Inspection on 26/09/06 for Stonehaven

This inspection was carried out on 26th September 2006.

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 13/11/07

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 26th September 2006 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.V302546.R02.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.V302546.R02.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.V302546.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 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 home provides care for up to twentyseven older people (including two residents with dementia and two residents with a physical disability) 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. One of the owners is the registered manager and both owners are involved in the day-to-day management of the home. Stonehaven DS0000012540.V302546.R02.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 26th September 2006. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately six and a half hours commencing at 10 a.m. and being completed at 4.30 p.m. All core standards and a number of additional standards were assessed. The inspector was able to spend time with the deputy care manager and care staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and service users. Prior to the visit a preinspection questionnaire was sent to the home and returned within the required time scale. External professional questionnaires were sent to people identified in the pre-inspection questionnaire as having regular contact with the home. Comment cards were returned from two GPs and three care managers and the home’s local pharmacist. Service user and relative comment cards were sent to the home. Ten service user and ten 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 inspector was able to meet with and talk to most of the service users and their visitors. What the service does well: The home provides a pleasant, safe, homely environment for residents and staff who confirmed that they felt social, health and care needs are met. Care staff are appropriately trained and available in sufficient numbers to meet residents’ needs. Residents were very complimentary of the food provided at the home. The home is well maintained and decorated with a range of comfortable communal space including a large dining area that can accommodate all of the residents. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 6 The home has purchased induction books that relate to the common induction standards and were shown to the inspector. These books contain lots of essential information for new care staff and have various worksheets to be completed by the employee as they progress through the book. The books and worksheets can also be used as evidence for later NVQ studies. The home is well managed and the registered owners are in day-to-day charge of the home. The registered manager, a qualified nurse, sets high standards for the care provided at the home. Residents were very positive about the proprietors and care staff employed at the home who they stated are very polite, helpful and kind. Residents and visitors stated that they would recommend the home to a friend or relative in need of residential care. What has improved since the last inspection? What they could do better: Although the inspector found many positive aspects of the service and felt that service users receive a good quality of care a few requirements are made following this inspection. The home must ensure that two written references are obtained and are available for inspection for all staff employed at the home. Care staff must have a minimum of six formal recorded supervision sessions and an annual appraisal each year. The manager must ensure that the CD register is fully completed on all occasions. It is also recommended that the home review the cleaning and disinfection procedure for commode pots and consider providing a sluice facility. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 7 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. Stonehaven DS0000012540.V302546.R02.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.V302546.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users’ needs are fully assessed and they know that their needs will be met when they enter the home. Service users and their families are invited to visit the home prior to admission. The home does not provide an intermediate care facility therefore Standard 6 is not applicable. EVIDENCE: The inspector viewed the pre-admission assessments for three people admitted to the home in recent months and discussed the admission process with the representatives of one service user also recently admitted to the home. The home’s admission process was also discussed with the home’s deputy care manager. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 10 Comment cards were received from ten service users, eight of whom confirmed that they had received a contract and the other two not answering this question. During the visit to the home the inspector was able to see the contracts folder, in which a signed copy of contracts is held for all service users. A list at the front contained the names of all service users and was ticked to indicate that a contract had been returned by the service user or their representative. The 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. During the inspector’s visit to the home the deputy care manager received a telephone call enquiring about a room. At this point it was made clear that a top-up on the social services basic fee would be required for the one vacant room the home had. The inspector viewed the pre-admission assessments and care plans for three people admitted to the home in recent months. All pre-admission assessments seen had been completed by the manager or deputy head of care. Preadmission assessments are completed on a specific form provided by the RCN which contains all the relevant areas required to enable the assessor to determine if the home is able to meet a potential service user’s needs. The form also enables the assessor to determine if the potential resident has nursing or residential care needs. Information gained during pre-admission assessments was seen to have been included on care plans formulated following admission. The inspector spoke with the representatives of a service user who had been recently admitted to the home. The representative confirmed that the home’s manager had visited the prospective service user to ascertain a full picture of the care needs. The representatives stated that they had felt reassured that the service user’s needs could be fully met prior to moving into the home and that since admission their relative had settled in well and they had no concerns about his care. The inspector discussed the admission procedure with the deputy head of care who confirmed that where possible potential service users are invited to visit the home. When this is not possible their relatives or representatives are invited to visit the home. One service user comment card received confirmed that the resident had visited the home for an afternoon prior to moving in to the home, the others indicated that they had received enough information or that the admission had been as an emergency or from hospital and visits could therefore not be arranged. Discussions with care staff indicated that they have appropriate information about new admissions to enable them to care for people from the day of admission. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 11 The home does not provide intermediate care but can provide respite care if a room is available and the manager is confident that care needs can be met. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. All service users have a care plan that clearly identifies health and social care needs and how these should be met. Risk assessments and management plans are in place. Medication is appropriately stored. The manager must ensure that the controlled medications record book is fully completed and always signed by two staff who administer and observe the administration of medication. Service users are treated with respect and their privacy is maintained at all times. EVIDENCE: During the unannounced visit to the home a number of care plans for new and existing service users were viewed. Comment cards were sent to care managers the home identified as being in regular contact with the home. Three completed comment cards were returned. Care managers confirmed that their service users had care plans and that they were satisfied with the overall care provided to their service users placed in the home. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 13 The inspector spoke with the majority of the people who live at the home. Some confirmed that they had been involved in their care plans, others were less sure about written plans but confirmed that they were able to make choices about their day-to-day care. Discussions with relatives indicated that they were aware of care plans and had been involved in discussions about their relatives’ care needs and how these should be met. Comment cards received from service users stated that they either always (8) or usually (2) received the care and support they needed, with the same responses received to the question “do you receive the medical support you need”. Additional comments being made on some forms including the “staff are very kind and helpful”. Care plans seen by the inspector confirmed that all service users have an individual care plan that had been reviewed every month and contained daily records of care received. Statements within care plans seen were concise and specific to enable the service users’ needs to be clearly identified and met. Care plans contained information as to what individual service users could do for themselves and what care staff should support them with. This information is important as it should maintain service users’ skills and abilities and prevent over dependence. Care plans were seen to contain all the information required including specific risk assessments and management plans to cover pressure areas, manual handling, continence, nutrition and falls. Risk assessments had been regularly reviewed and updated. Comment cards were sent to GPs service users living at the home are registered with. Two comment cards were returned. Both GPs stated they were happy with the care provided at the home and had no concerns or additional comments. Care plans were seen to contain information about health needs and how these should be met. The manager explained that most service users are registered with one GP who visits the home regularly and other times as requested. Records of visits from the GP and other health professionals were recorded by the staff. A chiropodist regularly visits the home with dental or optician appointments being organised as and when required for individual service users. At the time of the unannounced visit to the home a district nurse was also visiting, discussions between the nurse and deputy head of care were overheard and indicated that the nurse and the home had an open relationship and the home could request her advice if required. All relatives or representatives spoken with during the visit to the home stated that they were satisfied with the overall care provided at the home. All were very complimentary of the service received and stated they would recommend the home to a relative or friend in need of a residential care home. The arrangements for the management of medication within the home were assessed. All medication is administered by care staff who have completed relevant external medications courses and is stored securely within the home. Repeat prescriptions are collected monthly from the surgery and taken to the Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 14 pharmacy. Medication is booked into the home on its arrival. The medication administration records were viewed. The Medication Administration records were seen to be fully completed with no gaps. Medications records had an additional sheet stating what medications each service user was prescribed and additional information about what each medication was for and specific guidelines about PRN (as needed) medications such as Paracetamol. The arrangements for the storage of controlled medications were seen to be appropriate however the controlled drugs record book had not been fully completed. The inspector noted that on one occasion the person administering the medication had failed to sign the CD register and on another occasion the person witnessing the administration had not signed the register. The manager must ensure that the CD register is fully completed on all occasions. Unused medications are returned to the local pharmacy. A comment card was received from the home’s pharmacy and this stated that although the pharmacist no longer visits the home he had no concerns about the home’s management of medications. During the visit to the home the inspector observed many instances when service users’ privacy and dignity were supported and maintained by care staff. The approach by all staff to service users was seen to be respectful and appropriate. Service users stated that staff were nice and polite and that privacy and dignity were respected and maintained. Relatives confirmed that service users are treated with respect and that dignity is maintained at all times. Care staff were observed to knock on doors before entering and not to open doors too wide to preserve privacy. All rooms are used for single occupancy. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents are encouraged to be as active as possible and there is a range of social activities on offer each day. Visitors are welcomed at the home with residents having as much control over their lives as possible. Residents told the inspector that the food in the home is very good. EVIDENCE: There is a regular programme of organised social activities for the residents in the home and regular outings and trips to local venues of choice. Staff stated that they encourage residents to be as physically and socially active as possible and as well as regular visitors who provide activities and entertainments, staff usually organise games and activities in the afternoons. The inspector spoke with the majority of people who live at the home who confirmed that activities are provided and they can choose to join in or not. Comment cards returned from service users confirmed that activities occur with two responses stating that although activities are provided the respondents choose not to join in as he/she preferred their own company. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 16 Visitors also confirmed that activities are provided. Residents stated they are consulted about activities and outings they would like the home to provide. The home is located opposite the parish church. Service users confirmed that they can attend church services and events if they wish. The deputy head of care informed the inspector that the home has good links with the local primary school with the children visiting the home at Christmas to perform nativity plays and sing carols. The home has a visiting hairdresser every Monday with service users clearly enjoying having their hair done and chatting with the hairdresser. The hairdresser confirmed that some residents keep their own money and pay her at the time of their appointment whilst for others she invoices the home who in turn invoice the service user’s representative. This confirms the deputy head of care’s statement that some residents hold their own money and others have a representative responsible for their personal finances. All residents spoken with stated that the food provided at the home was very good with alternatives available if the main meal was not to their liking. Residents informed the inspector that the cook speaks to all service users each morning to ask them what they would like for their main lunchtime meal. Sample menus were provided with the pre-inspection questionnaire and indicated that a varied diet is provided. The home has a pleasant dining room with sufficient seating at tables for four people to enable all service users to eat in the dining room if they so choose. The inspector was able to observe the lunchtime meal. This was a relaxed and social occasion with choices of drinks observed, condiments and gravy boats on the table and requests responded to promptly by care staff. Throughout the inspection visit service users were seen provided with refreshments with choices observed at all occasions. The home operates a small shop and this was observed on the afternoon of the inspector’s visit. Additional items are purchased on behalf of service users from local shops either by care staff or by care staff escorting service users to the shop. The inspector was able to talk with some visitors during her visit to the home. Visitors confirmed that they are able to visit at any time, and although those seen were visiting their relatives in the main lounge staff confirmed that service users could be taken to their bedrooms for private visits if requested. Comment cards were received from ten relatives. These confirmed that visitors are welcomed into the home, able to see their relatives in private and were all satisfied with the overall care provided. The home holds a monthly service users’ meeting, the minutes of which the inspector was shown during the inspection visit. Comment cards from residents all stated that staff listen and act on what they say. The inspector therefore believes that service users are helped to exercise choice and control over their lives. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 17 Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home appropriately responds to complaints and service users are protected from abuse. The home must ensure that two written references are obtained and available for inspection for all staff. EVIDENCE: The inspector was able to speak with the majority of people who live in the home. Residents stated that they would inform the manager, deputy head of care or care staff if they had any concerns or complaints but did not have any at the time of the visit to the home. Comment cards from residents stated that they always (5) or usually (5) knew how to make a complaint with a similar response from relative comment cards all of whom confirmed that they had not made any complaints. Relatives confirmed that they were aware of the complaints procedure and stated that they would feel able to raise any concerns or complaints with the manager or deputy head of care. Relatives had no concerns or complaints to report to the inspector at the time of the visit to the home. Comment cards returned by care managers and GPs stated that they had not received any complaints about the service. The pre-visit questionnaire returned by the manager stated that the home had received one complaint in the preceding twelve months. The Commission had been aware of this and had received a copy of the home’s response to the complainant. Care staff were clear that should any concerns or complaints be raised to them they would inform the deputy head of care of the manager. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 19 The inspector discussed adult protection with the deputy head of care and care staff on duty. They were able to identify the appropriate action they would take if they suspected that adult abuse may have occurred to one of the service users. The inspector was shown the induction workbook used for all new staff and this comprehensively covers the protection of vulnerable adults. The home has also provided adult protection training for all staff in September 2006. The home does not become involved in service users’ personal finances with additional services (hairdressing, shop, chiropody or newspapers) being invoiced to the person responsible for the service user’s money. A sample of invoices was seen and these are clearly itemised so that people will know exactly what additional services are being charged for and how much. The home holds a small amount of personal cash for one service user. The records for this were seen and clearly state money received in (from the solicitor) and what this has been spent on (hairdressing, chiropody etc.). Following the previous inspection the home was required to ensure that all new staff have a satisfactory POVA check and criminal record check before starting work in the home. The home has recruited a number of new staff since the previous inspection. The recruitment records were viewed. All had POVA and enhanced CRB checks however two did not have evidence of two written references. The home must ensure that two written references are obtained for all new staff prior to their commencement of employment and that these are available for inspection. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, and 26 Quality in this outcome area is good. This judgement has been made using the 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. It is also recommended that the home review the cleaning and disinfection procedure for commode pots and consider providing a sluice facility. EVIDENCE: The inspector was shown around the home by the deputy head of care 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 who was present during the inspection undertaking various routine jobs around the home. Overall the home was well maintained both internally and externally with evidence of ongoing refurbishment and redecoration work. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 21 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 residents 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. Residents 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 residents 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 and the service user who smokes stated he was aware of this policy and was happy to smoke outside. The garden was seen to be equipped with a range of good quality garden furniture. Service users confirmed that they enjoyed the garden. Some of the bedrooms have en-suite facilities, with the deputy head of care 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 were seen located around the home close by bedrooms and communal rooms. The home has a range of equipment in place to assist residents; grab rails, hoists and, as stated, assisted bathrooms. 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. Staff confirmed they have received training to use hoists and other equipment. All rooms have call bell systems and residents spoken to confirmed that call bells are promptly responded to by care staff. 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. Service users stated they liked their bedrooms and confirmed they had been able to bring in personal items at the time of their admission. Some divan bed bases were noted to be worn. Following the inspection visit the manager informed the inspector that ten new bed bases had been ordered prior to the inspection visit and these were now in use. The inspector noted that all areas of the home were clean and there were no unpleasant odours at all. The home employs domestic staff who were seen cleaning bedrooms during the inspection visit. Service users and visitors confirmed that the home is always clean. Comment cards from service users also confirmed this. Care staff stated that they have access to adequate supplies of disposable aprons and gloves for infection control purposes. The home does not have a sluicing/disinfecting facility for commode pots. The deputy head of care explained the procedures used in the home. Sterident Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 22 tablets are used approximately weekly in pots. Whilst these may remove stains from pots it is unlikely to adequately disinfect pots and does not allow the outside of pots, which may become soiled during use or content disposal, to be thoroughly cleaned and disinfected. It is recommended that the home review the cleaning and disinfection procedure for commode pots and consider providing a sluice facility. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home provides appropriate numbers of care staff who have received good induction and ongoing training to meet residents’ needs. The home has good recruitment procedures but must ensure that two written references are obtained and available for inspection for all staff. EVIDENCE: The inspector spoke with most of the qualified nurses, carers and ancillary staff on duty during the unannounced visit to the home. Duty rotas, staff recruitment and personnel files were viewed. The inspector spoke with relatives of service users and comment cards from service users, visitors and professionals were received prior to the home visit. Information was also provided by the manager in the pre-inspection questionnaire. Ten comment cards were received from service users prior to the inspector’s visit to the service. These all contained positive responses to the questions relating to care staff who were additionally described as “kind and thoughtful”, “I can always find someone to help me”, “all staff have been very good to me since I came here” “usually someone around when I need something”. Comment cards from ten relatives were received which stated that most felt there were sufficient numbers of staff on duty and they were satisfied with the Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 24 overall care their relative received. Interactions observed during the visit between staff and visitors/service users were warm and friendly. Following the previous inspection the home was required to ensure that POVA and CRB checks were completed before new staff commenced employment at the home. Since the previous inspection the home has recruited twelve new employees, either to care or domestic positions. The recruitment records for the majority of these were viewed. All were seen to have had the required POVA and enhanced CRB checks undertaken. The deputy head of care explained the home’s recruitment procedure. If correctly followed this should ensure that all the necessary checks are undertaken. However the inspector found that two recruitment files did not contain written references. The manager must ensure that two written references are obtained and available for inspection. The deputy head of care explained the home’s induction process. The home has purchased induction workbooks that relate to the common induction standards and were shown to the inspector. These books contain lots of essential information for new care staff and have various worksheets to be completed by the employee as they progress through the book. The books and worksheets can also be used as evidence for later NVQ studies. Duty