appropriate facilities to carry out this task and manual cleaning is not the recommended method of decontamination. Disposable commode pots should be used. The Comment Card from the relative of one service user stated that the home provided a ‘very good laundry service’. Another respondent said that the home was, ‘spotlessly clean at all times’. However, another respondent stated that the Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 21 ‘cleaning needs to be looked into’ and that ‘all is well except for the cleaning’. The service users with whom discussions were held felt that the standard of cleanliness within the home was good. They expressed their satisfaction with the standard of laundering of their personal clothing. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 22 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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The staff were experienced and trained and were employed in sufficient numbers to meet the needs of the service users. However, the staff recruitment procedures needed to be more robust in order to fully protect the service users. EVIDENCE: A copy of the staff duty rota was made available for inspection. The requirement that was made as a result of the previous inspection that the duty rota must show the position/designation of all the staff on duty day and night had been implemented. It was noted that the hours worked by the registered manager were not being recorded on the duty rota. However, the registered manager agreed to record the hours she worked on the rota and the matter was addressed during the inspection. The staff rota showed that the home was adequately staffed and that additional staff were on duty at peak times of activity during the day. At night two waking members of staff were on duty and, in addition, a member of staff was currently residing on the premises. Three members of staff were employed to carry out catering duties. Two contract cleaners were engaged for a total of 40 hours per week. In addition to the registered manager, the home employed three deputy managers for a total of 80 hours per week, two senior care assistants (days) for a total of 65.5 hours per week and nine care assistants (days) for a total of 280 hours per week. The home employed one senior care assistant and four care assistants to cover night duty. A part time handy man was employed for 12 hours per week. The Comment Card completed by the relative of one service user stated that the home provided ‘high quality night time care’. Another respondent Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 23 stated that the home provided, ‘Excellent care, attention and friendliness from all the staff’. The same respondent felt that the staff were ‘always very caring and willing to listen’ and that they were ‘all very efficient at what they did’. Another respondent stated, ‘There is a very good atmosphere in the home. All staff are very helpful and communicate well with my mother who constantly remarks on how helpful and pleasant they all are and how lucky and happy she is there’. Other respondents made the following comments about the staff, ‘Very kind and caring towards the people they look after’, ‘Constant care for the residents, nothing is too much trouble for them’, ‘Mother and I are extremely satisfied with the quality of service provided’, ‘They appear to be genuinely concerned for the welfare of the residents. They take good care of my mother and I feel confident that she is being properly looked after’. ‘Kind and caring staff, excellent medical care and attention’. The service users with whom discussions were held spoke positively about the staff. One service user said, ‘The staff are excellent. They work very well’. Another service user said, ‘The staff are all very kind and very good. They do their best for us. They can’t always respond immediately. They do get their moments when they are short staffed’. Another service user said, ‘You can have a laugh with the staff but they’re very helpful. They’re very pushed sometimes. They seem to be short at weekends’. However, two of the service users felt that there was always a sufficient number of staff on duty. One of the service users said, ‘I couldn’t think of anything better apart from home and I can’t cope at home. This is the next best and it’s a good best’. The home employed a total of nineteen care staff (days and nights). Seven members of staff had a nursing qualification obtained either in this country or abroad. One of the seven, a senior member staff, had also undertaken the Registered Managers’ Award training. Four members of staff had completed the NVQ level 2 training and one member of staff had completed NVQ level 2 and 3 training. Therefore, twelve of the nineteen care staff had obtained an NVQ level 2 or equivalent. This exceeded the 50 trained members of staff required by the National Minimum Standards. It was pleasing to note that five of the remaining seven members of staff had either commenced or intended to commence NVQ level 2 training. The files of three members of staff were inspected. All three files contained evidence of an enhanced CRB disclosure check, proof of identity and a copy of a staff contract. It was also confirmed that all the staff had been issued with a copy of the code of conduct and practice set by the General Social Care Council. However, it was noted that in the case of one member of staff only one written reference had been obtained. In the case of two members of staff there was no reference to any declaration in respect of the person’s health. A requirement was made in regard to Standard 30 as a result of the previous inspection that all the staff must have an individual training and development assessment and profile. The requirement had been implemented. It was also confirmed that all the staff received at least three paid days training per year. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 24 The home had an induction programme and a ‘record of induction and basic training’ for each new member of staff. There was also a lengthier induction document. However, the induction was not necessarily to the Skills for Care standard. The registered manager was advised to obtain written information about the ‘Skills for Care’ induction training in order to ensure that the home’s induction training was comprehensive and carried out at the appropriate level. The home’s policy was to ensure that newly appointed staff completed the induction training before they were placed on NVQ level 2 training. Stonebow House DS0000065939.V328981.