Inspection on 22/03/06 for Stonebow House

This inspection was carried out on 22nd March 2006.

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 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 N Andrews Unannounced Inspection 09:20 22 and 23 March 2006 nd rd 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.V287104.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.V287104.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.V287104.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. 16th December 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. 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. At the time of the inspection 22 service users were residing at the home and a further two service users were in hospital. It was said that 27 service users was normally the maximum number accommodated. 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’. Stonebow House DS0000065939.V287104.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 two days. During the inspection time was spent with two senior members of staff and the two proprietors assessing the progress made by the home in implementing the requirements and recommendations arising from previous inspections. Individual discussions were held with four service users and three members of staff. Various records, policies and procedures that the home is required to keep were inspected. Parts of the premises were also inspected. The four service users with whom discussions were held spoke positively about the home and the care that they received. All the comments that were made in regard to the staff were positive. One service user described the staff as ‘very good’ and said that they were ‘all very kind’. Another service user said, ‘The staff are all very willing and very good. If there’s anything we want doing they will do it’. A third service user said, ‘The staff are very friendly and cheerful. There is always night staff to attend to you. The staff respond promptly. They always listen to you and they are very thoughtful’. A fourth service user stated, ‘The staff are extremely kind and treat you well. They are very friendly and make you feel at home. If there’s anything you don’t like you’ve only got to ask and they will take notice of you’. The service users felt confident about raising any concerns that may arise and the also felt that these would be dealt with quickly and appropriately. Positive comments were also made about the standard of food provided. One service user stated, ‘The food is very good. What I don’t like I leave’. Another service user made a similar comment and said, ‘I don’t find a fault with it. If there’s something I don’t like I have something else’. The same service user confirmed that the food provided was sufficient both in quantity, quality and variety. A third service user said, ‘The food is very satisfying, regular, well cooked and varied. You can have meals in your own room if you wish. The meat is cut up. They do take care about the way the meals are presented for those who have difficulty. I can’t think of anyone who’s complained’. The fourth service user described the food as ‘not too bad at all’. The three members of staff with whom discussions were held also spoke positively about the home. They confirmed that they had been issued with a copy of the statement of terms and conditions of employment (contract) and that they received individual supervision. It was also confirmed that staff meetings were held and that the senior staff were approachable and supportive. Two members of staff commented positively about the training opportunities that were provided. When asked to comment about the positive aspects of the home one member of staff said that the home had a ‘good atmosphere and nice residents’. Another staff member said, ‘The residents are very nice. The staff cooperation is good. The home is clean and tidy’. A third, recently appointed member of staff said that she had been made to feel Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 6 welcome and helped to settle in and that both the staff and the service users had made her ‘feel at home’. She also said that a good relationship existed between the staff and the service users. The staff were asked what changes they would like to see, if any, to improve the service users’ care. Two of the staff felt that the range and frequency of social and recreational activities could be improved. One member of staff said that ‘more activities and more entertainment’ could be provided. The other member of staff said that she was pleased that Bingo and music and movement had been introduced but felt that more could still be done to enhance the range and variety of social and recreational events. The home had continued to make steady progress towards meeting all of the National Minimum Standards. It was pleasing to note that, during the relatively short time since the previous inspection, the number of requirements and recommendations had fallen from 24 to 21 and from 12 to 5 respectively. Nine of the requirements related to issues that had been identified in previous inspections and had not yet been implemented. It was clear that further work still needed to be carried out in order to address all of the outstanding issues and to reduce the number of requirements to a more satisfactory level. However, having regard to the commitment of both the staff and the registered provider there is no reason to believe that this objective cannot be achieved in the near future. During this inspection the home was inspected against fifteen of the National Minimum Standards. Two of the Standards were exceeded, seven of the Standards were met, four Standards were nearly met and two Standards were not met. What the service does well: What has improved since the last inspection? Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 7 Several requirements and recommendations arising from previous inspections of the home had been implemented. The proprietor said that, following the recent change of proprietorship, the home had a new sense of direction and that the staff had been kept aware of the changes that had taken place. The home now provided an additional nine staff hours per week for the maintenance of the premises. 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.V287104.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.V287104.