CARE HOMES FOR OLDER PEOPLE
Stratford Court 35 Highfield Road Hall Green Birmingham West Midlands B28 OEU Lead Inspector
Brenda O’Neill Unannounced Inspection 28th November 2005 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 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. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Stratford Court Address 35 Highfield Road Hall Green Birmingham West Midlands B28 OEU 0121 778 3366 0121 778 6288 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) Mrs Carole Wilkins Mr Colin Wilkins Mrs Carole Wilkins Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection May 17th 2005 Brief Description of the Service: Stratford Court provides residential care for up to 30 older people on both a long and short-term basis. It is a purpose built care home conveniently placed for local amenities and public transport. The Home offers accommodation over 2 floors and an eight-person lift provides access between floors. Bedrooms range from single rooms with en suite facilities to studio type accommodation. These studio rooms are for single occupancy and also have en suite facilities. They are intended for use by residents who are more independent but who will still benefit from the security of 24-hour supervision, care and support services. There is one double room with en suite for use by couples or friends. There are also fully assisted bathing and showering facilities available. The main complex has three separate lounge areas, a large dining room, and a hairdressing salon. Disabled toilet facilities are available close to the lounges and dining room. The Home is equipped with a loop system and talking books for service users with sensory difficulties. Television and telephone points are sited in all bedrooms and a payphone is also available for residents use. There is a well tended garden with seating for residents to enjoy, and some car parking facilities are available for visitors. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over half a day in November 2005. This was the second of the two statutory visits for this home for 2005/2006. To get a full overview of all the standards assessed during this inspection year this report should be read in conjunction with the report written following the inspection on May 17th 2005. During this inspection a partial tour of the premises was made, three resident and two staff files were inspected as well as other care and health and safety records. The inspector spoke with the proprietors, one of whom is also the manager, briefly to two members of staff and eight of the twenty-nine residents. What the service does well: What has improved since the last inspection?
All the requirements from the previous inspection had been met. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 6 The requirements made in relation to the medication system were relatively minor but had been met ensuring the system was entirely safe. Copies of all prescriptions were being kept, all medication received was being entered on the medication administration record and the sharps box was locked away. Staff had received updated training in fire procedures and manual handling ensuring they were up to date in safe working practices. To ensure the protection of the residents all staff employed since July 2004 had been checked against the POVA register. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. The assessment procedures in the home were good ensuring the needs of the residents were known prior to admission. Prospective residents were able to visit the home to assess its suitability prior to moving in. EVIDENCE: Three residents’ files were sampled. There was evidence that where applicable social workers had undertaken the pre admission assessment and drawn up the initial care plan. All files included an assessment carried out by the staff at the home on the pre admission day that included all the necessary areas. Residents spoken with confirmed they were able to visit the home and spend some time there prior to admission. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 9 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 and 9. Care plans needed to be further developed to ensure they detailed all the personal care needs of the residents and how these were to be met. There were comprehensive personal risk assessments in place for all residents identifying how risks were to be minimised. Manual handling risk assessments needed to include the types of assistance to be given by staff. Resident’s health care needs were being met and the systems in place for the management of medication were good ensuring residents’ medication needs were met. EVIDENCE: Three care plans were sampled. The care plans were quite extensive and easy to follow. Each file included a ‘getting to know me’ section that included information on family, friends, past employment, interests and hobbies. The files also included information on preferred rising and retiring times, food and drink likes, dislikes and preferences and preferred activities. General health care needs were identified as well as any specific issues in relation to the safety of the individual. For each identified need there was an action plan that detailed how staff were to meet the need. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 10 Action plans seen in relation to personal care needed to be more detailed and include what the resident was able to do for themselves and the types of assistance to be offered by staff. Care plans were being reviewed but not on a monthly basis as required. All files sampled included a lot of risk assessments including, personal, manual handling, mini mental health, tissue viability and nutritional screenings. The majority of these included all the information for staff to follow in relation to minimising the identified risks. There was very good evidence of ongoing reviews of risk assessments as the needs of the residents changed, for example, one residents risk assessment had been reviewed in light of an incident that occurred when he went out independently, another residents risk assessment had been continually reviewed in light of a number of falls sustained. The manual handling risk assessments needed to be further detailed to include the action to be taken by staff in the event of a fall if the individual was uninjured. Where they specified assistance was needed the type of assistance needed to be detailed. It was also recommended that read and sign sheets were included on all the risk assessments confirming that staff had read and agreed to follow the risk assessments. There was evidence that when health care issues were identified by staff they were followed up and monitored. Any visits by health care professionals were recorded and most were detailed on ‘acute issue records’. There was evidence of visits from doctors, chiropodists, dentists, opticians and district nurses and of attendance at hospital appointments. Residents were also being weighed on a monthly basis wherever possible. The residents spoken with were happy that their health care needs were being met and that they could see the doctor if required. Medication was being administered via a seven day monitored dosage system and was well managed. The manager stated only staff who had the appropriate training and experience administered medication. The two minor requirements made following the last inspection had been met. All medication was being acknowledged when it was received into the home, copies of prescriptions were being kept, the MAR (medication administration records) were appropriately signed and any balances of medication held at the end of the 28 day cycle were brought forward making the system easy to audit. Controlled medication was being appropriately stored ad administered. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 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): 13 and 14. There were no rigid rules or routines in the home and the residents were able to exercise choice and control over their lives. EVIDENCE: The residents spoken with confirmed there were no rigid rules or routines in the home and they could spend their time as they chose. Residents were seen to wander freely around the home, go to their rooms when they wished, sit chatting in small groups, take part in an activity if they wished, sit reading and sewing. Residents stated they decided what time they went to bed and got up, what they ate and what they wore. Two of the residents continued to go out independently and residents movements were only restricted based on a full risk assessment that had been discussed with them or their representatives. One resident commented that she was taken to the doctors by the manager for a minor ailment rather than the doctor having to visit the home. Residents were encouraged to personalise their rooms with their own possessions and to their liking and this was observed during the tour of the home. Visitors were seen to come and go throughout the course of the inspection and appeared to be made very welcome. There was a specific visitors room if the residents wanted to see their visitors in private. The residents spoken with stated they could have visitors at any reasonable times.
Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 12 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): EVIDENCE: These standards were not assessed during this visit, however both were met at the last inspection. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 13 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, 24, 25 and 26. The standard of the environment within this home was very good offering residents an attractive, safe, comfortable and homely place to live. EVIDENCE: This home was purpose built and met all the National Minimum standards. It provided a very high standard of accommodation that was well maintained, safe and accessible. There were three lounges and one dining room that were furnished and decorated to a very good standard and provided residents with a variety of areas in which to sit. All the communal areas in the home had numerous pictures and ornaments which gave it a more homely feel. There was a very well maintained garden to the rear of the home that had paved walkways, decking and furniture for the use of the residents in fine weather. The home had two fully assisted bathrooms one on each floor and a floor level shower room on the ground floor also. There were toilets within easy access of the communal areas and separate toilets for the use of visitors and staff.
Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 14 All bedrooms had en-suite facilities of toilet and wash hand basin and fifteen also had a shower incorporated. Bedrooms varied in size and all were well furnished and equipped and had been personalised to the occupants choosing. The heating, lighting and ventilation throughout the home were safe, domestic in character and met with the needs of the residents. The home was found to be clean and odour free. The laundry was appropriately located and equipped with washing machine with sluice cycle and tumble drier. There was an appropriate system in place for the disposal of clinical waste and protective clothing available for staff as needed. The kitchen was not inspected during this visit. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 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): 27 and 29. Adequate staffing levels were being maintained with a staff group that could meet the needs of the residents. The recruitment procedures were robust ensuring the protection of the residents. EVIDENCE: The inspector was informed that minimum staffing levels at the home were five staff during the morning shift and three staff during the afternoon shift with two waking night staff and one sleeping in. Additional ancillary staff were also employed for cooking and cleaning. On the day of the inspection there were two care assistants, one senior care assistant, the deputy manager and office manager were on duty. Both proprietors, one of whom was the manager, were also present. The proprietor, who was not the manager, was cooking the lunch as the cook was not on duty. The staffing levels appeared adequate for the needs of the present resident group. The manager commented she had managed to build up a core group of staff who had remained employed at the home since it opened. Residents spoken with were very positive in their comments about the staff team and there were friendly relationships evident. Staff training was not fully assessed at this inspection however the two requirements in relation to training that were made following the last inspection had been met. Virtually all staff had had updated manual handling training facilitated by the manager who had become an accredited trainer in this topic and all staff had had updated fire training. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 16 The recruitment files for two of the most recently employed staff were sampled. With the exception of one reference all the required information and documentation was available for inspection. The manager stated the reference had been obtained and could not understand where it had gone. The files included POVA first checks and enhanced CRB checks. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 17 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, 33 and 38. The manager ensured the smooth running of the home in a competent manner. The health and safety of the residents and the staff was well managed. EVIDENCE: The manager of the home had several years experience both of caring for elderly people and managing and owning a residential home. She was a qualified nurse and also had her care manager’s award. Throughout the inspection she demonstrated a good knowledge of the needs of the residents in her care and the running of a care home. There were systems in place for monitoring the quality of the service offered to the residents including, ongoing audits of medication, safety issues, the standard of the environment, residents questionnaires and so on. The menus in the home were changed every few months after consultation with the residents.
Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 18 Although there were no formal residents meetings residents that were able were asked their views about the service on an ongoing basis. As a result of the ongoing audits and consultations with residents an annual development plan was drawn up for the home with a view to it being a benefit to the quality of life for the residents. The home was very well maintained and safe. There was evidence on site of the servicing of all equipment and all the in house checks on the fire equipment were being carried out. Fire training for staff had been updated since the last inspection however the fire drill was overdue. The systems in place for reporting accidents and incidents to the CSCI were appropriate. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 4 3 X X 4 4 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must include all the personal care needs of the residents and details of how these are to be met by staff. Care plans must include to what extent residents are to self care. Care plans must be reviewed monthly. Manual handling risk assessments must include the types of assistance to be offered and the actions to be taken by staff in the event of a fall. There must be two written references available for inspection for all staff. The manager must ensure that a fire drill takes place every six months. Timescale for action 01/02/06 2. OP7 13(5) 14/01/06 3. 4. OP29 OP38 19(1)(b) (i) 23(4)(e) 01/01/06 01/01/06 Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 21 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 OP7 Good Practice Recommendations It is strongly recommended that read and sign sheets are included with risk assessments to confirm staff have read and agree to follow any risk assessments. Stratford Court DS0000016788.V265574.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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