Inspection on 13/11/07 for Stonehaven

This inspection was carried out on 13th November 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

Stonehaven 26/09/06

Stonehaven 19/12/05

Stonehaven 16/08/05

Stonehaven 25/01/05

Stonehaven 16/06/04

Stonehaven 01/03/04

Stonehaven 31/07/03

Stonehaven 11/07/02

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

CARE HOMES FOR OLDER PEOPLE Stonehaven 23 Carter Street Sandown Isle Of Wight PO36 8DG Lead Inspector Janet Ktomi Unannounced Inspection 13th November 2007 10:00 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 Stonehaven DS0000012540.V349657.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. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonehaven Address 23 Carter Street Sandown Isle Of Wight PO36 8DG 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) 01983 402213 01983 405215 rayslegs@aol.com Mr Raymond Cowen Mrs Margaret Joan Cowen Mrs Margaret Joan Cowen Care Home 27 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (27), of places Physical disability over 65 years of age (2) Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Stonehaven is a large and spacious care home situated in a pleasant area of Sandown close to the seafront. The accommodation is on two floors with all bedrooms being accessible by a passenger lift or short stair lift. The home provides care for up to twenty-seven older people with the overall aim of providing a quality service within a comfortable and homely environment. Since purchasing the home, the present owners have made substantial improvements to the physical environment of the home for the benefit of the residents. The home has appropriate communal and bathing facilities. All bedrooms are for single occupancy, some with ensuite facilities and some with sea views. There is a car park to the front of the home and large garden with ramped access from the lounge. The home is owned by Mr and Mrs Cowen and at the time of the inspection visit the registered manager was Mrs Cowen. The scale of charges are £400.00 to £480.00 per week depending on room occupied and level of assessed care needs. The home will accept people funded by social services and top-up funding may be required. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 13th November 2007. All core standards and a number of additional standards and compliance with previous requirements were assessed. The visit to the home was undertaken by two inspectors and lasted approximately seven hours commencing at ten am and being completed at five pm. The providers Mr and Mrs Cowen were present for part of the inspection visit and the new manager was present throughout the inspection. The inspectors were able to spend time with staff on duty and were provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the proprietors completed an annual quality assurance assessment, information from which is included in this report. Comment cards were returned from one care manager and one GP. Seven staff who work at the home also completed comment cards. Comment cards were sent to the home for distribution to identified people who live at the home and their relatives/visitors. Five comment cards were received from people who live at the home and five relative responses were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspectors were able to meet with all and talk to many of the people who live at the home, staff on duty and visitors. What the service does well: All comment cards, from people living at the home, their relatives and external professionals were positive about the home and service it provides to people who live there. All comments made to the inspectors during their visit to the home were also positive about the service people receive. This is evident in a comment from a care manager who stated ‘they treat all clients as individuals’. A person who lives at the home stating ‘residents meetings are a good opportunity for me to have my say and the manager and staff do their best to meet our needs and requests’. A relative added in a comment card ‘the residents are well cared for by staff who are patient and caring, they are given choices in their care and are treated with respect, there is a real family atmosphere’. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The absence of locks on WC’s/bathrooms or bedrooms could result in peoples privacy being compromised during personal care or use of the WC. Discussions with people living at the home indicated that they were not particularly concerned about the absence of locks on doors however the home must ensure that privacy can be maintained during personal care and that should people wish to be able to lock their bedroom doors suitable locks (which cannot result in people being locked in their rooms) are fitted. None of the upstairs bedroom windows had opening restrictors. The home must undertake a risk assessment on all upstairs windows and fit opening restrictors where necessary. Some windows on the ground floor had been fitted with opening restrictors. The home does not have a sluicing/disinfecting facility for commode pots. A shower room has now been designated for this purpose however the facilities provided are inadequate to allow immersion disinfection of commode pots and there are no hand washing facilities for staff. Please contact the provider for advice of actions taken in response to this Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 7 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. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The manager explained the homes admission procedure and three preadmission assessments were viewed. The manager undertakes pre-admission assessments on all prospective people. The inspectors heard a telephone conversation between the manager and a relative during which she explained that a person could not move to the home without an assessment being completed by the home. The home has an assessment tool that covers all the relevant areas necessary to decide if it is able to meet a prospective persons Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 10 needs. The manager was clear about the level of care needs the home can accommodate and consideration would be given as to the available room when completing an assessment as a few bedrooms can only be accessed via a short flight of stairs or stair lift. The manager had completed some additional preadmission assessments for one person admitted with complex needs. The manager stated that ideally the person would visit the home prior to deciding to move in however when this was not practicable relatives or representatives are invited to visit the home and view the available room. A person living at the home stated in a comment card ‘my next of kin visited Stonehaven and thought it was suitable. The arrangement was originally for a one month trial, I returned back home and after my mobility was affected I decided to return back to Stonehaven’. Another person stating ‘I did look around the home and liked the look and feel of Stonehaven’. The home may accept emergency admissions and one inspector spoke with a person and her relatives who had been admitted in an emergency. The relatives confirmed although the admission had been organised by social services they had received written information about the home. A relative stated in a comment card that although the admission had been arranged in an emergency ‘we were able to view the home and see the bedroom before mum was admitted’. The inspectors were able to meet relative’s visiting the home on the day of the unannounced visit who confirmed that they had received appropriate written information about the home. Comment cards from people living at the home all confirmed they had received contracts. A sample of contracts were viewed during the previous inspection visit and the report stated ‘contacts seen clearly state the terms and conditions of the resident’s stay and what services are included in the fees and those for which additional charges may be made. The home accepts both social services and self-funding service users. Some rooms have an additional top-up on the social services fees and this is made clear on invoices and contracts’. A relative who manages a persons money on her behalf confirmed that he was aware of what services were included in the fees and that detailed invoices were received. The home does not provide intermediate care but can provide respite care if a room is available and the manager is confidant that care needs can be met. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are set out in an individual plan of care. Medication is appropriately stored, and records of medication administered were well completed. People are treated with respect. EVIDENCE: The inspectors viewed four care plans for new and existing people. Since commencing work at the home in June 2007 the manager has revised the risk assessment and care planning documentation and procedures. All care plans followed a similar format and are assessable for care staff and people should they wish to see their care plans. Care plans were seen to have been signed by either the person whose plan it was or if they were unable to do so a relative had signed the care plan. Care plans were seen to have been reviewed monthly or if needs changed significantly. The process and documentation relating to reviews was discussed with the manager as most were seen to state ‘no change’ and in one instance other recordings in daily records indicated that there had been a change in respect of the persons identified needs. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 12 Within all care plans were comprehensive individual moving and handling assessments, which clearly indicated how people should be supported with moving and handling. Also in care plans were risk assessments in relation to falls, information about nutritional needs and specific risk assessments relating to individual risk. Care staff confirmed that they have undertaken manual handling training. Appropriate manual handling equipment was seen during a tour of the home. The inspectors were able to meet many of the people living at the home. They all stated that they felt very well cared for; others whose level of disability made conversation difficult appeared comfortable, relaxed and well cared for. The inspector’s spoke with visitors who stated that they were very happy with the level of care their relative received. Comment cards were received from five relatives, all stated that care needs were always/usually met. No concerns about the level of care were raised in these comment cards. Comment cards were also received from five of the people who live at the home who stating that they always/usually receive the care and support they require. One adding ‘staff are always kind and helpful’. People the inspectors spoke with during their visit to the home made similar comments. One person confirmed that her request not to have a male carer for personal care was always met. People living at the home stated that they felt well looked after and that if they were ill the home would organise for a doctor to visit them. Comment cards from people living at the home stated that they always received the medical care they required. A comment card was received from one GP who stated that the home seeks advice and acts upon it to improve and manage people’s health care needs and that individuals health care needs are always met by the home. The GP also stated that they felt the staff had the necessary skills to meet people’s needs. The care manager who returned a comment card stated that people’s healthcare needs are always met and that the home had taken appropriate action when they were unable to meet a persons increasing needs and inappropriate behaviours. One of the proprietors and the new manager are qualified nurses. Discussions with the manager during the inspection visit indicated that she knew how to contact external professionals and when this should be done. Records seen during the inspectors visit indicated that health professionals are appropriately consulted. Care staff confirmed that they have undertaken dementia awareness training and are all booked to