Inspection on 16/12/05 for Stonebow House

This inspection was carried out on 16th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 01/02/07

Stonebow House 22/03/06

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 N Andrews Unannounced Inspection 08:55 16 and 18 December 2005 th 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.V274140.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 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 Amber Care Limited Mrs Janet Crouch Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 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. 27 January 2005 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. There are car-parking facilities 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. At the time of the inspection 26 service users were residing at the home and there were four vacancies. 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 home has undergone a change of proprietorship since the previous inspection. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection that took place over one and a half days. Service users’ records, staff records and other relevant policies and procedures were inspected. Parts of the premises were also inspected. Individual discussions were held with six service users and five members of staff. Time was also spent with the registered manager assessing the progress made by the home in implementing the requirements and recommendations arising from the previous inspection. It was disappointing to note that very little progress had been made by the home in addressing the previous requirements and recommendations. The home was also inspected against eleven of the National Minimum Standards. Five of the eleven Standards that were inspected were met, four were nearly met and two were not met. The service users were asked about the home and the standard of the care that they received. The majority of the comments made by the service users with whom discussions were held were very positive. One service user stated, ‘On the whole, I feel that you could settle in here and be really happy’. Another service user said, ‘It’s a nice place. It’s in beautiful surroundings. The gardens are kept nice. On a scale of 1 to 10, I would give this place 8 or 9. It’s right at the top’. The service users described the staff as ‘very kind and thoughtful’, ‘super, very, very good’, ‘very helpful’ and ‘very good on the whole, they treat you well’. One service user said, ‘They’re all marvellous. I’ve heard nothing said against them. Most of them are smashing and will do anything for me’. Another service user said, ‘Whatever you ask, they get it for you. I don’t think I would find staff any better wherever I went’. Three of the service users confirmed that their privacy was respected and that the staff always knocked the door before entering their bedrooms. Five of the service users said that there were no unnecessary restrictions in regard to the daily routines and that they were free to get up and go to bed at whatever time they chose. One service user said, ‘They don’t like you going to bed too early unless you’re not well’. Four of the service users said that visitors were always made welcome and were asked whether they would like a drink. One of the service users expressed satisfaction with the activities provided by the home. Another of the service users stated, ‘We have a lovely Monday doing exercises’ and another said, ‘We have physiotherapy on a Monday, which I like’. However, three service users felt that there could be more activities. One service user said, ‘There could be more mixing. For too many hours you’re left on your own’. One service user felt that there were not always enough staff on duty. Another service user confirmed that, ‘There are always sufficient staff on duty but sometimes you had to wait for help’. The four care staff with whom discussions were held had worked at the home for over 25 years in total. All four members of staff spoke positively about the home. They all confirmed that they enjoyed working at the home. One Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 6 member of staff said, ‘I love it here. The staff are very supportive, brilliant, they really are good. We get support from senior staff. The staff work well as a team. The residents are well cared for.’ Another said, ‘I’m quite happy here. Everyone is so happy and nice. The staff are great and the residents love the staff. The staff are happy and it reflects on the residents. It’s a warm environment’. A third member of staff said, ‘I love working here. It’s the girls. There’s a team approach. The residents are lovely. It’s very rewarding. The self-esteem of the residents is very important. They are never degraded. There’s a lot of social input from the girls. The care is 100 . The main objective for all the staff is the residents. We are well supported by the manager.’ A fourth member of staff said, ’I’m very happy here. There’s a friendly environment. The staff are supportive towards each other. We provide a high standard of care. It’s very much a hands on approach’. The staff confirmed that the service users had been involved in writing Christmas cards and that children from a local school had visited the home to sing carols. One member of staff said that she escorted the service users around the garden. Another member of staff said that the hairdresser visited the home on a Wednesday and that one of the service users played the organ. Another member of staff referred to making Easter bonnets. However, all the staff felt that there were not enough social and leisure activities. One member of staff said that Mondays was the only day on which there was an activity for the service users. She said that the service users ‘got bored watching television’ and ‘needed something to keep their minds occupied’. Another member of staff