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. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home was based on openness and respect for the service users’ best interests, rights and safety. EVIDENCE: A requirement was made as a result of the previous inspection that a suitable person must be appointed to manage the home who will make an application to the CSCI to become the registered manager. The requirement had been implemented. Since the previous inspection, an application for registration had been received and approved by the CSCI. The newly appointed registered manager had considerable relevant experience and was competent to run the home. In April 2005, the registered manager had successfully completed the NVQ level 4 and Registered Managers’ Award training. She had also undertaken more recent training including infection control (15/09/06) and adult protection (22/09/06). Prior to this, in June 2006, the registered manager had undertaken a two-day course in Human Resource DevelopmentStonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 26 Managing Staff Effectively. On 30 June 2006, she had been presented with a Consistent Achievement Award by Worcester College. Since her appointment, the registered manager had worked hard to continue to maintain and improve the service and to provide an increased quality of life for the service users. The registered manager displayed a strong ethos of being open and transparent in her management of the home. She was service user focussed. She led and supported a strong staff team who had been trained to a high standard. However, it was noted that the registered manager needed to undertake training in the protection of vulnerable adults from abuse at a managers’ level. The service users with whom discussions were held felt that the registered manager was approachable. The Comment Card from the relative of one service user said that the manager was ‘very understanding’. Two requirements and three recommendations were made in regard to Standard 33 as a result of the previous inspection. The first requirement was that a quality assurance system must be introduced. The registered manager said that the requirement had not been fully implemented and that further work was needed to introduce a complete quality assurance system. However, it was pleasing to note that an audit was carried out every three months that included the environment, hazards, equipment, the kitchen, staffing and service users. The second requirement was that an annual development plan for the home based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users must be introduced. The requirement had not been fully implemented and still stands. The first recommendation was that the results of service user surveys should be published and made available to current and prospective users, their representatives and other interested parties, including the CSCI. The second recommendation was that the views of family and friends and of stakeholders in the community e.g. GPs, chiropodists etc, should be sought on how the home is achieving goals for service users. Both recommendations had been implemented. The registered manager confirmed that during April and May 2006 questionnaires had been issued to service users, their relatives, stakeholders in the community and to staff. The results of the questionnaires were analysed and a copy of the findings was given to the service users, staff and to some of the service users’ relatives. Copies of the findings had also been displayed on the service users’ and staff notice boards. The registered manager was advised to issue a copy of the findings from the next survey to all of the service users and/or their relatives and other participants. The third recommendation was that evidence should be provided to demonstrate the home’s commitment to lifelong learning and development for each service user linked to the implementation of their individual care plan. The recommendation had been implemented. The registered manager stated that the home had recently introduced ‘Getting to know you’ forms. These enabled the staff to gather and record information regarding the family background and social history in respect of each individual service user. It was stated that the forms had been well received by the service users, relatives and staff. It was intended that the information obtained would help to develop the service users’ interests and learning. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 27 The registered manager stated that money was held in safekeeping on behalf of the majority of service users. The service users’ money and accounts were kept separately in individual folders in a lockable cabinet. Access to the money held by the home on behalf of service users was restricted to senior staff. The money and records of two service users were checked at random and were correct. The registered manager confirmed that no one employed by or connected with the running of the home acted as an agent or appointee on behalf of any of the service users. Standards 36 and 37 were not fully inspected on this occasion. However, the home’s response to the requirements that were made as a result of the previous inspection in regard to Standards 36 and 37 was assessed. The first requirement was that care staff must receive formal, individual supervision that includes all aspects of practice, philosophy of care in the home and career development needs, at least six times a year. The second requirement was that the fire equipment handling check and the emergency lighting check must be carried out and recorded at regular intervals in accordance with the recommendation of the Fire Safety Officer. Both requirements had been implemented. Six requirements were made in regard to Standard 38 as a result of the previous inspection. The first requirement was that fire safety training/instruction must be given to all existing staff and to all newly