Inspection on 05/12/07 for Stoneham House

This inspection was carried out on 5th December 2007.

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 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 25/05/07

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 Laurie Stride Unannounced Inspection 5th December 2007 09:45 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.V356444.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.V356444.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.V356444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th May 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 service users 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 range of fees is £410.00 to £525.00 per week. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection visit, which lasted eight and a half hours, during which we met and spoke with a number of the people who use the service and also with the home’s acting manager and two staff members. As part of the information gathering process postal questionnaires were received from nine of the people who use the service, five relatives, a health professional and a member of staff. For part of the inspection visit the inspector was accompanied by an ‘expert by experience’, who spent time talking with people who use the service and observing daily life in the home. During the visit samples of the homes records were seen and a tour of the premises was undertaken. The proprietor and the acting manager had also provided information about the service in the annual quality assurance assessment (AQAA) in May 2007. The findings of the previous inspection report of 25th May 2007 were also reviewed as part of the evidence used for this inspection report. What the service does well: What has improved since the last inspection? Risk assessments now cover more independent service users when undertaking activities away from the home. Medication recording has improved and is now more accurate. The storage facilities for medication have been made more secure. Improvements have been made to the building and there is an ongoing plan of maintenance. Cleaning chemicals used within the home are now stored securely. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are only admitted to the home following an assessment to ensure their needs can be met by the service. This service does not provide intermediate care, therefore this standard (6) is not applicable. EVIDENCE: We looked at a sample of five service users’ files, including details of a person recently admitted to the home. Care records contained copies of the homes’ assessment of the individuals needs, carried out prior to admission, and also copies of care managers assessments and hospital discharge summaries as applicable. The assessment contained all the necessary basic information and there was also evidence of the development of individual life histories in the care plans. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 9 The previous inspection report for 25/05/07 identified that the home uses the single assessment document recommended by the Department of Health for use in community settings. 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. We also saw evidence of the ongoing assessment of individuals’ changing needs through records of care plan reviews. Where possible, the individual service user had been asked to sign the care plan to show their agreement and people’s relatives had been invited to attend reviews. A health professional who completed a survey questionnaire indicated that the home seeks advice and acts upon it to meet individuals’ needs. 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. Since the last inspection the home has introduced a newsletter for service users and their relatives/representatives. Service users who returned survey questionnaires indicated that they have received a contract and were given enough information about the home before they moved in so they could decide if it was the right place for them. All who completed the questionnaires stated they receive the care and support they need. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service would benefit from more person centred planning and care practices that focussed on their individual needs. Improvements in the medication practices within the home help promote the welfare of the people using the service. EVIDENCE: The five care plans we saw contained basic information relating to individuals’ health and support needs, medication, dietary requirements and risk assessments. These care plans had dates and signatures indicating reviews in line with the homes procedures. The previous inspection report had identified a requirement that the risk assessment process included consideration of risks to service users when Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 11 undertaking activities away from the home. These risk assessments were seen to be in place. The expert by experience saw a wheelchair being used by one service user, which did not have the footplates attached. This could present a risk to the individual. The manager stated that the care plan did not show that the individual had chosen not to use the footplates and said he would update the care plan. A letter from the home has subsequently stated that information was in the care plan regarding this person not being able to use footplates. The lunchtime meal was observed by the expert by experience, who noted the way that one service user feeds him/her self without support. The care plan did not make it clear if this was the person’s individual preference or if there was any other support needed. This was also discussed with the manager during the visit. Care plans contained records of health care appointments and correspondence, visits by health professionals such as the district nurse, and also peoples’ social workers. This shows that service users are accessing the appropriate health care services when needed. One relative stated that any healthcare problems experienced by their relative are dealt with as soon as possible. The risk of falls was recorded for each individual and a recent fall had been recorded in the accident book. This enables the home to monitor the number of falls and to take further action if necessary. There was some general guidance from the Alzheimers Society about washing in one persons’ care plan for care staff to read. This document was quite lengthy. The care plan contained brief general instructions for the individual’s personal care but these were not personalised for the individual. The home is registered to provide care to older people including those with dementia. A significant number of the people using the service have a diagnosis of dementia. Records of staff training indicated that, while some staff had undertaken training in dementia care, this had not been updated and newer staff had not received such training. The manager said that there were plans to do more dementia training in the new year. The manager had a basic training DVD on dementia. The home uses a Monitored Dosage System and the manager was observed administering medication at