Inspection on 25/05/07 for Stoneham House

This inspection was carried out on 25th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stoneham House 02/12/09

Stoneham House 28/11/08

Stoneham House 05/12/07

Stoneham House 15/01/07

Stoneham House 28/04/06

Stoneham House 01/09/05

Stoneham House 13/04/05

Stoneham House 19/10/04

Stoneham House 12/05/04

Stoneham House 14/01/04

Stoneham House 11/07/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Stoneham House 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG Lead Inspector Mark Sims Unannounced Inspection 25th May 2007 11:30 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 Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoneham House Address 4 Bracken Place Chilworth Southampton Hampshire SO16 3NG 023 8076 8715 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) stonehamhouse@aol.com Mrs W L Bellett To Be Confirmed Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (37) of places Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th January 2007 Brief Description of the Service: 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. The current level of fees is £410.00 to £520 per week. This information was provided by Mrs Bellett the Registered Provider on 22/01/07. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second ‘Key Inspection’ for Stoneham House Residential Home, a ‘Key Inspection’ being part of the Commission’s inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the service was conducted over one day, where in addition to paperwork that required reviewing the inspector met with the service users, proprietor, manager and staff. The inspection process also involves far more pre-fieldwork visit activity, with the inspector gathering information from a variety of sources: the Commission’s database and pre-inspection information provided by the service provider, questionnaires, etc. The fieldwork visit was conducted over 6.5 hours and was undertaken in the presence of the manager, who was helpful and co-operative throughout. What the service does well: The following is an indication of the areas where the service is performing well: • Choice of Home: The manager discussed with the inspector the home’s use of the ‘single assessment process’ document, which is designed to assess peoples needs within a community setting and follow throughout their contact with health and social care services, being updated and amended as their needs change. Completed copies of this tool were seen on the files on people admitted to the home; and whilst this specific tool was not specifically designed for use within a residential setting, it does provide sufficient information about the persons, needs, wishes and abilities. • Daily Life and Social Activities: On arriving at the home the inspector was greeted by the sound of music, singing and laughter, with the majority of the service users sat in the lounge enjoying the entertainment being provided by a visiting act. In conversation, people stated that they enjoyed this and that the person/act present that day was their favourite as he was very good at getting people involved. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 6 It was also noted that a schedule of planned events are listed on the notice board, including several church visits and that the home has its own car for taking people out, this was in use during the fieldwork visit. People are also encouraged to maintain their independence, one service user still taking his own car out and about, whilst another person makes very good use of his bus pass, going shopping or visiting family. • Complaints & Protection: The home has clear policies that cover both these issues, the complaints policy included within the Statement of Purpose and Service Users Guide documentation and advertised on the home’s central notice board. Staffing: The staff appeared very motivated and friendly throughout the inspection and were noted to have a good understanding and/or appreciation for the needs of the people they care for. Training opportunities appear reasonable, with access to National Vocational Qualifications, an induction process that follows the Skills for Care programme, in house training events and update sessions. • Management and Administration: The manager was co-operative and helpful throughout the fieldwork visit and is known to have commenced the process of Registration with the Commission. Management processes such as quality assurance, regular auditing of records and events, etc, are in place to ensure the home runs effectively and the service users, their relatives and staff appear happy to bring issues of concern to the manager, as observed throughout the day. • What has improved since the last inspection? The following is an indication of the areas where the service has improved its performance: At the last inspection a number of requirements were made, including: • Medication: ‘The Registered Provider must ensure medication is stored in a clean and secure environment at all times.’ ‘The Registered Provider must ensure all staff receive medications training.’ ‘The Registered Provider must ensure that all medications are administered directly from the original, labeled container, to the resident and not placed into any secondary container for administration by another care worker’. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 7 The evidence indicates these areas have been successfully addressed. • Health & Social Care: ‘The Registered Provider must ensure all healthcare needs that have been identified are documented in residents’ files to evidence what treatment is to be given, by whom and when, with a clear outcome recorded.’ ‘The Registered Provider must ensure all discussions held with visiting professionals are recorded by the Home and signed by the staff member involved. The records must be held in residents’ files and be available for staff at all times.’ ‘The Registered Provider must implement a system to ensure staff are aware of and are monitoring residents needs at all times’. The evidence indicates these areas have been successfully addressed. • Protection: ‘The Registered Provider must ensure that no staff are working in the Home without a protection Of Vulnerable Adult (POVA) First check. Staff without a Criminal Record Bureau (CRB) clearance, must work under supervision at all times’. The evidence indicates these issues have been successfully addressed. • Environment: ‘The Registered Provider must ensure a broken reinforced glass window in a fire door on the ground floor is replaced’ ‘The Registered Provider must ensure the infection control policy and procedure is reviewed and reflective of the care practices in the Home’ ‘The Registered Provider must ensure there is a system in place to ensure all parts of the Home are kept clean including the dining room.’ ‘The Registered Provider must ensure maintenance records are kept up to date, to include the date a request was reported and when the work was completed and by whom.’ ‘The Registered Provider must ensure a plan is in place and available to the commission in relation to a programme of decoration of the premises’. The evidence indicates these areas have been successfully addressed. • Staffing: ‘The Registered Provider must ensure staff files hold details of the initial induction undertaken by all new staff employed including agency staff’. The evidence indicates these areas have been successfully addressed. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 8 • Management Quality Audit: ‘The Registered Provider must ensure there is documented evidence of a quality assurance system in place that demonstrates that residents are receiving the care they require and, that the home is run in their best interests.’ ‘The Registered Provider must ensure all accidents reported are analysed to monitor recurring themes and take action where required’. The evidence indicates these areas have been successfully addressed. • Management Health & Safety: ‘The Registered Provider and manager must ensure they are familiar with the new Fire Regulations and, that any new procedures are implemented in the Home’. The evidence indicates these areas have been successfully addressed. What they could do better: The following is an indication of the areas where the service feels it could perform better: At the last inspection a number of requirements were made, including: • Medication: ‘The Registered Provider must ensure medication prescribed to residents is appropriately documented on the Medical Administration Record (MAR sheet)’. A number of issues were noted with regards to the services maintenance of accurate ‘medication administration records’ (MAR), including a gap in the chart, carers signing for medication on the wrong days, inappropriate or undefined use of the medication codes, regular prescribed medication being used as a PRN (as and when required) medication. • Environment: ‘The Registered Provider must ensure there are sufficient hand washing facilities in the Home to meet the needs of residents and staff. In the interim staff must be provided with alternative means of washing their hands’. This issue remains a concern, as one toilet, located beneath the main stairs, has no hand washing facilities and no means of sanitising or removing faecal debris, etc, from a persons hands after use. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 9 Additional issues identified at this inspection included: • Medication: It must be made possible for the home’s medication trolley to be secured to the wall to prevent theft, it being noted during the tour of the premise that this has not yet been addressed, although the proprietor stated she has a chain and bolts for the job. Environment: A significant amount of dust and cobweb was noted around the home. Bedroom furniture, including divans, wardrobes, chest of draws, require replacing, due to damage or poor condition. Bathrooms and toilets, a heavily stained and marked bath should be replaced, as should the cracked toilet seat identified to the proprietor, soil piping requires boxing in, where work has been undertaken. • Health & Safety: Chemicals Hazardous to Health, must be appropriately stored away at all times, when not in use, the domestic staff having left a cleaning trolley in a corridor unattended and a cleaning agent noted on the windowsill behind a curtain in the downstairs toilet, adjacent to the toilet beneath the stairs. • Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 10 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 Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 3: Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: Assessment: The evidence indicates that service users are appropriately assessed prior to admission and provided with information relating to the facilities and services available at the home. • Five service user plans were reviewed during the fieldwork visit, each containing an assessment document, some of which were an older style record whilst others were based on the single assessment document. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 12 Single assessment documents being those recommended by the Department of Health for use in community settings, as they assess the persons needs and abilities and are updated and/or amended as they become involved with various health and social care parties and their needs change. Whilst the document was not specifically designed for use in a residential home setting, it does provide a reasonably good baseline from which the persons care plans can be produced. • Observations and conversations indicated that all of the service users residing at the home are having their needs appropriately addressed and that people are generally happy with the service provided. The ‘Annual Quality Assurance Assessment’ (AQAA), completed by the provider/manager and returned prior to the fieldwork visit establishes that four out of the last six people admitted to the home, visited before making a decision about accepting the offer of accommodation. Information relating to the services and facilities provided at Stoneham House are accessible within the main entrance hallway/reception, along with various other leaflets and brochures. • • Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 7, 