rotas, the manager and staff confirmed that there are four care staff on duty in the mornings, three care in the afternoon. At night there are two care staff. The manager and deputy head of care are not included in the above staffing numbers although can cover shifts if necessary. The home employs a full time maintenance person, cooks and housekeeping staff. On the day of the unannounced visit the home had the deputy head of care and three care staff on duty. Care staff stated that they had adequate time to meet residents’ needs and that everyone worked together as a team. The home does not use agency staff. When necessary the home’s own staff cover extra shifts to cover sickness and holidays. This means that staff caring for service users are familiar with the home and know service users’ needs. Information supplied by the manager stated that the home has fifteen care staff of whom eight have an NVQ level two or above in care. This equates to over fifty per cent. At the time of the inspection visit two staff were undertaking their NVQ. The manager supplied details about staff training with the pre-inspection information. The information supplied indicated that the home supports staff training. Additional information about new policies and procedures and training is also undertaken during staff meetings. Care staff stated that they have opportunities for training and felt they had the necessary skills to care for the people living at the home. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 25 Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The registered manager has many years of experience and undertakes quality monitoring audits within the home. Service users’ financial interests are safeguarded. Most records are well maintained and stored appropriately. The manager must ensure care staff receive formal supervision at least six times per year. Evidence seen indicates that the home is a safe place for service users, visitors and staff. EVIDENCE: One of the home’s joint proprietors is the registered manager. Mrs Cowen is a qualified nurse and has many years experience as a nurse manager as well as extensive experience managing residential care homes. However she does not have a recognised management qualification. The home has recently Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 27 advertised for a manager with the necessary qualifications to take over the day–to-day running of the home. Comment cards and discussions with residents, staff and service users indicated that the manager is much respected and available to all the above mentioned people. 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. There are monthly staff meetings and also service user meetings, the minutes of both meetings being seen during the inspector’s visit to the home. Since the previous inspection undertaken in December 2005 the home has undertaken some quality assurance work. Resident questionnaires have been produced and service users requested to complete these. The responses were shown to the inspector. The inspector felt the questionnaires covered all the necessary quality areas in an easy to understand format. 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 service users these are quickly resolved by the manager. An example being that one service user had commented in a morning service user meeting that she would like more vegetables and that since that day, including that day, she had always received extra vegetables at meal times. The home does not become involved in service users’ personal finances with additional services (hairdressing, shop, chiropody or newspapers) being invoiced to the person responsible for the service user’s money. A sample of invoices was seen and these are clearly itemised so that people will know exactly what additional services are being charged for and how much. The home holds a small amount of personal cash for one service user. The records for this were seen and clearly state money received in (from the solicitor) and what this has been spent on (hairdressing, chiropody etc.). The manager and deputy head of care informally supervise all staff through their observations of working practises on a daily basis however formal supervision sessions do not regularly occur. Whilst reviewing new staff files there was no evidence of records of supervision sessions and those seen in longer term staff files were not recent or regular. Care staff confirmed that they do not receive formal recorded supervision. The manager must ensure care staff receive formal supervision at least six times per year. Supervision must cover all aspects of practice, philosophy of care in the home and career development needs and have written records that are available for inspection. 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, menus, contracts and invoices. With the exception of the CD register and lack of written references all records were found to be appropriately maintained and securely stored. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 28 All evidence indicates that the home provides a safe place for staff, visitors and service users. 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 service users’ needs. The home appeared well maintained with a planned programme of maintenance. The pre-inspection questionnaire stated that fire equipment was last serviced in June 2006, gas in April 2006 and water temperature checks in August 2006. The home has maintenance contracts for the lift and moving and handling equipment that has been serviced within the past year. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 29 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 3 3 3 3 3 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 3 Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 30 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. 2. Standard OP9 OP37 OP18OP29 OP37 Regulation 13 (2) 19 (1)(b) Sch 2 (5) Requirement Timescale for action 01/12/06 3. OP36 1(2) The manager must ensure that the CD register is fully completed on all occasions. The home must ensure that two 01/12/06 written references are obtained for all new staff prior to their commencement of employment and that these are available for inspection. The manager must ensure care 01/01/07 staff receive formal supervision at least six times per year. 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 It is also recommended that the home review the cleaning and disinfection procedure for commode pots and consider providing a sluice facility. Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stonehaven DS0000012540.V302546.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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