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): 3 All prospective service users were assessed prior to admission. However, the form that was used by the home to carry out the pre-admission assessments needed to be amended. EVIDENCE: The home’s response to the requirement that was made in regard to Standard 1 as a result of the previous inspection 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 reflect any changes as indicated in this (i.e. the previous) report. A copy of the service users’ guide was made available for inspection. The service users’ guide was clear, well written and included a reference to most of the relevant issues. However, the service users’ guide did not include a standard form of contract for the provision of services and facilities by the registered provider to service users as required by Regulation 5 (1) (c). A copy of the standard form of contract must be included as part of the service users’ guide. The home’s response to the requirement that was made in regard to Standard 2 as a result of the previous inspection was assessed. The requirement was that a statement of the terms and conditions of residence (contract) that Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 10 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 proprietor stated that new contracts had been prepared and that all of the service users would have received a copy of the new contract by 23 March 2006. A copy of the contract was subsequently made available for inspection. The contents of the contract were satisfactory. The requirement was regarded as having been implemented. The senior deputy manager confirmed that all of the service users had been assessed by the home including those service users who had been admitted following a community care assessment. A copy of the form that was used by the home to assess the care needs of prospective service users was made available for inspection. The form was called ‘Prospective Resident Assessment Portfolio’. The form included a reference to most of the aspects of care listed in Standard 3.3 in addition to other relevant issues. However, the assessment form must also include a reference to, • History of falls, • Mental state and cognition and, • Personal safety and risk. It was confirmed that all of the service users had a care plan that was based on their individual assessments. 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 should be included in the service users’ guide. The recommendation had been implemented. Stonebow House DS0000065939.V287104.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): 7, 8 and 10 All of the service users had a care plan that was reviewed every month. However, the contents of the care plans needed to be improved. The home worked well with other agencies to ensure that the service users’ healthcare needs were met. The service users felt that they were treated with respect and that their right to privacy was upheld. EVIDENCE: It was confirmed that all of the service users had a care plan. A copy of the care plan that was used by the home was made available for inspection. 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. It was confirmed that all of the care plans had been signed. It was also confirmed that the contents of the care plans were reviewed by the care staff every month. However, it was difficult to identify in the care plans all of the issues referred to in Standard 3.3. Following discussion it was agreed that a new care plan would be introduced that would cover all of the issues referred to in Standard 3.3. A new form would also be introduced that would show clearly that the care plans had been reviewed. It Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 12 was confirmed that the service users were involved in the review of their care plans. The staff helped the service users to maintain their capacity for self-care. It was confirmed that the staff were aware of what to look for in regard to service users at risk of developing pressure sores. It was also stated that any indication that pressure sores were developing would be reported to a senior member of staff. Currently, the district nurse visited twice a week to attend to one service user with a pressure sore. Pressure relieving mattresses and foot and chair pads were provided as necessary. The help of the continence adviser was sought when it was appropriate to do so. Five service users were under the supervision of a consultant psychiatrist. It was stated that approximately ten service users took part in the ‘keep fit’ sessions held at the home on Monday afternoons. In better weather the staff escorted the service users around the garden. Once a month a ‘movement therapist’ visited the home and carried out ‘movement and massage’. It was confirmed that the service users’ dietary preferences were recorded and special needs e.g. diabetes, were taken into account. The service users were weighed weekly. The senior deputy manager had no concerns at the present time in regard to any of the service users’ weight gain or loss. All of the service users were registered with one of two local GP surgeries. A chiropodist visited the home at least once a month. The senior deputy manager stated that none of the service users required the help of a physiotherapist or occupational therapist at present. It was also stated that the service users’ families usually accepted responsibility for ensuring that the service users received appropriate dental treatment. Similarly, the families of the service users arranged any hearing tests that were required. It was confirmed that the optician was also ‘called in on a needs basis’ if the service users required an eyesight test or, alternatively, they were referred to their GP. The home’s response to the one requirement and two recommendations that were made in regard to Standard 9 as a result of the previous inspection was assessed. The requirement was that the policy and procedure for the administration of medication must be developed in accordance with the guidance ‘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. It was confirmed that 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 recommendation had been implemented. The second recommendation was that the list of the staff that are involved in the administration of medication, together with their signatures and initials, should be updated. The recommendation had been implemented. It was stated that the responsibility for the administration of medication was limited to the senior staff members, the evening staff and the night staff. Standard 9 was not fully inspected on this occasion. However, it Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 