lunchtime and completing the records. The Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 12 previous inspection report had identified a requirement that medication administration records are accurately maintained. The sample of medication records we saw contained no errors. ‘As and when’ required (PRN) medication was also clearly marked on the record. The medication trolley was fixed securely to a wall when not in use and there is a secure storage facility for medication being delivered or returned to the pharmacy. The home has a medication fridge, which is monitored regularly to ensure its temperature range remains with normal parameters. During our visit, we spoke to and observed service users in their rooms and the communal areas. The expert by experience saw two service users during the morning wearing soiled and stained clothes. Another service user was seen with stains on her jumper from lunch and this was not changed after the meal was over. One relative commented that there was very little interaction between staff and people using the service other than for care tasks. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Daily life within the home does not provide a full and stimulating lifestyle for all of the people using the service. Practices at mealtimes do not promote the dignity and wellbeing of the people using the service. EVIDENCE: The home has a weekly activity schedule that the manager said is being rewritten. The current schedule included a lot of television, for example ‘Neighbours’ and ‘Hollyoaks’, a Film Hour and DVD bingo/quizzes. The schedule also included a hairdresser and scrabble. A range of games and puzzles were available in the communal areas although these were not being used at the time of our visit. The manager stated that he was going to change the schedule and hoped it would rely less on television, although some people do like to watch it. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 14 There are service user meetings where activities, food and routines are discussed. The minutes for a meeting held on 26/09/07 indicated that people had said they like watching TV and had agreed to have meetings every other month. The manager also informed us that three service users’ relatives are involved in the home, organising some activities such as knitting, outings and parties. The homes’ notice board outside of the lounge contained details of the months’ forthcoming events, including a church visit, a monthly musical session, Christmas and New Years Eve parties. There is also a mobile library. Previous events included a Halloween party, a firework display and visits to a wildlife sanctuary. A birthday party had been held for a service user the day before the inspection visit. The manager said that the home provides transport to take service users to health care appointments and this also provides a means for getting small groups of people out of the home on trips/outings. The manager told us that when individual service users have health care appointments, this is often followed by a ride out through the forest. One relative surveyed stated that they would like their relative to have more trips out. We saw no evidence of activities having been designed around the needs and abilities of individuals with dementia. We discussed this with the manager (and asked if he had considered having a member of staff designated as activities co-ordinator. The manager said he would like to have an activities co-ordinator and key workers, but that current funding prevented this as there are only 18 service users). The home has obtained some of the details of peoples’ life histories and memories, but these were not linked to activity planning for individuals. Eight of the nine service users who returned survey questionnaires indicated that there are always activities arranged by the home that they can take part in. The other said there usually is. The manager told us that he asks what people want regarding activities and has been told that service users are satisfied with the activities. However, during our conversations with people who use the service, one person told the expert by experience “Some one comes once a month to sing, and we have church service here quite often, a lady sings hymns on the piano.” “Other than that, we never have activities.” When asked about trips Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 15 out, the expert by experience was informed that two weeks ago the owner or manager took two service users out. Other than that no-one could remember the last time a trip was taken. We asked if the staff sat down to talk or play games and were told “No they haven’t the time, but if you ask them a question, they will answer you.” A relative remarked that ‘residents in the lounge are not spoken to by staff except for care duties and going in to meals.’ We asked two members of staff about activities in the home. One said that “service users do what they like to do”. Another said service users are “not doing much” as “some don’t respond or take part”. We observed two members of staff who sat in the lounge for approximately 20 minutes, chatting to each other and watching T.V prior to lunchtime. Six of the nine service users who returned survey questionnaires said they always like the meals at the home while three said they usually do. Overall comments from service users about food during our visit were that the “food is mediocre/ok/not that good.” When we pointed out the menu offering choices, several service users told us there was only one meal of the two on offer for each day, and the only choice was that ‘greens’ could be removed “as not every one likes veg.” We were also told that “the veg is over cooked.” Relatives who completed questionnaires indicated that the home helps service users to keep in touch with them. One told us that “ staff are always pleasant and welcoming.” One said that their relative in care would like more trips out and another said there are not enough mentally stimulating activities, if any. One person’s relative commented that “the various cooks don’t always seem to make the kind/quality of food residents might prefer – odd combinations, overcooked meat, vegetables which are not especially liked, not many ‘home cooked’ desserts”. However they later remarked that staff “try to meet my relatives’ requests in terms of food most of the time.” There was evidence that people are being provided with the opportunities to make choices and independent decisions on a daily basis. For example, care plans reflected individuals’ wishes regarding visiting arrangements and keeping in touch, and also about having keys/locks on doors. Four out of five relatives Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 16 indicated that the home supports people to live the life they choose, one was not sure. The home currently has a small dog, which was observed running in the corridor while a service user was walking with the use of a walking frame. We enquired about this and the manager said that having the dog in the home was not planned as being permanent. The manager confirmed that service users had been consulted although