8, 9 and 10: The health and personal care that people receive is based on their individual needs and the principles of respect, dignity and privacy. EVIDENCE: Care Planning and Risk Assessment: The evidence indicates that home’s care planning process sets out the individual needs, wishes and aspirations of the service user. However, the risk assessments do not consider all potential risks faced by the service users and therefore require updating. • As indicated above five service user plans were reviewed as part of the inspection process, each containing an individualised plan, which clearly linked to the initial assessment, was relevant to the person and provided DS0000012356.V336113.R01.S.doc Version 5.2 Page 14 Stoneham House concise instructions for the staff on how to deliver an individualised care package. • The plans were also clearly being reviewed, the manager updating each file on a monthly bases, with the inspector provided with the opportunity to compare the last two months plans, where additional information, which had been included on the care plans was detected/observed. In addition to the plans of care, each service user file contained regularly updated and reviewed ‘Bartel Assessments’, which gauge changes in peoples dependency levels (there is a set criteria to measure dependency by), mental capacity assessments, ‘Waterlow’ scores, moving and handling assessments, falls assessments and nutritional screening documentation. In discussions with the service users, it was evident that they felt their needs were being appropriately catered for at the home and none had any concerns or complaints with the care provided. Observations also enabled the inspector to determine that the staff and the service users have developed good relationships and that the staff have a good understanding and appreciation of the service users needs. Staff were also noticed completing the running records at the end of their shift, these particular records providing a reasonable account of the activities undertaken with and by people (service users) during the day/night. • Each service user plan was noted to contain various risk assessments, although these appeared to focus extensively on risks posed to clients from activities undertaken within the home. However, one service user still drives a car, whilst another regularly goes off on his own to visit friends, shops, etc. Neither or these people had any form of risk assessment given their activities and absences from the home and it was suggested to the manager that he consider the risks associated with both activities and produce the documentation required. Health and Social Care: The evidence indicates that people’s health and personal care needs are being well looked after. • During the fieldwork visit the manager took time out from the home to accompany a service user to a dental appointment, this was a planned event, which the manager informed the inspector about, as soon as he arrived. • • • Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 15 Later in conversation with the resident it was ascertained that this was one of a series of appointments she required for cosmetic purposes, as some of her medication effected her teeth colouration. In discussion with the manager it became clear that one of the residents tablets if chewed caused discolouration of the teeth, which the dentist was addressing and which the home had taken up with the general practitioner to rectify by changing the prescription from a tablet to a liquid preparation. • The five service user plans reviewed provided further evidence of the support provided to people when accessing health care services, with correspondence from professional sources and appointment confirmation letters, etc, noted on several files. The files were also noted to contain running records, which the staff maintained following a professional visit/contact, which provided details of the purpose of the visit and the outcome. • The AQAA and dataset information, also provided evidence of the variety of professionals involved with the home, community nurses, general practitioners, community psychiatric nurses, nutritionist, chiropodist, dentist, etc. The people spoken with during the visit also had no complaints or concerns with regards to the support provided by the home in accessing appropriate health care professionals/agencies, although one person was concerned with the service received from the NHS, which the home are supporting him explore. • Medication: The evidence indicates that the home’s medication management is generally good, although some work is required to ensure accurate records are maintained. • The AQAA and the dataset establish that the home provides staff with access to medication policies and procedures and that staff have been provided with training around the administration of medications. During the fieldwork visit the manager was able to demonstrate, how staff receive training producing copies of certificates from various companies and a training video, that evidence that staff are being provided with information around the safe administration of people’s medicines. One scrutinising the records held by the home, it was evident that several service users self-medicated and that their decision to continue managing their own medication has been supported via the home’s risk DS0000012356.V336113.R01.S.doc Version 5.2 Page 16 • • Stoneham House assessment strategy, the files of two people noted to contain appropriate risk assessment documentation. • The medication administration records (mar), were also reviewed and found to be inappropriately maintained, with gaps noted on occasions, staff having signed for medications (on two occasions) on the wrong date, a code used to denote why a medication was omitted, incorrectly used and a regularly prescribed medicine being treated as an ‘as and when’ required (PRN) drug. The home’s approach to the storage of medications was also found to be unsafe, as the new medications trolley, cannot be appropriately secured when not in use, as the device used for securing the trolley has not yet been bolted to the wall. However, all other aspects