appointed staff within one week of the date of the commencement of their employment at the home. The requirement had been implemented. The second requirement was that all staff must receive updated training in all of the core areas i.e. infection control. It was confirmed that updated training in all of the core areas had been carried out or that arrangements had been made to ensure that it would be undertaken in the near future i.e. by 30 April 2007. Therefore, the requirement was regarded as having been implemented. The third requirement was that risk assessments must be carried out and recorded for all safe working practice topics covered in Standards 38.2 and 38.3 including the regulation and recording of water temperatures. The requirement had been implemented. However, in regard to the risk assessments on the maintenance of window restrictors the registered manager was advised to replace the word ‘regularly’ when referring to routine checks with a specific period e.g. weekly or monthly. The registered manager confirmed that the fourth and fifth requirements that all fire-resisting doors must be kept closed and not wedged open and that all fire-resisting doors must be upgraded by the fitting of cold smoke seals and intumescent strips had been implemented. The sixth requirement was that thermostatically controlled mixer valves must be fitted to all hot water outlets used by service users in order to prevent the risk of scalding. The registered manager stated that approximately 50 of the hot water outlets used by service users had been fitted with a control valve. It was anticipated that the work would be completed by the end of March 2007. The requirement had not been fully Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 28 implemented and still stands. The home had a health and safety policy. The accident book was up to date. Safety procedures were posted in appropriate places. The stair lift had been serviced on 7 January 2007. Bath hoists had been serviced on 3 February 2007. The home had relevant information regarding COSHH and RIDDOR and copies of reports made in accordance with Regulation 26. PAT tests had been carried out. The fire safety records were checked and these were satisfactory. Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 29 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 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 2 Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4,5 Requirement The statement of purpose and service users’ guide must be amended in accordance with the guidance given in this report. The form used by the home to assess the care needs of prospective service users must be amended so that it includes a reference to all of the aspects of care referred to in Standard 3.3. All the service users’ care plans must be reviewed at least once a month. The registered person must ensure that the refrigerator used for storing medication that requires cold storage is kept locked at all times when not in use. (Previous timescale 01/06/06 not met). All the staff that are involved in the administration of medication must undertake accredited training that includes basic knowledge of how medicines are used and how to recognise and deal with problems in use and the principles behind all aspects of the home’s policy on DS0000065939.V328981.R01.S.doc Timescale for action 31/03/07 2 OP3 14 31/03/07 3 4 OP7 OP9 15 13 31/03/07 28/02/07 5 OP9 13 30/04/07 Stonebow House Version 5.2 Page 31 6 OP9 13 7 OP9 13 8 OP26 23 9 10 OP29 19 19 OP29 11 OP33 24 12 OP33 24 13 OP38 13 medicines handling and records. The home’s policy on the administration of medication must include the procedure to be followed in the event of an error in administration occurring. The Medication Administration Record (MAR) charts must be signed at the time when the medication is administered to the service users. The wall and window frames in the kitchen that require repainting and the parts of the wall that require re-plastering must be made good in accordance with the recommendations of the Environmental Health Officer. Two written references must be obtained in respect of all staff prior to their appointment. All newly appointed staff and any prospective member of staff must be asked to sign a health declaration prior to their appointment as evidence that they are physically and mentally fit for the purposes of the work that they are to perform. A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale 30/06/06 not met). An annual development plan for the home based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users must be introduced in accordance with Regulation 24 and Standard 33. (Previous timescale 30/06/06 not met). Thermostatically controlled mixer valves must be fitted to all hot water outlets used by service users in order to prevent the risk of scalding. (Previous timescale 31/07/06 not met). DS0000065939.V328981.R01.S.doc 28/02/07 28/02/07 31/03/07 28/02/07 28/02/07 31/03/07 31/03/07 31/03/07 Stonebow House Version 5.2 Page 32 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 OP3 Good Practice Recommendations The assessment forms should be signed and dated by the member of staff undertaking the assessment to confirm that the information provided has been checked and is correct. The home’s policy on the administration of medication should include a clear statement that when a service user dies, medication will be retained for a period of seven days in case there is a coroner’s inquest. When medication is written on to the MAR charts by hand it should always be checked and signed for as being correct by two members of staff. The policy on ‘Managing Aggression and Violent Behaviour at Work’ should be amended in accordance with the guidance given in this report and reviewed at least annually. The toilets available for shared use should be clearly marked. Disposable commode pots should be used. The registered manager should obtain relevant information from ‘Skills for Care’ in order to ensure that the home’s ‘in house’ induction training is comprehensive and provided at the correct level. 2 OP9 3 4 OP9 OP18 5 6 7 OP21 OP26 OP30 Stonebow House DS0000065939.V328981.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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