CARE HOMES FOR OLDER PEOPLE
Strand House The Strand Starcross Exeter Devon EX6 8PA Lead Inspector
Megan Walker Unannounced Inspection 14:00 16 March 2006
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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 Strand House DS0000003816.V262427.R01.S.doc Version 5.1 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. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Strand House Address The Strand Starcross Exeter Devon EX6 8PA 01626 890880 NONE pepigs@starcross.freeserve.co.uk 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) Mr P E Pigott Mrs Pigott Mrs Pigott Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8), Physical disability over 65 years of age (8) of places Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 2nd August 2005 Brief Description of the Service: Strand House is a listed building registered as a Care Home for eight older people who may also have some degree of physical disability. It was registered and has been run by the present owners since 1988 and has been improved and adapted to its present attractive and functional state over that time. The owners live on the premises and with the help of a small number of staff they manage and work in the home. Strand House is located in Starcross, a small seaside town close to Exeter in the county of Devon. It is set back from the main road and is close to Starcross railway station offering direct access to Exeter and Cornwall via Newton Abbot. There are six single bedrooms and one double room. There is a bathroom with bathing aid to assist bathing and another bathroom with a shower. There is a chair lift available for the residents to use if they wish. The home has a large family style kitchen where meals are served, a sitting room and a smaller “quiet” room. To the rear of the home there is a patio area and small area laid to lawn that is used by the residents when the weather is suitable. Strand House is not registered for nursing care and it does not provide intermediate care. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on Thursday 16th March 2006 between 14h00 and 16h00. Mrs Pigott, the Registered Owner and Manager was present for the inspection and provided information as required. All the residents were at home on the day of the inspection and were introduced and spoke to the inspector. Three members of staff were working during the inspection and one offered views about working at Strand House. This inspection also included a tour of the premises. There were three requirements given at the last inspection and these had all been met within the timescale. There were three requirements as a consequence of this inspection. What the service does well:
Strand house is a small home that offers family-style accommodation. The atmosphere on the day of the inspection was relaxed and friendly. Most of the residents have lived at the home for many years and the staff group is stable; this was reflected in the banter and good-natured humour with which residents and staff spoke to each other. The registered Provider and staff were observed as maintaining a professional conduct that allowed them to also be objective about their work and interactions with residents. Each bedroom was individual in character and style, representing the preferences of its occupant. The residents are encouraged to be as independent as possible. Most of the residents are active Christians and a local vicar visits the home monthly to bring Holy Communion to those unable to attend Sunday worship. The home offers regular trips out on a minibus and the residents are invited to make suggestions of places to visit. Mrs Pigott endeavours to ensure that these trips are suitable for older people with a level of physical disability and frailty, and not too long so as to become over tiring. The home has excellent support from the local medical practice. The pharmacy is next door to the home and this also provides the home with a good service. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The Registered Provider must ensure that the home is heated adequately to suit external weather conditions and that residents are warm and comfortable, and their health is not at risk from cold internal conditions, particularly those whom are less mobile and frail. Individual staff files must have a photograph of the staff member. The home must undertake a quality audit and make its results available for residents, other interested parties, and the Commission. Prospective residents should receive written confirmation that the home can meet their assessed needs prior to moving into Strand House. A copy of this should be kept on that individual’s personal care file. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 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. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 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 Strand House DS0000003816.V262427.R01.S.doc Version 5.1 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): 4 Residents know that the home will meet their assessed needs. EVIDENCE: All prospective residents have an opportunity to visit the home prior to moving in, and also a four-week trial period. Mrs Pigott confirmed that currently she always verbally accepts a new resident however she has only on one occasion written to confirm the agreement. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, 11 Medication is monitored and kept in date. EVIDENCE: Since the last inspection Mrs Pigott has disposed of all out of date creams, and continues to check all medication to ensure that it is within the “use by date”. At the time of this inspection the home did not have a formal policy of requesting information from residents about their last wishes if they are dying or after death. Mrs Pigott stated that residents often talk about their preferences although except for preference about burial or cremation this is not formally recorded on their individual care plans. Mrs Pigott explained that the local medical practice is very supportive to the home and that on occasions when a resident has been very poorly, the GP has offered hospitalisation or care at the home. The district nurses have also supported the home’s care staff in caring for a dying resident in the home. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 The residents find that the lifestyle they experience in the home meets their religious needs, and that they are encouraged and enabled to maintain contact with whom so ever they wish. EVIDENCE: At the time of this inspection all the residents living at Strand House were white, British-born, and predominantly of a Christian faith; Protestant, Church of England denomination. The Registered Provider confirmed that there have been in the past residents who were Christian Roman Catholics. Other residents at the home are non-believers or no longer practicing Christians. The Registered Provider explained that a local vicar visits the home monthly and brings Holy Communion for those wishing to partake, and who are unable to attend Sunday worship. The Registered Provider and staff confirmed that the residents have regular contact with their families. Residents spoken to also confirmed this. Residents also have the opportunity to go out on “house” trips as the Registered Provider regularly hires a minibus to take out residents to places of their choice. A list has recently been made available to residents for their suggestions of places to go in the coming weeks.
Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 12 Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents’ legal rights are protected. EVIDENCE: All the residents at the home are on the electoral register. At the time of this inspection the majority voted by post although for those who prefer to go to the polling station, staff would be available to take them. Residents have used the Age Concern Advocacy Service in the past although currently families assume responsibility and act as representative for their relatives living in the home. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25, 26 Residents live in a home that is safe and well presented, clean and hygienic however the internal temperature was not compatible with the external weather conditions. EVIDENCE: On the day of the inspection a member of staff was deep cleaning the kitchen. She explained that this was a weekly task. A tour of the premises found the home to be pleasant smelling through out, and clean and tidy. During the inspection all the residents were observed with woollen blankets over their legs and/or around their shoulders. The radiators were off at this time and the home was cold for anyone sitting for any extended period of time. On the day of this inspection outside weather conditions were extremely cold with strong freezing winds. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 15 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): 28 Residents are in safe hands. EVIDENCE: Three members of staff have an NVQ Level 2 in care and two are planning to continue with an NVQ Level 3 in care. One member of staff has partially completed an NVQ Level 2 in care, and another member of staff has recently started an NVQ Level 2 in care. The Registered Provider hopes to complete a Registered Manager’s Award by the end of this year, 2006. As an outcome of the previous inspection there was a recommendation that every staff file should have a photograph of the individual. This had not been done by the time of this inspection, however the Registered Provider confirmed that this would be done in the near future. Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 16 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): 35, 36 Residents can be confident that their financial interests are safeguarded. Staff are appropriately supervised. EVIDENCE: The Registered Provider explained that currently she does not hold any monies on behalf of any resident as their families take responsibly for all financial matters. Since the previous inspection each staff member has had three formal supervision sessions. The Registered Provider has recorded each of these. It is the intention of the Registered Provider to ensure that every member of staff receives the required six supervision sessions within the year, including an annual appraisal.
Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 17 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 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 4 18 X X X X X X X 2 4 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 4 X X Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 18 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 OP25 Regulation
13,4c 16,2c 23,1a2p Requirement The Registered Provider must ensure that the home is appropriately heated particularly during colder periods such have recently been experienced in Devon. Clear photographs of staff must be provided for their individual staff files. The Registered Provider must undertake a quality audit of the service and the results must be made available to the residents, the Commission, and any other interested parties. Timescale for action 16/03/06 2 3 OP29 OP33 Sch2,1 30/05/06 Sch1,10 24 30/08/06 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 OP4 Good Practice Recommendations The Registered Provider should write to prospective residents to confirm that the home can meet their assessed needs.
DS0000003816.V262427.R01.S.doc Version 5.1 Page 19 Strand House Strand House DS0000003816.V262427.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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