of the home’s medication storage, was appropriate, including the provision of a medications fridge, which the staff are monitoring regularly to ensure its temperature range remains with normal parameters. Privacy and dignity: The evidence indicates that the service is committed to ensuring that the clients’ rights to privacy, dignity and respect are upheld. • The home’s brochure documentation contains the following statement ‘we aim to preserve the dignity and privacy of all our clients’, in discussion with service users it was evident that they felt the staff were respectful and that their dignity was considered at all times. The home’s quality assurance programme encourages people to comment on their experiences of being treated with dignity and respect, asking people to state yes or no with regards to their experience. During the tour of the premise it was noted that all doors are fitted with locks, providing the occupant with the option to secure their door when not in the room should they wish. The tour of the premise and observations also establishing that staff knock doors before entering and speak to people in a polite and appropriate manner. • • • • Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 14 and 15: The people using this service are able to make choices about their lifestyle, and are supported to develop life skills, via social, educational, cultural and recreational activities. EVIDENCE: Entertainments and Social Activities: The evidence indicates that the home’s social activities programme is meeting the needs of the people accommodated. • As previously stated within this report, the inspector was greeted by singing, dancing and merriment on arriving at the home, with a musical entertainer involved in a sing-a-long involving almost all of the residents. In discussion with people it was clear that they had enjoyed the activity and that this particular entertainer was well received, with his act described as polished. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 18 People also discussed some of the other entertainments, some of which appeared to be less well received, as the residents spoken to appreciated the singing and dancing, as opposed to playing the instruments, as one act asked them to recently. • A wide range of activities would appear to be available to the service users, the notice board outside of lounge containing details of the months forthcoming events, including church visits and additional monthly musical sessions. The inspector also noticed during the tour of the premise that a range of games and puzzles were available, one large puzzle set out on the lounge table, which people were completing in their own time. The inspector also noticed, when in the dining room that a large number of knitted squares had been laid out to form a large blanket, which required stitching together. In discussion with the manager it became evident that these squares were knitted by members of the resident group and that they would be sewn together and donated to the home’s chosen charity, which this year was a wildlife sanctuary, which the home had visited recently. • The home/proprietor also provides transport, which was used when taking a client to the dentist but which also provides a means for getting small groups of people out of the home on trips/outings. In discussion it was made clear that normally the resident visiting the dentist would have a ride out through the forest, following her treatment, as she liked this and it help relieve any stress following the dental visit. Visiting Arrangements: The evidence indicates that the visiting arrangements at the home met both the service users and/or their relatives/visitors needs. • The company’s brochure makes clear that ‘we encourage visiting throughout the day. The importance of contact with the family can never be underestimated. Resident’s families and friends are welcome to have a meal with us. Please arrange beforehand so we can cater’. • This statement is supported by the comments returned by relatives, all of whom ticked ‘yes’ in response to the question ‘do staff welcome you in the home at any time’. • Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 19 • Throughout the day the inspector met with or observed visitors arriving at the home and taking tea with their relative, within the quiet lounge or socialising in private within the persons bedroom. A signing in book, also provided further evidence of the numbers and regularity with which visitors attend the home, some people now having formed a ‘Friends of Stoneham House’ group. • Choice and Independence: The evidence indicates that service users are being provided with the opportunities to make choices and independent decisions on a daily basis. • Several examples of choice being provided to people have been identified within the report: 1. 2. 3. 4. 5. 6. • Locks on doors Activities Visiting arrangements Choice of accepting offer of accommodation Choice of outings Choice of independent outings. In addition to the information already contained within the report the inspector also found that choice was promoted for people through: 1. Meal and Menu options. 2. Choice of communal setting, with the home offering a large lounge, dining room, several patio/balconies, quiet lounge and a conservatory. 