this had not been recorded. The expert by experience observed service users having lunch in the dining room. One carer sat with a service user and fed her. Another service user who was incapable of feeding herself had her food dished out. The expert by experience saw that 9 minutes passed between her food being dished and the carer giving her the first mouthful. The carer proceeded to feed her a mouthful at a time, standing whilst doing so, then moved away from the table. The individual had five mouthfuls of the main course within a period of 29 minutes. The last time the carer came back he asked if she was finished. The same occurred with her pudding. The carer never once sat with the service user. Another service user used a spoon and picked up what she couldn’t cut with her fingers. As the spoon was taken away with the first course, the service user used her fingers for the custard and peach. The carers where available all through lunch and did not assist. The manager, on his way to the medicine trolley, gave a service user a spoon and cut up two other service users meals that the carers had not assisted with. On the way out of the dining room, the manager gave the first lady another spoon for her pudding. All this time the carers were still there. It was noticed in the afternoon 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.V356444.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has suitable procedures for dealing with concerns and people who use the service are protected by the home’s policies and procedures. EVIDENCE: The previous inspection report mentioned that the Local Authority had been involved in monitoring the care provided and supporting the service to address any issues of concern. The report also mentioned that the Local Authority had at that time indicated that improvements were being seen in the service being provided. The previous inspection report identified that the homes’ Statement of Purpose’ and Service Users Guide both contain details of the service’s complaints policy, a copy of which is displayed within the home for information. Eight of the nine service users who returned survey questionnaires indicated that they know how to make a complaint. All said that they ‘always’ or ‘usually’ know who to speak to if they are not happy. Three of the relatives of people who use the service also said they know how to make a complaint, one Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 18 did not and another was not sure. All five confirmed that the home responded appropriately if they or the person using the service has raised concerns. A health professional said the service has usually responded appropriately. Evidence taken from the home’s own survey also indicates that people are aware of the home’s complaints process. Since the last inspection visit we had received a complaint about the home from a service users relative, which we forwarded to the provider. The home had provided a satisfactory written response to the complainant and us. 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. The homes’ annual quality assurance assessment (AQAA) and dataset 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. The AQAA also identifies that staff receive training during their induction on and around adult protection, the home uses 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. Staff spoken to at the time of our visit were aware of the procedure for reporting any suspected abuse and said they would report this immediately. In October staff members had undertaken training in managing challenging behaviour. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements continue to be made to provide a safe but functional home for people using the service, which could be enhanced through greater attention to individual needs and the creation of a more homely environment. EVIDENCE: The previous inspection report had identified a requirement that chemicals used within the home must be appropriately stored at all times, in order to reduce the likelihood of accidents and misuse of the substance. The homes action plan stated this had been addressed. During a tour of the premises we saw no evidence of chemicals being left in areas where there would be a risk to people who use the service, therefore this requirement has been met. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 20 We saw that the home has a maintenance log, which documents when a problem had been reported and the actions taken by the maintenance person in addressing the problem, who signs off the work once completed. There is also a programme of planned maintenance and re-decoration. Since the last inspection the manager reported that the home has been issued with a new electrical wiring certificate. Some of the work on the homes’ electrical wiring was still in the process of being completed, for example additional plug sockets are being fitted in bedrooms. A new flat roof and guttering has been completed and the hallway has been decorated. The manager stated that there are plans to replace more carpets and to replace one of the bathroom suites. At the start of our inspection visit, it was noted that some bedrooms and corridors of the home contained odours. It was also noted that the domestic assistant was in the process of cleaning. Service users said that the cleaners did not work at the weekends. Some of the communal areas, such as the lounge and dining room, while being functional, did not in our opinion appear welcoming and homely but rather institutional. Worn looking chairs were placed around the lounge in a uniform manner and the dining room was rather bare. The manager said he would ask service users if they wanted tablecloths at mealtimes. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are supported by sufficient numbers of staff and are protected by the homes’ staff recruitment procedures. Staff are trained to meet the needs of most people who use the service but this is inconsistently put into practice for those with more complex needs. EVIDENCE: We saw the homes’ staffing rota, which indicated that the home is sufficiently well staffed and that carers are available across the twenty-four hour period to meet the needs of service users. In addition to the care staff on duty the manager also works full time, the proprietor is available to provide care, maintenance or catering support. Domestic, laundry and maintenance staff are also employed. On the day of our visit, staff members were receiving training updates in moving and handling and first aid, being held in the home by a training company. Three staff, including agency staff, were on duty throughout the day to assist with the care of service users. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 22 The previous report identified that the homes’ recruitment and selection process was being appropriately operated. During this visit we looked at the recruitment records for three staff members, two of who had started work in the time since the last inspection. The records contained the required information, such as dates of employment and completed job application forms, two written references and evidence of satisfactory Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks. The home also keeps a file containing the recruitment and training details of agency staff members who work in the home. We looked at the details of the agency worker employed during the day of our visit. These details had been supplied by the agency when the worker had covered a shift on 07/01/07 and stated that the individuals moving and handling certificate expired on 24/08/07. We advised the manager that the information needed updating. The sample of staff records we saw showed that staff receive training in First aid, Moving and handling, Fire awareness, Health and safety, Medication and Infection control. As mentioned in other sections of this report, staff had also recently had training in managing challenging behaviour and some had previous training in dementia care, although the dementia care certificate we saw for one staff member was valid for one year and expired on 31/01/07. The sample of records contained 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. In house training events are used to keep staff updated on issues such as food hygiene, fire safety and medications, via training videos and questionnaires. When asked how they would monitor the needs of people with dementia, a member of staff said they would record changes in the person’s mood and behaviour in the daily records. The two staff spoken with did not demonstrate that they were knowledgeable about promoting choice and activities for people with dementia and complex needs where people using the service could not verbalise their own wishes. When asked about promoting choice for people using the service a member of staff stated “some people can tell staff.” One relative surveyed said that staff do not interact much with residents, another commented that there may be difficulties with language. Another relative said they felt that staff have the necessary experience. The manager informed us that six members of staff had completed a National Vocational Qualification (NVQ) at level 2 or are enrolled on a course. The Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 23 domestic and laundry workers are also doing relevant NVQ training. Two members of staff who we spoke to also confirmed they had completed NVQ awards and that they received regular supervision. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager did not demonstrate that he had updated his knowledge and skills in dementia care and was not aware of recent developments in dementia care practice. The home’s quality assurance process would benefit from improvement to address the shortfall in meeting complex needs. EVIDENCE: Comments received from people who use the service, relatives and staff indicate that they are satisfied with the overall level of care provided. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 25 Service users and/or their relatives have the opportunity to comment on the service provided through the homes own quality assurance questionnaire, the results of which also indicated that people are satisfied with the service. The manager said that health and social care professionals who are involved with the home had also been sent a questionnaire, but that to date there had been no responses received. Thank you cards were seen from two relatives of people who had used the service. The homes’ management need to ensure that staff working with service users do so in a manner that meets individual needs and promotes dignity and respect, particularly when providing support at mealtimes. The range of activities being provided needs to take into account the needs and abilities of those with dementia as well as those who are more independent. Greater attention to staff training in providing care to people with dementia would enhance the quality of life for people who use the service. The manager stated he had attended Mental Health Act Capacity training. We discussed with the manager areas of concern around providing dementia care. The manager did not demonstrate that he was aware of recent developments in dementia care practice. The manager demonstrated the database used to log and track all monies held and spent on behalf of people who use the service. The database provides a complete financial history for the service user throughout their time in the home, as well as enabling the manager to produce monthly statements, which can be provided to the service user or their relative/advocate if required. We saw that 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. We checked the balance for one service user and the amount was 2p over the balance recorded. The manager informed us that one service user’s finances are organised through receivership. Through discussion it also emerged that the manager had personally lent this service user money to go shopping with. We discussed this with the manager, stating that this was not considered good practice as this is could be a potential conflict for the person using the service. The homes’ annual quality assurance assessment (AQAA) and dataset indicates that full health and safety policies/guidance documents are made available to the staff and that equipment is regularly maintained and serviced, such as gas, electrical installations, portable electrical appliances, hoists and baths. We saw Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 26 that the fire safety logbook had been kept up to date with records of training, drills and servicing of equipment. We also saw that health and safety related training is made available to staff. Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 27 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 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 28 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 12(1)(a) Requirement Care plans must detail service user preferences for the use of footplates with wheelchairs and associated risk assessments to ensure their health and safety is protected. Support for people needing assistance with meals must be conducted in a manner that respects their dignity and meets their individual needs. Staff must be trained to meet the specialised needs of people using the service and supported to put this training into practice so all people using the service receive appropriate care and stimulation. Timescale for action 23/01/08 2. OP15 12(4)(a) 10/02/08 3. OP30 18(1) 22/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 29 1 OP33 The manager should further develop the home’s quality assurance process to monitor and ensure that the service is meeting complex needs. The manager should ensure that service users monies are managed in line with good practice principles and the service’s policy and procedure and not use his own personal money as a loan. 2 OP35 Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 30 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. Extracts may not be used or reproduced without the express permission of CSCI Stoneham House DS0000012356.V356444.R01.S.doc Version 5.2 Page 31 - 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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