CARE HOMES FOR OLDER PEOPLE
Stoneham House 4 Bracken Place Chilworth Southampton SO16 3NG Lead Inspector
Beverley Rand Unnannounced 13.04.05 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Stoneham House Address 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG 02380 768715 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs W L Bellett Mrs Josephine Mary Ann Mills CRH 37 Category(ies) of Dementia (DE) - 37 registration, with number Old Age (OP) - 37 of places Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19.10.2004 Brief Description of the Service: Stoneham House is a care home providing personal care and accommodation for a maximum of 37 older people, some of whom have dementia. The home is located on the outskirts of Southampton with easy vehicular access to local amenities. The home was opened in 1995 and is a large detached property standing in extensive grounds. There is a car parking area at the front and the side of the building. The building stands on a slight hill, so has three floor levels, which can be accessed with a shaft lift. The home has some shared bedrooms, but the present philosophy of the home is to operate at less than full capacity, thus ensuring that current residents have a single room. Communal space is provided by way of a large lounge, a dining room and a conservatory area. There are also two patio areas, with some furniture. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over six and a half hours and was a routine, unannounced inspection. One additional visit has been made since the last inspection, to investigate two complaints. One complaint was partially substantiated and the other was unsubstantiated/unresolved. The letter sent to the registered person following this visit can be obtained from the CSCI office on request. A partial tour of the home took place and the inspector looked at records, and spoke with the manager, three staff and four residents. The Commission has registered a new manager since the last inspection. What the service does well: What has improved since the last inspection? The medication records have improved since they were last inspected at an additional inspection. The activities programme is being improved and residents who expressed a view said that they liked the entertainer. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed on this occasion EVIDENCE: Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8. The care planning system enables staff to meet the needs of service users but would benefit from clear guidance on challenging behaviour. Improvements have been made in the administration of medication but inaccurate records means there is a potential for mistakes to be made. EVIDENCE: The service user plans sampled contained all the necessary information, but there were not always clear plans of action for meeting the needs of people who display challenging behaviour. A requirement had been raised in this regard since the last inspection but the timescale had not elapsed. It therefore appears in this report. A requirement with regard to medication records had also been raised, and these were much improved. However, a few gaps were found on the recording sheets, one tablet had not been given but had been signed for, and another person’s tablet was missing from the box for a future day. A correct procedure is now in place and tippex is not being used to adjust
Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 10 records. The home now has a copy of the Royal Pharmaceutical Society guidelines for the storage of medicines. Procedures are in place for the receipt, handling, disposal etc. of medication and records kept. Eye drops are kept in a fridge, solely for that purpose, and the temperature is recorded daily. However, four cartons of ‘Fortisip’ were found to be out of date by between two and seven months. The manager removed these straight away. Staff have recently received training on the administration of medicines from the community pharmacist. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Improvements in the activities programme meet the recreational needs of residents. Residents enjoy the food. EVIDENCE: The new manager has worked to improve the activities programme. A notice on the main notice board showed something happening every weekday, which was singing, flower arranging, reading, finger painting and arts and crafts. A named member of staff has responsibility for organising small groups and encouraging participation. Other ideas are also being considered, such as gardening with tubs, and the manager is open to ideas which originate from service users. Entertainers visit the home at least fortnightly, which the service users asked about this said they enjoyed. The manager observed that some people who used not to join in with activities, now do so. Service users spoken with confirmed that their visitors are welcome. A record of visitors is kept and the manager said that resident’s wishes would be respected if they did not wish to see a particular person. People choose where they eat and the menu is varied and changes regularly. Alternatives are available – one resident said that they do not like fish and chips and the home has provided
Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 12 frozen curry meals, which had been requested instead. Teatime menus have reverted back to sandwiches and soup with some supplements such as sausage rolls, but the majority of service users who expressed a view said they liked this. On the day of the inspection, the dinner consisted of roast lamb, roast (fresh) potatoes and fresh swede and carrot, and appeared appetizing. All service users who spoke with the inspector said they enjoyed the food, (one particularly liked the puddings), although two people who eat in their rooms said it could sometimes be cold. Following observation, this would appear to vary with which staff are on and which order the food is dished up. On the day of the inspection, the trays were taken first and the resident asked confirmed that it had been piping hot. The same service user also passed comment about the amount of gravy they like – but as there is little continuity of staffing, requests like this can be overlooked. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed. EVIDENCE: These standards were not assessed. However, two complaints have been made directly to the Commission, which have been investigated. One was with regard to medication, the provider not working shifts as per the rota and service users being left alone at a certain time of day. There were problems with medication (although this part of the complaint was only partially upheld) and two requirements were raised. The other two areas were not upheld. The second complaint focussed on care of a service user: three aspects were not upheld and a fourth was unresolved, and will continue to be monitored at future inspections. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Residents live in a clean and homely environment but would benefit from attention to the environment and maintenance standards. EVIDENCE: During the last year the provider has undertaken re-wiring in the dining room, installed extra emergency lighting and other fire safety related products, bought new fire proof beds and new bedding. The carpets have been replaced in two bedrooms. However, when the fire office last visited, he noted that the step over the fire exit threshold was too high. The provider has built a step up, which did not appear to solve the problem. The inspector also considered that it might create a health and safety issue as it is next to a cupboard where the cleaner is kept, and a person could turn and trip over the raised edge. An immediate requirement was raised with regard to seeking professional advice about this arrangement. The Environmental Health Officer had visited on 18/2/05 and made a requirement to clean the floor. It had been the cook’s
Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 15 day off and this was soon rectified. The inspector looked at a sample of bedrooms as well as the communal areas. Some of the furniture was worn, for example, a chair, chests of drawers and a wardrobe was standing at a worrying angle in one room. Several of the walls needed painting. Bathrooms were functional but not inviting. One empty bedroom still had a smell of urine and body odour, and one en-suite toilet smelt of urine. There was a slide lock on the outside of a shared en-suite toilet, and no reason could be found for this. The manager agreed that this would be removed. The home does not have a maintenance or fabric renewal programme, which may account for the condition of some of the rooms. The home has a laundry and appropriate procedures are in place. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Not all service users needs can be met by a staff team which changes on a daily basis, and service users are not completely protected by the home’s recruitment policies. EVIDENCE: The home has lost a number of staff which has resulted in there only being five permanent day carers, three night staff, two cleaners, one laundry person, one cook plus the manager and provider. Two new staff are due to start soon. The manager accesses agency staff to ensure that there are four staff on shift during the hours of 8-4, (sometimes there are three after 2pm), and three between 4 and 8. On the day of the inspection, the staff team was comprised of one permanent member of staff and three agency staff, (plus the manager) one of whom had not worked in the home before. Service users told the inspector that although the staff were nice, they ‘did not recognise them a lot of the time’ and there was ‘no consistency’. The inspector spent some time sitting in the lounge after lunch, where the majority of people had fallen asleep. A new member of agency staff remained at the edge of the room, appearing unsure what to do, whilst the other staff were asking certain residents if they wanted a bath, telling them that everyone must have a bath once a week. The manager said that it was not acceptable practice to discuss this in front of other service users, and baths were usually done in the morning. Staff records sampled showed that two out of the seven did not have proof of identity. This was raised as a requirement in the last inspection report. New
Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 17 files showed that the appropriate checks and references were in the process of being undertaken. One existing staff file was missing and could not be found by the manager or provider. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed on this occasion. EVIDENCE: There is an outstanding requirement regarding staff supervision, which has been raised again in this report. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Service user plans must cover all aspects of care, including how staff should deal with challenging behaviour. The timescale for this had not elapsed at the time of the inspection. All medication records must be accurate The provider must seek advice from the Fire Safety Officer with regard to the step on the fire exit door, and act on the advice given. This was made as an immediate requirement on the day of the inspection All staff files must contain proof of identity This remains partially outstanding from the last inspection - the timescale of 31/11/04 was not met Care staff must receive supervision six times a year. Supervision must follow the format required by the standard, and must be recorded. This remains outstanding from the previous two inpections and the last timescale of 30/12/04 Timescale for action 30/06/05 2. 3. OP9 OP19 13 (2) 23 (4)(ac) 30/06/05 13/04/05 4. OP29 19 (1)(b) 31/06/05 5. OP36 18 (2) 31/06/05 Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 21 was not met. The new manager has organised dates for the first sessions. 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 OP19 Good Practice Recommendations The provider should devise a programme for maintenance and renewal of the fabric and decoration of the premises. Stoneham House H54 S12356 Stoneham House V221017 130405.doc Version 1.20 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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