3. Residents meetings. Meals and Menus: The evidence indicates that the meals and menus afford service users choice and variety. • Two mealtimes were observed during the inspection, lunch and tea and both appeared quiet relaxed social occasions when the staff and the service users could chat and interact. The meals served during these periods appeared to be well presented and from observations, well received by the residents who generally ate well and appeared to enjoy the food provided. The latter observation supported by comments on the day, when the food was praised by the people spoken to and who thought their was sufficient choice and variety within their diet. • Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 20 • During the tour of the premise the inspector noted that copies of the home’s rotational menus are displayed outside of the dining room and that there is a four weekly cycle to the menus, although in conversation with residents it became apparent that the menu is a rough guide and not an absolute, the cook often substituting or varying the daily menu, with an alternative. The home’s brochure states: ‘we provide a varied menu of delicious home-cooked dishes, which are well balanced and nutritional; which takes into account religious and dietary needs of each person. We also serve tea, coffee, drinks and snacks between meals’. • • Tea and coffee was observed being offered to residents and their relatives, one person seen taking afternoon tea with her visitor in the quiet lounge, whilst generally people were offered drinks in the lounge or dining area following dinner. The proprietor, during the tour of the home, also discussed how one family often takes a meal with their relative in the conservatory, the resident coming from abroad and the family providing traditional fare for her consumption. • It was also noticed during the tour of the premise that fresh fruit was made available in the lounge, a bowl containing a variety of fruits placed on the coffee table in the middle of the room for people to help themselves. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 16 and 18: People who use the service are able to express their concerns and have access to a robust, effective complaints procedure. They are protected from abuse, and have their rights protected. EVIDENCE: Complaints and Concerns: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and are confident that the issues will be appropriately handled and addressed. • The brochure document, which is made readily and easily accessible to people, makes no reference to complaints or a complaints process, however, the ‘statement of purpose’ and ‘service users guide’ do both contain details of the company’s complaints policy, a copy of which is displayed within the home for information. Evidence taken from the dataset, which includes a summary of the home’s complaints activity for the past twelve months, indicates that: 1. No complaints were received in the last twelve months 2. No complaints therefore were partially substantiated 3. No complaints therefore were substantiated Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 22 • Information relating to any complaint is maintained within the home’s complaint book, which includes details of the concern, investigation and outcome, copies of any response to the complainant, if applicable, would be held on the service users file. • Evidence taken from the home’s own survey, indicate that people are aware of the home’s complaints process and comments during the inspection support the fact that people would be willing to raise concerns with the management should they feel the need. During the fieldwork visit the inspector witnessed/observed a relative approach the manager to raise a concern with their relative’s care, this was well handled by the manager, who was able to provide reassurance to the visitor, that their fears were misplaced and that their relative had been up and about all morning and had opted to retire to bed for a rest themselves. Safeguarding Adults: The evidence indicates that the service users’ welfare is promoted and that the management and/or staff seek to protect people from abuse and harm by their practices. • Following the last inspection and other protection concerns the Local Authority has become involved in monitoring the care provided and supporting the service to address any issues of concern. The latest e-mail, from the Local Authority, clearly setting out that improvements were being seen in the service being provided. • Ironically, the surveys carried out by both the home (internally) and the Commission raise no concerns about the service with people clearly appreciative of the care and support provided and happy to raise issues with the staff and management as reflected above. People making comments like: ‘I am still surprised how cheerful and friendly the staff are and how they find the time to talk and keep me informed, a remarkable team’. • The AQAA also identifies that staff receive training during their induction on and around adult protection, the home using a ‘Skills for Care’ induction model to introduce all new staff to the care field, and a video presentation for staff to keep updated on general protection measures. The dataset also contains a statement, to the effect that the home provides staff with access to both a safeguarding adults policy, last reviewed in 07/2006 and a disclosure of abuse and bad practice (whistle blowing) policy, reviewed last in 09/2006. DS0000012356.V336113.R01.S.doc Version 5.2 Page 23 • Stoneham House • The service users raised no concerns, either via the comment cards or verbally during the fieldwork visit, people going to great lengths to impress upon the inspector how much they appreciated and enjoyed living at the home. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 19 and 26: The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: Environment: The evidence indicates that the service users live within a reasonably well-maintained environment that meets their immediate and longterm care needs. • Maintenance logs were seen during the visit, which clearly documented when a problem had been noted and reported and the actions taken by the maintenance person in addressing the problem, who signs off the work once completed. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 25 • During the tour of the premise the inspector was shown several rooms, which had recently been refurbished, as well as a room in the midst of being redecorated and re-carpeted. The completed bedrooms appeared fresh and inviting, although generally the rooms visited during the fieldwork visit appeared homely, with most personalised by the occupant, one person having established an office space within his room for undertaking his correspondence, this including a fax machine, and previously a computer linked to the internet, although the person no longer required this technology. • The AQAA, also identifies that since the last inspection the management have arranged for: five bedrooms to be upgraded, with new carpet and bedroom furniture and that plans are in place to complete another six bedrooms and replace a flat roof, which is beginning to cause problems. Whilst, these improvements have been made and/or planned, a number of issues came to light during the tour of the premise, which the home will need to include within their maintenance schedule for consideration/attention. • 1. The base of the bed in room 24 requires replacing, as it is ripped and damaged. 