said that they were ‘going to build up the activities’. One member of staff said that the home would benefit from the appointment of an ‘activities person to work for a few hours each day’. The staff were asked what changes or improvements they would like to see introduced within the home. Three members of staff said that they would like more staff so that they had more time to talk to the residents. One member of staff said that she would like to improve the appearance of the dining rooms. What the service does well: What has improved since the last inspection? The registered manager stated that since the previous inspection staff morale had improved following the introduction of staff from overseas. The commitment to staff training had increased. Several bedrooms had been Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 7 completely refurbished and the five-year electrical check had been carried out. A new fuse board had been installed. 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. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Prospective service users had the opportunity to visit the home prior to admission. A new statement of the terms and conditions of residence (contract) needed to be issued to each service user. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 1 as a result of the previous was assessed. The requirement was that the service users’ guide must be amended to include all of the information detailed in Regulation 5 and Standard 1.2 and copies must be given to all current, and any prospective, service users. The reference to the NCSC must also be changed to the CSCI. Since the previous inspection the home had undergone a change of proprietorship and a new statement of purpose and service users’ guide had been supplied to the Commission for Social Care Inspection (CSCI). However, the registered manager stated that more recently one of the former senior members of staff had left and the fees had also been increased and that the service users’ guide needed to be amended to reflect these changes. The requirement, therefore, still stands. The registered provider must ensure that any similar amendments are also made to the statement of purpose. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 10 The registered manager confirmed that all of the service users had been issued with a statement of their terms and conditions of residence (contract). However, as result of the recent change of proprietorship the home was in the process of issuing a new contract to all of the service users. The wording of the requirement that was made in regard to the statement of terms and conditions of residence (contract) as a result of the previous inspection has, therefore, been amended and is repeated in this report. The registered manager confirmed that prospective service users were invited to visit the home prior to admission, wherever possible. It was also confirmed that the first four weeks following admission were regarded as a trial period. The registered manager stated that the home admitted people in an emergency if the initial assessment of the prospective service user indicated that their care needs could be met. Prospective service users had the opportunity to meet staff in the prospective service users’ own homes or in different situations e.g. hospital, prior to admission as part of the assessment process. The home’s response to the recommendation that was made in regard to Standard 5 as a result of the previous inspection was assessed. The recommendation was that appropriate information regarding pre-admission visits and the home’s four-week trial period should be included in the service users’ guide. It was noted that the service users’ guide contained a copy of the statement of terms and conditions of residence which stated at paragraph 5 ‘The first four weeks of residence shall be regarded as a trial period for the benefit of the resident and the proprietors’. However, there was no reference in the first section of the service users’ guide to pre-admission visits. Therefore, the recommendation had not been fully implemented and this part of the recommendation still stands Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 The practices and procedures for handling dying and death ensure that service users and their relatives are treated with dignity, sensitivity and respect. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 7 as a result of the previous inspection was assessed. The requirement was that the service user care plans must be agreed and signed by the service user whenever capable and/or representative (if any). All of the aspects of care referred to in Standard 3.3 must be reviewed by the care staff at the home at least once a month and dated. The service users’ care plans were discussed with the registered manager who stated that ‘a more effective care plan was in the process of being created with each issue identified’. The proposed care plans as explained by the registered manager would address the requirement. However, the requirement had not been implemented and still stands. The home’s response to the two requirements and two recommendations that were made in regard to Standard 9 as a result of the previous inspection was assessed. The first requirement was that the policy and procedure for the administration of medication must be developed in accordance with the guidance in ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ published by the Royal Pharmaceutical Society of Great Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 12 Britain and Standard 9 of the NMS. The registered manager stated that the requirement had not been implemented and that all of the home’s policies and procedures needed to be updated. The requirement still stands. The second requirement was that accredited training in the administration of medication must be