13 was agreed that, following the inspection, the CSCI Pharmacist Inspector would be asked to visit and to inspect the home fully against Standard 9 of the NMS. The senior deputy manager confirmed that the arrangements for health and personal care ensured that the service users’ privacy and dignity were respected. It was stated that the staff always kept the doors to the service users’ bedrooms closed when they were undertaking personal care tasks. The service users were always asked about the way in which they preferred their personal care tasks to be carried out and the staff always endeavoured to remember to knock the door before entering the service users’ bedrooms. The four service users with whom discussions were held felt that they were treated with respect and that their privacy was respected. They all confirmed that the staff knocked the door before entering their bedrooms. The senior deputy manager stated that medical and other formal consultations always took place in private. 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 senior deputy manager stated that the majority of the service users had their own telephones. Nevertheless, the requirement had not been implemented and still stands. It was confirmed that all of the good care practices referred to in Standards 10.3 to 10.6 were upheld. The home had three double bedrooms. However, the double bedrooms were being used as single bedrooms at the present time. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 The number and variety of social, recreational and religious events provided by the home needed to be developed in accordance with the service users’ interests, preferences and needs. The service users were able to maintain contact with their relatives and friends as they wished. The service users were also helped to exercise choice and control over their lives. EVIDENCE: The senior deputy manager stated that the daily routines followed a regular pattern but that the routines were made flexible when necessary. The service users confirmed that there was sufficient flexibility in the daily routines e.g. to allow them to get up and go to bed when they wished. The service users were given a choice of whether to join in any particular activity. The home had arranged for ‘keep fit’ sessions to be held. A mobile library that supplied large print books visited the home every month. It was stated that there was a choice of food and that the service users could eat their meals in their own rooms if they wished. Three service users consistently chose to eat their meals in their bedrooms. An Anglican vicar visited the home to hold a Communion service. Members of no other religious groups visited the home and none of the service users attended any of the local places of worship. The ‘talking book’ service was available for one service user. The senior deputy manager stated that information about social and recreational activities was placed on the notice board and, in addition, the service users were informed verbally. The four service users with whom discussions were held made less Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 15 positive comments regarding the social and recreational activities. One service user said, ‘Sometimes the afternoons are very long but they’re going to introduce more activities’. Another service user said, ‘I’d love to see the activities increased’. Another service user said that she would welcome more activities. The members of staff with whom discussions were held also felt that this aspect of the service could be improved. The service users were able to receive their visitors at any reasonable time. Three of the four service users with whom discussions were held confirmed that their visitors were always made to feel welcome. The senior deputy manager stated that the principles and practices outlined in Standards 13.2 to 13.4 were maintained by the home. 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 been implemented. The senior deputy manager stated that the service users enjoyed visits by children from the local school on special occasions. The senior deputy manager confirmed that the service users were encouraged to handle their own financial affairs for as long as they were able to do so. 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 been implemented. It was stated that no advocates were involved in the care of the service users at the present time. There was evidence to show that the service users were entitled to bring their personal possessions with them when they were admitted to the home. In addition, the service users’ guide contained the following statement, ‘Residents are encouraged to bring personal items from home and we are happy to hang pictures’. The service users’ guide also contained clear information about the service users’ right of access to the records held about them by the home. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 16 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): N/A It was not possible to form an overall judgement as none of the Standards in this section of the report were fully assessed. EVIDENCE: The home’s response to the two requirements that were made in regard to Standard 16 as a result of the previous inspection was assessed. The first requirement was 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 and a copy given to all of the service users and/or their relatives. The requirement had been implemented. The second requirement was that 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 (i.e. the previous) report. The requirement had been implemented. It was noted that the complaints record contained one recent complaint dated 9 February 2006. The complaint had been dealt with satisfactorily. 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 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. The requirement had been implemented. 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 must also be Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 17 provided to raise staff awareness of local vulnerable adult protocols and the home’s respective policies for the protection of service users. The senior deputy manager stated that a video on the protection of older people from abuse had been purchased to aid ‘in-house’ training. In addition, more formal training for the staff had been arranged to take place in June organised by ACT. The requirement, therefore, had not yet been fully 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 been implemented. 