attend training in December and the New Year relating to the Mental Capacity Act. The inspectors undertook a tour of the home with the manager and were therefore able to meet some people who had chosen to remain in their bedrooms. Care staff stated that they felt they had enough time to meet people’s health and personal care needs. Discussions with and comment cards Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 13 received from people confirmed that staff are available when required. Observations throughout the visit indicated that care staff were aware of and followed best practise in relation to communication and supporting people with Dementia. Only senior staff who have undertaken additional training and been deemed competent administer medication in the home. All medication was seen to be appropriately stored in a secure locked facility. The home uses a pre-dispensed blister system where possible. The Medication administration records were viewed and found to be fully completed. The controlled medications record was also viewed and found to be fully completed. One inspector viewed the lunch time medication administration procedures and noted that the medications trolley was left unlocked in the hall whilst individual medications were take to people. This was discussed with the manager who stated that this was not usual practise and she would ensure that this was not repeated. Comment cards received from people confirmed that staff listen and act on what they say. People and relatives the inspectors spoke with confirmed that staff treat them with respect and that their privacy is maintained during personal care. During the inspectors visit staff were observed to treat people with respect, this was also confirmed by professional comment cards received. The GP confirmed that the home always respects individual’s privacy and dignity and responds to individuals’ different needs. As previously stated peoples request for female carers for personal care are respected. The inspectors noted that WC’s around the home did not have locks on the doors, whilst those which did have locks had bolt style locks which would prove impossible for staff to open from the outside in an emergency. Although bedroom doors are potentially lockable the style of locks could result in people either locking themselves in their bedrooms or becoming locked in from the outside and unable to leave. Nobody living at the home had a key to his or her bedroom and no rooms were locked. The absence of locks on WC’s/bathrooms or bedrooms could result in peoples privacy being compromised during personal care or use of the WC. Discussions with people living at the home indicated that they were not particularly concerned about the absence of locks on doors however the home must ensure that privacy can be maintained during personal care and that should people wish to be able to lock their bedroom doors suitable locks (which cannot result in people being locked in their rooms) are fitted. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. People receive an appealing balanced diet in pleasing surroundings. EVIDENCE: The routines for daily living and activities made available are flexible and varied to suit people’s individual needs and wishes. People and relatives confirmed to the inspector that they are able to choose where in the home they spend their day; many were seen to spend time in the homes lounge with a few remaining in their bedrooms. People confirmed to the inspectors that they are given choice over their meals with options being chosen on a daily basis. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, catering and religious needs. People stated that they are able to get up and go to bed at times of their choosing. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 15 The home stated within the annual quality assurance assessment that a range of entertainments and activities are organised and that an activities person has been appointed who works three mornings a week. The inspectors observed the activities person undertaking a discussion/reminiscence activity with people in the lounge. A list of daily planned activities for the week was observed in the lounge. The home supports people to attend bingo and a coffee morning at the nearby church twice a week and has a monthly slide show from a visiting activities professional. Discussions with people and comment cards indicated that they are able to join activities or not as is their wish. The manager identified that outings have been difficult to organise due to transport problems. People were positive about a recent firework party to which relatives were invited. The inspectors were able to meet visitors with comment cards from relatives stating that they are able to visit at any time and kept informed about issues affecting their relative. The home has a large dining room where many people choose to have their meals. People confirmed that they can choose to eat some or all of their meals in their bedrooms and two had chosen this on the day of the inspectors visit. People stated that the food is always/usually good, and choice provided. Several comment cards suggested that fresh fruit was not readily available and that relatives brought this into the home. One person described to the inspectors how she is provided with a fresh fruit salad ‘fruit like melon, orange, apple cut up in a dish’, as she has told the manager that she does not like puddings. The inspectors saw fresh fruit in the kitchen. The manager confirmed that fruit is available to people however it may be necessary to make this option more obvious to people with possibly a bowl of fruit in sight or the cook clearly offering this as a choice at meal times. People informed the inspectors that the cook visits them each morning to inform them what is the main lunchtime and evening meal. The manager stated that alternatives are available and special diets are catered for. The inspectors were present for the main lunchtime meal. The food appeared well presented, appetising, was served piping hot and people appeared to be enjoying their meal. Some people require prompts to eat and assistance was tactfully provided. Drinks and snacks are also available throughout the day with people confirming this as well as the inspectors observing people being given morning and afternoon hot and cold drinks. The need for special diets or supplements is recorded preadmission. The home has not recently been inspected by environmental health in respect of food hygiene standards and therefore does not have a food hygiene rating. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are aware of how to complain. People are protected from abuse. EVIDENCE: The homes complaints procedure is included in the service users guide provided to all prospective admissions or their relatives. Within the entrance hall is a notice providing further information as to what to do if a person or visitor has any concerns or complaints. The annual quality assurance assessment completed by the home prior to the inspection stated ‘we take any complaint from residents, families, visitors and staff very seriously and investigate, taking remedial action’. People and relatives the inspector spoke with also stated that although they had no concerns or complaints they would feel able to raise any issues with staff or one of the proprietors or the manager. One person commented that when she had recently informed the proprietor that her room felt cold this had immediately been addressed and her room was now an appropriate temperature. Comment cards from relatives stated that they knew how to make a complaint and the home had responded appropriately if any issues had Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 17 been raised. Many stating that they would raise any concerns with the new manager. Comment cards from visiting professionals stated that no complaints in respect of the service had been made to them. Comment cards from staff confirmed that they were aware of what to do if a service user or relative raised any concerns. One comment card stated that the home has service user meetings and that issues can be raised in meetings. Care staff confirmed that they have attended safeguarding adults training. Care staff have also attended dementia training and all care staff are booked to attend training on the Mental Capacity Act. The proprietor identified in the annual quality assurance assessment that the home follows the Isle of Wight policy on safeguarding adults and discussions with the manager and one of the providers confirmed they were clear about safeguarding procedures. Information in the homes annual quality assurance assessment stated that the home had made one safeguarding adults referral and been involved in one safeguarding investigation. These were fully investigated by Social Services under safeguarding procedures with the full cooperation of the manager and the allegations were unsubstantiated and there is to be no further action. The homes policies and procedures in respect of recruitment and people’s personal finances should ensure that unsuitable people are not employed at the home and that people will not be financially abused. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained both internally and externally with evidence of ongoing refurbishment and redecoration work. The tour of the premises revealed a property that was clean and tidy throughout. The home must ensure that an adequate sluicing facility and hand washing facilities is provided and risk assess upstairs windows and provide opening restrictors where necessary. EVIDENCE: The inspectors were shown around the home by the manager at the start of the visit. The majority of bedrooms and all communal areas including the garden and kitchen were viewed. The home employs a maintenance person. Overall the home was well maintained both internally and externally with evidence of ongoing refurbishment and redecoration work. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 19 The home has a very large and spacious entrance hall area and a large sitting room in which furniture has been arranged to provide smaller seating areas so that people can sit and socialise in small groups if they wish. The home has a separate attractive dining area with small tables seating four people and space for people who use wheelchairs. People can choose a number of places to sit and socialise or they may spend time in their own rooms. Throughout the inspection visit the majority of people were spending time in the lounges. The home has pleasant enclosed flat gardens with ramped access from a decked area outside one lounge. The home has a no smoking policy with clear signs to this effect around the home. Some of the bedrooms have en-suite facilities; with the manager saying that the proprietors are considering ways in which additional bedrooms may be provided with en-suite facilities as part of the home’s improvement plan. Bathrooms, equipped with hoists, showers and WC’s were seen located around the home close by bedrooms and communal rooms. As previously identified bathrooms and WC’s did not have suitable privacy locks. The inspectors noted that the underneath of the upstairs bath hoist and several of the toilet seat raisers are in need of a thorough cleaning. The home has a range of equipment in place to assist people. The home has a shaft lift from the ground floor to the first floor and a small stair lift for the short flight of stairs from the first floor to some bedrooms at the back of the home. The home has purchased a Stairmatic (portable stair lift) that can be used in the unlikely event of the main lift not working. The inspectors identified that the lift will not automatically stop working if an obstruction prevents the doors from closing and this should be reviewed by the home as may result in injury to people using the lift independently. Staff confirmed they have received training to use hoists and other equipment. All rooms have call bell systems and residents spoken to confirmed that care staff respond promptly to call bells. The level of lighting in some corridors and the dining room was discussed with people who live at the home, care staff and the manager. People did not identify that lighting was insufficient however the lighting in some areas could be improved especially in respect of the corridors leading to the upstairs bedrooms at the back of the home where people may be using a short flight of stairs. Some areas of the home had grab/hand rails however other corridors did not. None of the upstairs bedroom windows had opening restrictors. The home must undertake risk assessments on these windows and fit opening restrictors where necessary. Some windows on the ground floor had been fitted with opening restrictors. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 20 All bedrooms are for single occupancy with a number being seen during the inspection visit. All bedrooms were well decorated and had been personalised by their occupant. Bedrooms varied in size and shape. People stated they liked their bedrooms and confirmed they had been able to bring in personal items at the time of their admission. Since the previous inspection the home has replaced a number of divan bed bases. During the inspection visit some bedrooms felt cold with the manager reporting that heating is on a timer that comes on at 6pm. Some bedrooms were seen to have supplemental heating that the manager reported was removed when people are in their bedrooms due to risks presented from the unprotected hot surfaces. Whilst most people had chosen to leave their bedrooms and spend the day in the homes lounge (which was warm), it was not clear how bedrooms on the timer system would be heated it the person was ill or had chosen to remain in their room. The inspectors noted that the home was clean and there were no unpleasant odours at all. The home employs domestic staff who were seen cleaning bedrooms during the inspection visit. People and visitors confirmed that the home is always clean. Comment cards also confirmed this. Care staff stated that they have access to adequate supplies of disposable aprons and gloves for infection control purposes, however none were available in the homes laundry. The home does not have a sluicing/disinfecting facility for commode pots. A shower room has now been designated for this purpose however the facilities provided are inadequate to allow immersion disinfection of commode pots and there are no hand washing facilities for staff. Stonehaven DS0000012540.V349657.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of care and ancillary staff that ensure that peoples needs are met. Staff receive the necessary training and fifty per cent of care staff have NVQ in Care of at least level 2. The homes recruitment procedures should ensure that unsuitable people are not employed at the home. EVIDENCE: All comment cards, from people who live at the home, relatives and professionals were positive about care staff. One relative commented ‘the residents are well cared for by staff who are patient and caring, they are given choices in their care and are treated with respect, there is a real family atmosphere’. Another relative stated ‘the care staff are very kind and caring and treat all residents with respect, they are patient and always have time for the residents, even though they are very busy’. Observations of interactions during the inspectors visit were positive. Duty rotas were seen during the visit to the home and indicated that adequate numbers of care and ancillary staff are provided. In addition one or both of the homes providers is available most weekdays, as is the homes newly recruited manager. People and visitors stated that there are sufficient staff on duty. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 22 During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet people’s needs and throughout the inspection care staff appeared to have time to meet people’s needs. The home identified in their annual quality assurance assessment that they have implemented a new shift pattern which means that more staff are on duty at busiest times. The manager confirmed that on call support is available. Training and qualification information was provided during the inspection and in the homes annual quality assurance assessment. The home has fifty per cent of care staff having at least an NVQ level 2 with one senior carer informing the inspectors that she has almost completed her level 3 qualification. The new manager has an NVQ assessor’s award. The registered manager identified in the homes annual quality assurance assessment that the home promotes staff training. The inspector viewed training certificates in staff files and staff stated that they have regular opportunities for training both in house and external training such as at the local college. All staff are booked to attend Mental Capacity Act training in the near future at the college. External professionals and people who live at the home felt that staff have the necessary skills and knowledge to meet their needs. Care staff confirmed that they were not expected to undertake tasks outside their level of knowledge or skill. Comment cards from care staff confirmed they felt they had sufficient training to meet people needs. Information contained in the homes annual quality assurance assessment stated that fifteen care staff have left the home in the previous twelve months. The home has recruited new staff (many with previous care experience) however, many staff are relatively new to the home. The home identified in the annual quality assurance assessment that they need to ‘encourage team building to encourage staff to work together’ and ‘examine possible management styles which could help with the retention of staff’. The recruitment records for four new staff were viewed. These contained all the required information and confirmed that all staff are fully checked including references, CRB and POVA checks prior to commencing employment at the home. The manager explained the homes induction procedure and showed the inspector the induction booklet in use at the home for care staff. Staff files contained evidence of appropriate induction. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 23 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, 37 and 38 Quality in this outcome area is good. The providers and new manager have the necessary skills and experience to ensure that the home is appropriately managed and run in the best interests of the people who live there. People’s financial interests are safeguarded. Records are generally well maintained and stored securely. The health, safety and welfare of people and staff are promoted. EVIDENCE: One of the home’s joint proprietors is the current registered manager. Mrs Cowen is a qualified nurse and has many years experience managing residential care homes. However she does not have a recognised management qualification. The home appointed a manager in June 2007 with the necessary qualifications to take over the day–to-day running of the home. The manager informed the inspectors that she has now completed her application form Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 24 which has been forwarded to the Commissions registration team to become the homes registered manager. Comment cards and discussions with residents, staff and visitors indicated that the new manager is respected and available to all the above-mentioned people. Comments made to inspectors identified that people would raise any concerns with the new manager and also stated they would ‘speak to the manager about anything’ and that ‘since the new lady came (manager) it’s come alive’. Another relative commented that ‘the home has not been too highly rated locally, but it’s bucked up since the new manager came’. The home has a staff structure of deputy care manager and senior carers so there is always a designated senior person on duty when the manager is not at the home. The providers are regularly at the home approximately four days per week and the inspectors met them on the day of the unannounced visit. There are staff meetings and service user meetings, the minutes of both meetings being seen during the inspector’s visit to the home. The home has undertaken some quality assurance work with inspectors viewing completed resident questionnaires from May 2007. Generally all the responses were positive. Comment cards received prior to the inspector’s visit indicate that should any requests or negative comments be made by people these are quickly resolved by the manager. Examples of these were given to the inspectors and included in the relevant sections of the report. The Annual Quality Assurance Assessment was completed to a good standard and identified areas the home wished to improve and how they hoped to achieve this. The home does not become involved in people’s personal finances with additional services (hairdressing, shop, chiropody or newspapers) being invoiced to the person responsible for the person’s money. A visiting relative confirmed to the inspector that he receives invoices and these clearly state any additional services his relative has received. The visitor confirmed that he was fully aware of what is included in the fees and things for which an additional charge may be made. The home holds a small amount of personal cash for one person that the provider is responsible for. It was not possible to view the records for this, as the provider was not available in the afternoon of the inspectors visit. However the previous report stated that the arrangements and records are satisfactory and the solicitor responsible for the person’s finances is happy with the arrangements. During the unannounced inspection visit a variety of records was viewed. These included care plans, risk assessments, Medication Administration Records, CD register, staffing rotas, staff recruitment records, quality assurance questionnaires and meeting minutes. These were all stored appropriately. The inspectors noted that the district nurse records are not stored such that people’s confidentiality is maintained. Discussions with the Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 25 manager indicated that she has identified this as an issue and has decided that district nurse records should be stored in people’s bedrooms where in future all treatments will take place. The evidence indicates that the home provides a safe place for staff, visitors and people. Staff receive induction, mandatory and update training, appropriate numbers of care staff were on duty supported by a range of ancillary staff. Staff have the necessary equipment to enable them to meet peoples needs. The home appeared well maintained. The annual quality assurance assessment stated that fire equipment was last serviced in June 2007 and gas services in April 2007. The home has maintenance contracts for the lift and this was serviced in August 2007. Also moving and handling equipment that has been serviced within the past year. Within the environment sections of this report some issues and requirements have been made in respect of risk assessments and the fitting of window restrictors to upstairs windows and the provision of hand washing facilities in sluicing facilities. Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 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 3 3 X 3 X 3 2 Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 27 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 OP10 Regulation 12 (4)(a) Requirement The home must ensure that privacy can be maintained during personal care and use of WC’s. Should people wish to be able to lock their bedroom doors suitable locks (which cannot result in people being locked in their rooms) are fitted. The home must undertake a risk assessment of all upstairs windows and fit opening restrictors where necessary. The home must ensure adequate sluicing facilities are provided including hand washing facilities for staff. Timescale for action 01/04/08 2. OP38 13(4)(a) 01/04/08 3. OP26 23(2)(k) 01/04/08 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 Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 28 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 Stonehaven DS0000012540.V349657.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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