provided for the five recently appointed members of care staff and must include 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 medicines handling and records. The registered manager confirmed that Boots had provided appropriate training in medication in May 2005. The requirement had been implemented. The first recommendation was that a copy of ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ published in June 2003 by the Royal Pharmaceutical Society of Great Britain should be obtained and kept in the home for reference. The registered manager was unable to confirm whether the home had a copy of the publication. The recommendation, therefore, still stands. The second recommendation was that the list of the names of the staff that are involved in the administration of medication, together with their signatures and initials, should be updated. The registered manager stated that the list still needed to be updated. The recommendation, therefore, still stands. The home’s response to the requirement that was made in regard to Standard 10 as a result of the previous inspection was assessed. The requirement was that telephone facilities that are suitable for the needs of service users in private e.g. the provision of a mobile handset or the bringing back into operation of the home’s telephone booth must be provided. The requirement had not been implemented and still stands. The registered manager gave an outline of the practices and procedures that were followed by the staff during the illness and subsequent death of a former service user. The description of the care provided reflected the practices and principles outlined in Standard 11. The staff were supported in their care of the service user by the district nurse. The service user remained in her room. The service user’s relatives were able to spend time with the service user. The service user received visits from the priest. Members of staff and other service users were given the opportunity to pay their last respects and to attend the funeral service. The home had a satisfactory policy and procedure for handling dying and death. The registered manager stated that, in most cases, the service users’ relatives imparted to the home the information about the service users’ wishes concerning terminal care and arrangements after death. The registered manager stated that the information was recorded in the service users’ individual files. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 13 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): 15 The service users received a wholesome, balanced and nutritious diet. EVIDENCE: The home’s response to the recommendation that was made in regard to Standard 13 as a result of the previous inspection was assessed. The recommendation was that relatives, friends and representatives of service users should be given written information, preferably in the service users’ guide, about the home’s policy on maintaining relatives and friends’ involvement with service users at the time of an admission to the home. The recommendation had not been implemented and still stands. The home’s response to the recommendation that was made in regard to Standard 14 as a result of the previous inspection was assessed. The recommendation was that information about the advocacy service should be included in the service users’ guide. The recommendation had not been implemented and still stands. The home operated a six-week menu. A varied, wholesome and nutritious diet was provided. The service users were offered three full meals each day. Lunch was the main meal of the day and usually consisted of meat and vegetables. The cook confirmed that an alternative meal was always provided where necessary. Breakfast was served at 08.00 am in the dining room. Lunch and tea were also served in the dining room at 12.15 pm and 5.15 pm Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 14 respectively. A small number of the service users ate their meals in their own rooms. At 7.15 pm the service users were served supper. Drinks and snacks were served mid morning and mid afternoon. None of the service users required liquefied meals. None of the service users required special diets for religious, cultural or healthcare reasons. Two service users required their food i.e. meat, cut into small pieces. All the service users were able to eat without staff assistance. Adapted cutlery was provided where necessary. The cook stated that she consulted the service users about the food approximately every two months. A list of the service users’ food preferences was kept in the kitchen. The cook confirmed that she had all of the kitchen equipment she needed to enable her to carry out her catering duties. It was also confirmed that the kitchen equipment was properly maintained. The service users with whom discussions were held were asked about the standard of the food provided. They stated ‘ The food is good and adequate for me’, ‘The food is very good, I’ve no complaints’, ‘The food is quite good. I don’t get grumbled at if I leave it’, ‘The food is very good’, ‘The food is excellent’, ‘The food is really good. There’s always a hot meal at lunchtime and a good sweet after’. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 15 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 and 18 The service users felt confident about making complaints and that any complaints would be dealt with quickly and appropriately. However, the complaints procedure needed to be improved. Improvements were also needed to ensure the protection of service users from abuse. EVIDENCE: The home had a complaints procedure. A requirement was made as a result of the previous inspection that the complaints procedure must be amended to include the timescales for dealing with complaints and information for referring a complaint to the CSCI at any stage, should a complainant wish to do so. The requirement had not been implemented and still stands. In addition, the complaints procedure headed ‘Home Sweet Home’ that was kept in the folder containing all of the home’s policies and procedures still included an out of date reference to the National Care Standards Commission (NCSC). The registered manager acknowledged that a number of the home’s policies and procedures needed to be updated. Since the previous inspection the home had received one complaint regarding the standard of cleaning provided by an outside contractor. The registered manager had dealt with the complaint appropriately and had taken the matter up with the company involved. The registered manager stated that she kept copies of all the correspondence relating to complaints. Nevertheless, a book or register must be maintained in which any complaints made against the home are recorded. The book or register must contain all the relevant details of the complaint including, the date on which the complaint was made, the nature of the complaint, the name of the complainant, the name of the person responsible for investigating the complaint, the outcome of the investigation, any action taken and whether the complainant was satisfied with the outcome. Four of the service users with Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 16 whom discussions were held were asked specifically about whether they felt confident about raising any concerns or making a complaint about the home or the care they received. The four service users all stated that they felt confident about making a complaint if necessary. They also confirmed that they felt confident that any complaint or concern would be dealt with quickly and appropriately. The registered manager confirmed that no instances of suspected or alleged abuse had been reported to her or had otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had no concerns about the way in which the service users were treated by the staff. The registered manager also confirmed that she had had no reason to refer any member of staff for consideration for inclusion on the Protection of Vulnerable Adults (POVA) register. The home’s response to the two requirements and two recommendations that were made in regard to Standard 18 as a result of the previous inspection was assessed. The first requirement was that the home’s policy on abuse must be amended in order to include the full name, address and telephone number of the CSCI to which all suspected or alleged incidents of abuse must be reported in accordance with Regulation 37, the name and telephone number of the Adult Protection Coordinator and information about different types of abuse that may occur. The requirement had not been implemented and still stands. The out of date reference to the NCSC in the policy on abuse should be deleted. The second requirement was that the person registered must ensure that all members of staff receive training on abuse and the protection of service users. Training should also be provided to raise staff awareness of local vulnerable adult protocols and the home’s respective policies for the protection of service users. The requirement had not been implemented and still stands. The first recommendation was that a copy of the Department of Health Guidance ‘No Secrets’ and Worcestershire’s Policy and Procedure for the Protection of Vulnerable Adults should be obtained and kept in the home. The recommendation had not been implemented and still stands. The second recommendation was that the home’s policy on the ‘Management of Service Users’ Money and Financial Affairs’ should state clearly that the staff are precluded from any involvement in assisting in the making of or benefiting from service users’ wills. The recommendation had not been implemented and still stands. The out of date reference to the NCSC should be deleted. The registered manager stated that talks had been given to the staff in the past by members of the Mental Health Team on dealing with challenging behaviour. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 17 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): 20 and 26 The service users lived in safe, pleasant and comfortable surroundings. EVIDENCE: The home’s response to the recommendation that was made in regard to Standard 19 as a result of the previous inspection was assessed. The recommendation was that the home’s programme of routine maintenance and renewal of the fabric and decoration of the premises should include an appropriate space for recording the date when the items of work have been completed. The recommendation had not been implemented and still stands. The registered manager stated that the new proprietors would be ‘bringing in their own system’. The home provided two dining rooms, one of which was also used occasionally by the service users for playing cards and board games etc. The home also provided a lounge and an activities room. None of the service users smoked and, therefore, it had not been necessary to designate a specific room/area within the home for people who smoked. The registered manager stated that any new service user that did smoke would be asked to either give up smoking as a condition of admission or to be prepared to smoke outside the premises. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 18 The home’s rules on smoking and any other related matter e.g. the use of alcohol, should be clearly stated in the service users’ guide. The home provided wheelchair access to an attractive garden and extensive outdoor space that had seating. The lighting and the furnishings in the communal areas were domestic in character and of a satisfactory standard. The home’s response to the recommendation that was made in regard to Standard 21 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 home’s response to the recommendation that was made in regard to Standard 24 as a result of the previous inspection was assessed. The recommendation was that the process of providing each service user with a lockable storage space for medication, money and valuables should continue. The registered manager stated that the process had continued but had not yet been completed. It was stated that the process of providing each service user with a lockable storage space could be completed by 31 March 2006. It was, therefore, agreed that the recommendation would become a requirement to be implemented by that date. The home was free from unpleasant odours. The laundry was appropriately sited and contained hand-washing facilities. The laundry floor finishes were impermeable and these and the wall finishes were readily cleanable. The washing machine had a sluicing facility and a maximum hot water temperature of 93 degrees C. The home had an ‘Infection Control Policy and Procedure’ that included a reference to hand washing, spillages, disposal of clinical waste, use of protective clothing, disposal of needles, storage, preparation and serving food, and RIDDOR. The ‘Infection Control Policy and Procedure’ had not been reviewed since 2 February 2004. All of the home’s policies and procedures should be reviewed at least annually. The home’s response to the requirement that was made in regard to Standard 26 as a result of the previous inspection was assessed. The requirement was that the person registered must consult with the Environmental Health Officer in order to obtain written confirmation that the existing arrangements for accessing the laundry area meet with their approval. If they do not, a separate means of access to the laundry must be provided. The registered manager stated that vinyl covers had been provided for the laundry skips. The registered manager also stated that the Environmental Health Officer had confirmed that the action taken by the home was sufficient to provide safe and satisfactory access to the laundry. The requirement, therefore, had been implemented. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 19 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’s staff recruitment practices and procedures had improved since the previous inspection. However, there was scope for further improvement. EVIDENCE: The home’s response to the four requirements that were made in regard to Standard 29 as a result of the previous inspection was assessed. The first requirement was that an application for an enhanced Disclosure check from the Criminal Records Bureau must be made in respect of five members of staff, (and in respect of all new staff prior to their appointments). The registered manager stated that an enhanced CRB disclosure had been obtained in respect of ‘every single member of staff’. The files of four existing members of staff were inspected and each file contained evidence to show that a CRB disclosure had been obtained. The requirement had been implemented. The second requirement was that two written references must be obtained before appointing any member of staff and any gaps in employment records must be explored. One of the four staff files that were inspected contained only one written reference. The registered manager stated that a second reference had been obtained and was on the person’s work experience file. The requirement was, therefore, regarded as having been implemented. The third requirement was that all of the staff files must include a photograph and evidence of proof of identity. Two of the four staff files that were inspected did not contain a photograph and one of the files did not contain any proof of identity. The registered manager acknowledged that there were a ‘few gaps’. The requirement had not been fully implemented and still stands. The fourth requirement was that a copy of the code of conduct and practice set by the General Social Care Council must be issued to all members of staff as part of Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 20 their employment at the home. The registered manager stated that copies of the codes of conduct and practice had arrived in the post but not all of the staff had been given them. It was stated that a copy of the documents would be ‘handed out with the new contracts of employment’. The requirement had not been fully implemented and still stands. It was pleasing to note that the new proprietors were in the process of issuing a new statement of the terms and conditions of employment (contract) to all the staff. The home’s response to the requirement that was made in regard to Standard 30 as a result of the previous inspection was assessed. The requirement was that all the staff must have an individual training and development assessment and profile. The registered manager stated that staff training was encouraged. It was also confirmed that a record of the training undertaken by the staff was maintained. However, the discussions that were held with individual members of staff regarding training and the training needs that were identified were not always recorded. The requirement had not been fully implemented and still stands. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 21 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): 36 and 37 The frequency and content of staff supervision meetings and aspects of the home’s record keeping needed to be improved. EVIDENCE: The home’s response to the two requirements and two recommendations that were made in regard to Standard 33 as a result of the previous inspection was assessed. The first requirement was that a quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. The requirement had not been implemented and still stands. 