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 been implemented. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 18 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): 19 The service users lived in comfortable and homely surroundings. However, written evidence was needed to show that the building complies with the requirements of the local fire service and environmental health department. EVIDENCE: The service users lived in homely and comfortable surroundings. The proprietor stated that the premises required some maintenance work and that quotes were awaited. The premises were accessible to people in wheelchairs. The majority of service users were accommodated on the ground floor. There were 3 single bedrooms and 2 double bedrooms on the first floor of the original part of the building. The home did not have a passenger lift. However, a stair lift had been installed on part of the stairway to enable service users that lived in this part of the home to have easier access to the bedrooms on the first floor. 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 premises. 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 Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 19 should include an appropriate space for recording the date when the items of work have been completed. The recommendation had been implemented. One of the service users with whom discussions were held commented on the ‘lovely grounds’ and said that they were ‘kept tidy’. It was confirmed that a gardener visited the home each week in order to maintain the grounds. In addition, a maintenance man had been appointed to work 9 hours per week. A risk assessment must be carried out and recorded in regard to the maintenance of a safe environment including the outdoor steps and pathways. The senior deputy manager stated that the Fire Safety Officer had visited the home on 24 January 2006. However, there was no correspondence available to confirm the outcome of the inspection. There was also no written evidence to show that the home complied with all of the recommendations contained in the Fire Safety Officer’s letter dated 3 March 2005. The senior deputy manager was unable to confirm the date of the most recent visit to the home by the Environmental Health Officer. The senior deputy manager subsequently stated that she would obtain a copy of the Fire Safety Officer’s letter following his recent visit and also make appropriate arrangements for the Environmental Health Officer to visit. The home’s response to the recommendation that was made in regard to Standard 20 as a result of the previous inspection was assessed. The recommendation was that the home’s rules on smoking and the use of alcohol should be clearly stated in the service users’ guide. The recommendation had been implemented. 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 requirement that was made in regard to Standard 24 as a result of the previous inspection was assessed. The requirement was that a lockable storage space/facility must be provided for each service user for medication, money and other valuables etc. The requirement had been implemented. 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 home’s policies and procedures for the control of infection must be reviewed at least annually. The proprietor confirmed that the requirement had been implemented during the period of the inspection. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 20 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): 27, 28 and 30 The service users’ needs were met by a satisfactory number of staff who were appropriately trained and/or experienced. The staff had undertaken a high level of NVQ training or other equivalent training and displayed a high level of competency. EVIDENCE: The service users’ needs were met by a satisfactory number of appropriately trained and experienced staff. In addition to the registered manager the home employed two senior deputy managers for a total of 59.5 hours per week, a deputy manager for 17 hours per week, a senior care assistant for 25.5 hours per week and 10 care assistants for a total of 310.5 hours per week. The home also employed a senior night care assistant and four, night care assistants who worked a total of 132 hours per week. The night care staff were supported by day care staff working 3 night shifts per week. Two waking night care staff were on duty at night. Three members of staff were employed for a total of 64 hours per week to undertake all of the catering duties. Two contracted cleaners were employed for a total of 40 hours per week. A copy of the staff rota was made available for inspection. The staff rota must include a clear indication of the designation/position of each member of staff. In the mornings the staff on duty normally included one senior member of staff, four care staff, a cook and two cleaners. In the afternoons (1:00 to 5:00 pm) one senior member of staff and three care assistants were normally on duty. In the evenings from 5:00 pm onwards there were normally three care assistants and one tea assistant on duty with a senior ‘on call’. All of the care staff were above the age of 18 years. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 21 The home employed a total of nineteen care staff excluding the registered manager. Of the nineteen members of care staff employed, thirteen had undertaken NVQ level 2 training or equivalent. Seven of the thirteen members of staff had undertaken NVQ level 2 training or above, one member of staff was a qualified nurse and five members of staff had obtained a nursing qualification from abroad. It was confirmed that agency staff and trainees were not employed by the home. The home’s response to the two requirements that were made in regard to Standard 29 as a result of the previous inspection was assessed. The first requirement was that all of the staff files must include a photograph and evidence of proof of identity. The requirement had been implemented. The second 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 their employment at the home. The requirement had been implemented. The home was committed to staff training that included all of the core areas. The senior deputy manager confirmed that the home had a satisfactory staff induction training programme that met the TOPSS (Skills for Care) standards. It was also confirmed that all the staff had received a minimum of three paid days training per year. 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 requirement had not been fully implemented and still stands. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 22 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): 31, 33, 35 and 38 The home had an experienced, competent and trained registered manager. The systems for monitoring the quality of the service needed to be developed. The service users’ financial interests were safeguarded. The health and welfare of the service users was promoted but further improvements were needed to ensure their safety. EVIDENCE: The registered manager was competent and experienced and had been the registered manager for over twenty years. Throughout this period the registered manager had undertaken relevant training in order to enhance her knowledge and skills. The training had included the Registered Managers’ Award. The registered manager and her husband had also been the registered providers until November 2005. The registered manager, therefore, had considerable knowledge of the administrative and business aspects of the service. The registered manager had a sound understanding of the needs of older people and had demonstrated a close involvement with and commitment to their care. The senior members of staff had also undertaken appropriate Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 23 training and had a shared understanding of and commitment to the people in their care. However, the registered manager was intending to retire in the near future. Therefore, a suitable person must be appointed as acting manager who will make an application to the CSCI to become the registered manager. 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 proprietors stated that consideration was being given to the introduction of an ISO accredited scheme. 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. However, the proprietors were aware of the need to provide a plan and it was confirmed that consideration was being given to the implementation of this requirement. 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. It was confirmed that surveys had been carried out but that the results had not yet been analysed or published. The recommendation, therefore, had not been fully implemented and still stands. 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. The recommendation had not yet been fully implemented and still stands. There was no evidence to show the home’s commitment to lifelong learning and development for each service user linked to the implementation of their individual care plan. However, it was clear that the home had a pro-active approach to the development of relevant policies and procedures that underpin good care practice. The senior deputy manager stated that the service users were encouraged to retain control over their own money wherever possible. However, the home did accept responsibility for the personal allowances handed over for safekeeping in respect of the majority of service users. The money was used by the service users for their personal expenses e.g. hairdressing, chiropody etc. The service users’ money was kept in individual packets. The service users’ financial accounts were also individually maintained. The system for recording and maintaining the service users’ finances was checked and was correct. It was confirmed that no one connected with the running of the home acted as an agent or appointee on behalf of any of the service users. The money that was held for safekeeping on behalf of the service users was kept in a secure facility and access to the money was restricted to senior members of staff. The home accepted responsibility for service users’ personal Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 24 possessions/valuables handed over for safekeeping e.g. credit cards, jewellery. The senior deputy manager confirmed that records and receipts were kept of all such items. The home’s response to the requirement that was made in regard to Standard 36 as a result of the previous inspection was assessed. The 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. It was stated that the requirement had not yet been fully implemented in respect of all the staff. Therefore, the requirement still stands. The home’s response to the two requirements that were made in regard to Standard 37 as a result of the previous inspection was assessed. The first requirement was that 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 (i.e. the previous) report. It was confirmed that the requirement had been implemented. The second requirement was that fire alarm tests must be carried out and recorded at the frequency recommended by the Fire Safety Officer. The home’s fire safety records were made available for inspection. It was noted that the requirement had been implemented. However, it was also noted that the monthly fire equipment handling check had not been carried out since 30 November 2005 and the monthly emergency lighting check had not been carried out since 23 November 2005. A Notice of Immediate Requirement was issued at the conclusion of the inspection in regard to this matter. The outside contractor Force Three had checked the fire extinguishers on 6 March 2006. It was confirmed that moving and handling training, food hygiene training and first aid training had been carried out on 23 and 30 January, 13 and 20 February and 27 February and 13 March 2006, respectively. The home’s response to the five requirements that were made in regard to Standard 38 as a result of the previous inspection was assessed. The first requirement was fire safety training/instruction for all staff must be carried out and recorded at the frequency recommended by the Fire Safety Officer. It was confirmed that the last fire safety training/instruction had been given to the staff on 21 December 2005. However, one newly appointed member of staff who had commenced working at the home at the end of January 2006 had not received the fire safety training/instruction. Therefore, the requirement had not been fully implemented. A similar requirement has been made in regard to this matter in this report. The second requirement was that all staff must receive updated training in all of the core areas i.e. infection control. This requirement had not been fully implemented and still stands. 