2. Soil piping in room 24 requires boxing in, following the laying of a new floor. 3. The toilet seat in the first floor bathroom was split and required replacing and the bath in this room, also requires replacing, as it is heavily marked or stained. 4. A downstairs toilet has no hand washing facilities, means of sanitising a person’s hands or means of removing debris from their hands following the use of the facility. Cleanliness: The evidence indicates that some areas of the home are generally unclean, although the property appears tidy and free from odours. • During the tour of the premise the inspector noticed that the home appeared to be unclean and generally dirty/dusty in high areas, with notable debris on fire extinguishers, tops of wardrobes, light switches and with cobwebs around ceiling light fittings and lampshades. The proprietor who had accompanied the inspector on the tour of the premise was shocked by the level of dust and debris noticeable around the home and undertook to speak with the domestic staff. • The manager is also planning to discuss with the domestic staff team, the need to ensure that all chemicals used to clean the house, are appropriately stored when not in use, with the cleaners trolley left DS0000012356.V336113.R01.S.doc Version 5.2 Page 26 Stoneham House unattended along the first floor corridor and a bottle of a cleaning agent noticed on the window ledge in the downstairs toilet (close to the lounge). All chemicals must be controlled under the ‘Control of Substances Hazardous to Health’ regulations and subject to correct use and storage at all times. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 27, 28, 29 and 30: Staff are trained, skilled and employed in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: Staffing levels: The evidence indicates that the needs of the service users are being met by the supply and deployment of staff. • Copies of the staffing roster, seen during the fieldwork visit, displayed outside the office, indicates that the home is sufficiently well staffed and that carers are available, across the twenty-four hour period to meet the needs of the service users’. Four care staff on duty from 08:00hrs to (14:00) 16:00hrs Three care staff on duty from 16:00hrs (14:00) to 20:00hrs Two care staff on duty from 20:00hrs to 08:00hrs. In addition to the care staff on duty the manager also works fulltime, the proprietor is available to provide care, maintenance or catering support, domestic, laundry and maintenance staff are employed. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 28 • Observations further evidence the fact that adequate staff are available to meet people’s health and social care needs, the staff on duty comprising: 1. 2. 3. 4. 5. 6. The manager The Proprietor Four care staff One cook One Ancillary A Domestic staff member. • In discussions with service users, it was evident that people appreciated the staff and the work they undertake and that the residents felt they had built up good relationships with the staff. It was also evident given comments such as: ‘I am still surprised how cheerful and friendly the staff are and how they find the time to talk and keep me informed, a remarkable team’, that relatives also have good relations with the staff team. Training & Development: The evidence indicates that the training opportunities for the staff are reasonable. • 1. 2. 3. 4. 5. • Information included within the AQAA identifies that staff have received training in the following areas: First aid Moving and handling Fire awareness Health and safety Medication This declaration was supported by findings during the fieldwork visit when the staffing files were reviewed and found to contain certificates for the courses completed by the staff, as well as confirmation of completion of a ‘Skills for Care’ induction if the employee was new to the home. The manager was also able to demonstrate, via training videos and questionnaires, how in house training events are used to keep staff updated on issues such as, food hygiene, fire safety, medications, etc. Information taken from the AQAA, also indicates` that currently two thirds of the care staff either posses a National Vocational Qualification (NVQ) at level 2 or are enrolled on course, with the home committing itself to training all staff to this level within next twelve months. • • Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 29 • The AQAA also commits the home to providing NVQ training, in housekeeping, etc, to the domestic, ancillary and catering staff over the next twelve months, which appears to be an ambitious aim. Recruitment and Selection: The evidence indicates that the recruitment and selection process is now being appropriately operated. • At this visit the files of three recently appointed staff were reviewed and found to contain the following information: 1. 2. 3. 4. 5. 6. 7. 8. 9. • An application form Two written references Dates of employment Protection Of Vulnerable Adults (POVA) clearance Criminal Records Bureau (CRB) check outcome Induction details Training and development evidence (certificates). Contracts Home Office Clearance. The dataset establishes that a recruitment and selection strategy is in place and that this was last reviewed in the July of 2006, this strategy or procedure also including details of redundancy arrangements if required. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 31, 33, 35 and 38: The management and administration of the home is based on openness and respect, and has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: Management: The evidence indicates that the home is currently being managed to a satisfactory standard. • Information taken from the Commission’s databases indicate that an application has been received and is being processed in respect of the DS0000012356.V336113.R01.S.doc Version 5.2 Page 31 Stoneham House current manager, who is seeking to become the ‘Registered Manager’ for the home. • In discussions with the manager, it became apparent that he has extensive experience of working within both the private and public care sector. The evidence within the report already indicates and supports the fact the home is being well run: 1. 2. 3. 4. 5. Actions undertaken to manage staff training Positive recruitment strategy Reasonably well maintained premise Good record keeping and care planning Experiences of the Service Users and observations of interactions with relatives 6. Promotion of choice and independence for service users 7. Auditing and involvement of service users in the day-to-day service delivery. • The combined comments of the service users, relatives and staff, who all indicate that they are satisfied with the overall level of care provided, also supports the impression that the home is being well run and managed. As does the observation of the Local Authority, who following their last visit to the home, indicated that improvements in the service provided were noticeable. • • Quality Audit and Assurance: The evidence indicates that service users and/or their relatives are afforded the opportunity to comment on the service provided at the home. • Service users and/or their relatives are afforded the opportunity to comment on the service provided at the home via the home’s satisfaction survey/questionnaire, which is based upon the Commission’s old style surveys. During the inspection the manager provided the inspector with sight of completed questionnaires, from both residents and their relatives, the majority of which were positive about all aspects of the service provided. The manager has also broken the response down into graphs for statistical analysis and use when reviewing the service being provided, this graphic display quite useful in monitoring trends in responses, etc. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 32 The last residents and relatives surveys undertaken in January 2007, prior to that the residents completed surveys in March 2006, whilst the relatives were surveyed in October 2006. • In addition to the quality questionnaires made available to service users and their relatives the manager also arranges regular residents meetings, which are fully minuted and which clearly give rise to changes in practice/service delivery, the activities programme altered to meet the clienteles choices, preferences. In addition to the residents meets the management also organise regular staff meetings, the agenda for the next meeting, scheduled for the 29th May 2007, noticed on the board outside the office. • Service users finances: The evidence indicates that appropriate arrangements are made to support service users with their finances. • The manager demonstrated for the inspector the database used to log and track all monies held and spent, etc on behalf of the service users. The database was found to provide a complete financial history for the service user, throughout their time in the home, as well as enabling the manager to produce monthly statements, etc which can be provided to the resident or their relative/advocate if required. • All monies held on behalf of the service users were individually stored and secured within a suitable locked facility within one of the home’s locked offices. All accounts/monies are regularly balanced, contain receipts for purchases and each account when closed is issued a final invoice. • Health and Safety: The evidence indicates that the health and safety of the service users and staff is being reasonably well managed. • The AQAA and dataset information establishes that full health and safety policies/guidance documents are made available to the staff and that equipment is regularly maintained and serviced, gas, electrical installations, portable electrical appliances, hoists, baths, etc. Health and safety training is clearly made available to staff, with the AQAA evidencing that staff have completed fire safety, moving and handling and first aid training recently. Maintenance issues are also being appropriately identified and reported by staff and according to the maintenance log responded to within a reasonable time period by the maintenance person. DS0000012356.V336113.R01.S.doc Version 5.2 Page 33 • • Stoneham House • However, the tour of the premise did identify concerns with regards to the safe storage of chemicals, when not in use and the home’s risk assessments should include consideration of the risks posed to residents when absent or going out of the home. The tour of the premise also established that a pane of glass within a fire door, noted to be damaged at the last inspection, has been replaced. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 34 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation Requirement Timescale for action 06/07/07 Regulation The manager must ensure the 13 home’s risk assessment process is extended to include consideration of risks faced by residents, when undertaking activities away from the home. This could prevent delays in responding to injuries/accidents, people becoming lost or stranded, etc. Regulation The manager must ensure that 13 medication administration records are accurately maintained. This reduces the likelihood of errors, and enables visit professional to get a true picture of a persons medication history. Regulation The manager must ensure 13 chemicals used within the home are appropriately stored at all times. This will reduce the likelihood of accidents and misuse of the substance. 2 OP9 06/07/07 3 OP19 OP38 06/07/07 Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations The manager should review the domestic staffs cleaning schedules to ensure time is given over to high dusting. Stoneham House DS0000012356.V336113.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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