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 in accordance with Regulation 24 and Standard 33. The requirement had not been 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 recommendation had not been implemented and still stands. The second Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 22 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. The recommendation had not been implemented and still stands. The four staff files that were inspected contained a record of some supervision meetings. However, the supervision meetings were not being held at the required frequency. For example, one member of staff had only attended supervision meetings on 25 January and 26 April 2005. Another member of staff had attended supervision meetings 28 February and 27 April 2005. There was no evidence to show that another member of staff, who had been working at the home for five months, had attended any supervision meetings. The forms that were used to record supervision did not cover all of the issues referred to in Standard 36.3. Therefore, the requirement that was made as a result of the previous inspection 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 had not been implemented and still stands. The records that the home is required to keep were inspected. Some of the records needed to be improved/updated as indicated in this report. In addition, all of the out of date references to the National Care Standards Commission (NCSC) should be deleted and replaced with a reference to the Commission for Social Care Inspection. The home’s statement of the procedure to be followed in the event of a service user becoming missing must state that such an incident must be fully and accurately recorded including the action taken and be reported to the CSCI without delay in accordance with Regulation 37. The fire safety records were inspected. It was noted that the last recorded weekly fire alarm test was dated 2 December 2005. Other fire safety checks were due to be carried out before the end of December. The last recorded fire training/instruction for the staff was dated 2 July 2004. The record of staff training in fire safety showed that six new members of staff, including one night care assistant, had not undertaken the relevant training. (See below). The home’s response to the two requirements that were made in regard to Standard 38 as a result of the previous inspection was assessed. The first requirement was that all staff must receive updated training in all of the core areas i.e. moving and handling, fire safety, first aid, food hygiene and infection control. The registered manager confirmed that staff training in moving and handling, first aid and food hygiene had been provided during January and February 2005. However, the staff had not yet undertaken updated training in fire safety or infection control. The parts of the requirement that had not been implemented still stand. The second 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. It was confirmed that risk assessments had been carried out and recorded on several of the safe working practice topics e.g. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 23 moving and handling, fire safety, infection control etc. However, risk assessments on other safe working practice topics referred to in Standards 38.2 and 38.3 had not been carried out e.g. first aid, food hygiene and the regulation and recording of water temperatures etc. The requirement, therefore, had not been fully implemented and still stands. During the inspection it was noted that nine service users were taken to the dining room in a wheelchair. Only two of the service users had footplates fitted to their wheelchairs. The registered manager stated that the other seven service users refused to use footplates. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 24 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 2 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 X 3 X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 1 2 X Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 25 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 5 Requirement Timescale for action 28/02/06 2 OP2 5 3 OP7 15 4 OP9 12,13 The service users’ guide must be amended to include all of the information detailed in Regulation 5 and Standard 1.2 and reflect any changes as indicated in this report. (Previous timescale of 31/03/05 not met). A statement of the terms and 28/02/06 conditions of residence (contract) that includes all of the information detailed in Standard 2.2 must be issued by the new registered provider to all of the service users and a copy retained on each service user’s file. The service user care plans must 31/03/06 be agreed and signed by the service user whenever capable and/or representative (if any). All of the aspects of care referred to in Standard 3.3 must be reviewed by the care staff at the home at least once a month and dated. (Previous timescale of 31/03/05 not met). The policy and procedure for the 28/02/06 administration of medication DS0000065939.V274140.R01.S.doc Version 5.1 Stonebow House Page 26 5 OP10 16 6 OP16 22 7 OP16 22 8 OP18 12,13 9 OP18 12,13 must be developed in accordance with the guidance in ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ published by the Royal Pharmaceutical Society of Great Britain and Standard 9 of the NMS. (Previous timescale of 30/04/05 not met). Telephone facilities that are suitable for the needs of service users in private e.g. the provision of a mobile handset or the bringing back into operation of the home’s telephone booth must be provided. (Previous timescale of 31/03/05 not met). The complaints procedure must be amended to include the timescales for dealing with complaints and information for referring a complaint to the CSCI at any stage, should a complainant wish to do so and a copy given to all of the service users and/or their relatives (Previous timescale of 31/03/05 not met). A record i.e. a book or register, must be maintained with details of all the complaints made against the home in accordance with