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 Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 25 recording of water temperatures. The requirement had not been implemented and still stands. A Notice of Immediate Requirement was issued at the conclusion of the inspection in regard to this matter. The fourth requirement was that footplates must be attached to wheelchairs and used at all times when wheelchairs are used to assist service users. The requirement had been implemented. The fifth requirement was that 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 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. The requirement had been implemented. The senior deputy manager stated that two service users had refused to have footplates attached to their wheelchairs. It was confirmed that the service users’ decision regarding this matter had been recorded and the relevant statement signed and placed in the service users’ personal files. During the inspection it was noted that a number of bedroom doors were wedged open. All fire resisting doors including bedroom doors must be kept closed. A Notice of Immediate Requirement was issued at the conclusion of the inspection in regard to this matter. If any of the service users prefer to have their bedroom doors left open the doors must be fitted with an automatic, self-closing device e.g. a dorgard, in order to ensure that the doors close when the fire alarm is sounded. The self-closing devices must conform to the British Standard recommended by the Fire Safety Officer in his letter dated 3 March 2005. It was subsequently confirmed by the senior deputy manager that the fire resisting doors had not been fitted with cold smoke seals and intumescent strips as recommended by the Fire Safety Officer in his letter dated 3 March 2005. The home used the ‘yellow bag’ system for the removal of waste material under contract. It was stated that all hazardous substances were kept in a lockable cupboard in the laundry. It was also confirmed that the boilers and central heating system had been serviced since the previous inspection, the electrical system had been checked and that PAT testing had been carried out within the past twelve months. Thermostatically controlled mixer valves had not been fitted to all of the hot water outlets used by the service users. The senior deputy manager stated that every bathroom had a thermometer that was used to check the temperature of the water before any of the service users had a bath. It was confirmed that all of the radiators had been fitted with covers and that opening restrictors had been fitted to the windows. The home had the relevant documentation in regard to COSHH and RIDDOR. A first aid box was provided in the kitchen. The senior deputy manager agreed that it was advisable having regard to the size of the home to obtain another first aid box. The home had a health and safety policy. Safety procedures were displayed in the office and ‘wash your hands’ signs and exit signs were appropriately sited. Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 3 28 4 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 1 X 3 X X 1 Stonebow House DS0000065939.V287104.R01.S.doc Version 5.1 Page 27 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 The service users’ guide must include a standard form of contract as specified in Regulation 5 (1) (c) as indicated in this report. (Previous timescale 28/02/06 not met). 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. The service users’ care plans must include all of the aspects of care as set out in Standards 7.2 and 3.3. 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 28/02/06 not met). The service users must be consulted about the programme of activities arranged by or on behalf of the home and DS0000065939.V287104.R01.S.doc Timescale for action 31/05/06 2 OP3 14 31/05/06 3 OP7 15 31/05/06 4 OP10 16 31/05/06 5 OP12 16 31/05/06 Stonebow House Version 5.1 Page 28 6 OP18 12,13 7 OP19 13 8 OP19 13 9 10 OP27 OP30 17 18 11 OP31 8 12 OP33 24 13 OP33 24 appropriate social, recreational and religious facilities and activities provided according to the service users’ interests, preferences and needs. The person registered must 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 31/03/06 not met). 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. A risk assessment must be carried out and recorded in regard to the maintenance of a safe environment, including outdoor steps and pathways. The duty roster must show the position/designation of all the staff on duty day and night. All the staff must have an individual training and development assessment and profile. (Previous timescale 28/02/06 not met). A suitable person must be appointed to manage the home who will make an application to the CSCI to become the registered manager. A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale 31/03/06 not met). An annual development plan for the home based on a systematic cycle of planning, action, review, DS0000065939.V287104.R01.S.doc 30/06/06 31/05/06 31/05/06 30/04/06 31/05/06 31/05/06 30/06/06 30/06/06 Stonebow House Version 5.1 Page 29 14 OP36 18 15 OP37 13,23 16 OP38 13,18,23 17 OP38 13,18 18 OP38 13 19 20 OP38 OP38 13,23 13,23 21 OP38 13 reflecting aims and outcomes for service users must be introduced in accordance with Regulation 24 and Standard 33. (Previous timescale 31/03/06 not met). 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. (Previous timescale 30/04/06 not yet met). The fire equipment handling check and the emergency lighting check must be carried out and recorded at regular monthly intervals in accordance with the recommendation of the Fire Safety Officer. 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. All staff must receive updated training in all of the core areas i.e. infection control. (Previous timescale 28/02/06 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 23/12/05 not met). All fire-resisting doors must be kept closed and not wedged open. All fire resisting doors must be upgraded by the fitting of cold smoke seals and intumescent strips. Thermostatically controlled mixer valves must be fitted to all hot water outlets used by service DS0000065939.V287104.R01.S.doc 30/06/06 31/03/06 30/04/06 31/05/06 31/03/06 23/03/06 31/05/06 31/07/06 Stonebow House Version 5.1 Page 30 users in order to prevent the risk of scalding. 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 OP12 Good Practice Recommendations 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 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. 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. 2 3 OP21 OP33 4 5 OP33 OP33 Stonebow House DS0000065939.V287104.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.V287104.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. 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