the guidance given in this report. The home’s policy on abuse must be amended to include the full name, address and telephone number of the CSCI to which all suspected or alleged incidents of abuse must be reported in accordance with Regulation 37, the name and telephone number of the Adult Protection Coordinator and information about the different types of abuse that may occur. (Previous timescale of 31/03/05 not met). The person registered must DS0000065939.V274140.R01.S.doc 28/02/06 28/02/06 31/01/06 28/02/06 31/03/06 Page 27 Stonebow House Version 5.1 10 OP24 16 11 OP26 13,16 12 OP29 19 13 OP29 18 14 OP30 18 15 OP33 24 16 OP33 24 17 OP36 18 ensure that all members of staff receive training on abuse and the protection of service users. Training must also be provided to raise staff awareness of local vulnerable adult protocols and the home’s respective policies for the protection of service users. (Previous timescale of 30/04/05 not met). A lockable storage space/facility must be provided for each service user for medication, money and other valuables etc. The home’s policies and procedures for the control of infection must be reviewed at least annually. All of the staff files must include a photograph and evidence of proof of identity. (Previous timescale of 31/03/05 not met). A copy of the code of conduct and practice set by the General Social Care Council must be issued to all members of staff as part of their employment at the home. (Previous timescale of 31/03/05 not met). All the staff must have an individual training and development assessment and profile. (Previous timescale of 30/04/05 not met). A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale of 30/06/05 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 of 30/06/05 not met). Care staff must receive formal, DS0000065939.V274140.R01.S.doc 31/03/06 28/02/06 31/01/06 28/02/06 28/02/06 31/03/06 31/03/06 30/04/06 Page 28 Stonebow House Version 5.1 18 OP37 17 19 OP37 13,23 20 OP38 13,18,23 21 OP38 13,18 22 OP38 13 23 OP38 13 24 OP38 13 individual supervision that includes all aspects of practice, philosophy of care in the home and career development needs, at least six times a year. (Previous timescale of 30/06/05 not met). All of the records, policies and procedures that the home is required to keep including the statement of the procedure to be followed in the event of a service user becoming missing, must be reviewed and, where necessary, amended or updated in accordance with the guidance given in this report. Fire alarm tests must be carried out and recorded at the frequency recommended by the Fire Safety Officer. Fire safety training/instruction for all staff must be carried out and recorded at the frequency recommended by the Fire Safety Officer. (Previous timescale of 30/04/05 not met). All staff must receive updated training in all of the core areas i.e. infection control. (Previous timescale of 30/04/05 not met). 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. (Previous timescale of 28/02/05 not met). Footplates must be attached to wheelchairs and used at all times when wheelchairs are used to assist service users. If service users adamantly refuse to have footplates attached to their wheelchairs or to use them, their decision must be recorded in their personal file and they DS0000065939.V274140.R01.S.doc 31/03/06 19/12/05 23/12/05 28/02/06 23/12/05 18/12/05 23/12/05 Stonebow House Version 5.1 Page 29 must be asked to sign an appropriately worded statement confirming their decision. A risk assessment must be carried out, recorded and kept under review in respect of all the service users who use wheelchairs without footplates attached. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP5 OP9 Good Practice Recommendations Appropriate information regarding pre-admission visits should be included in the service users’ guide. A copy of ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ published in June 2003 by the Royal Pharmaceutical Society of Great Britain should be obtained and kept in the home for reference. The list of the names of the staff that are involved in the administration of medication, together with their signatures and initials, should be updated. Relatives, friends and representatives of service users should be given written information, preferably in the service users’ guide, about the home’s policy on maintaining relatives and friends’ involvement with service users at the time of an admission to the home. Information about the advocacy service should be included in the service users’ guide. A copy of the Department of Health Guidance ‘No Secrets’ and Worcestershire’s Policy and Procedure for the Protection of Vulnerable Adults should be obtained and kept in the home. The home’s policy on the ‘Management of Service Users’ Money and Financial Affairs’ should state clearly that the staff are precluded from any involvement in assisting in the making of or benefiting from service users’ wills. The home’s programme of routine maintenance and renewal of the fabric and decoration of the premises should include an appropriate space for recording the date DS0000065939.V274140.R01.S.doc Version 5.1 Page 30 3 4 OP9 OP13 5 6 OP14 OP18 7 OP18 8 OP19 Stonebow House 9 10 11 OP20 OP21 OP33 12 OP33 when the items of work have been completed. The home’s rules on smoking and the use of alcohol should be clearly stated in the service users’ guide. The toilets available for shared use should be clearly marked. 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 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. Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 31 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: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Stonebow House DS0000065939.V274140.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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