Inspection on 19/04/06 for Strathmore House

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Strathmore House 08/09/08

Strathmore House 11/10/07

Strathmore House 18/04/07

Strathmore House 10/11/06

Strathmore House 07/11/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Strathmore House Friday Bridge Road Elm Near Wisbech Cambridgeshire PE14 0AU Lead Inspector Mrs Jenny Cangy Unannounced Inspection 19th April 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 Strathmore House DS0000066352.V288373.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. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Strathmore House Address Friday Bridge Road Elm Near Wisbech Cambridgeshire PE14 0AU 01945 860569 01945 860202 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) Ashbourne (Eton) Limited Care Home 46 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (46), of places Terminally ill over 65 years of age (25) Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Maximum of 25 TI(E) beds Maximum of 20 DE(E) beds Maximum of 46 OP Date of last inspection 7th November 2005 Brief Description of the Service: Strathmore House is situated in secluded mature gardens set back from the road between the villages of Elm and Friday Bridge. It is a large 18th century house that has been extended beyond its original to provide the present facilities. Accommodation in the old house is on two floors with the first floor being accessed by a shaft lift There is a variety of sitting areas and a dining room. The extended area of the house is single story and within this area is a self contained unit for older people with dementia. A detached bungalow next to the main house has accommodation for six people. The home can be contacted by email on Strathmore.house@ashbourne.co.uk Current weekly fees range from £330 for local authority funded residential care to £624 for service users receiving privately funded nursing care. Additional charges are made for newspapers, hairdressing and private chiropody. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This an unannounced inspection. The inspection commenced at 10:00 with the inspector being admitted to the home by a member of the care staff who verified the inspector’s identification. The appointed manager was on duty and the inspector spent time with her going through the inspection process, requirements from the last inspection, the standards being inspected at this inspection and records required to be kept. A tour of the buildings and gardens followed when staff, service users and relatives were spoken to and activities observed. As part of this inspection a falls survey was conducted. For the latter part of the inspection the inspector was joined by a regulation manager. The inspection concluded at 17:15 following feed back on the inspection findings to the acting manager. What the service does well: What has improved since the last inspection? All care plans are currently being rewritten as the format has changed to the corporate format of the parent company Southern Cross. Whilst doing this care plans are being reviewed and updated. Service users preferences during their final illness and after death are being recorded as a care [plan in the new format. A coffee morning and cheese and wine evening are being organised to offer service users and their families the opportunity to share in and understand the care planning process. Redecoration of the home is underway and all areas will be refurbished and redecorated. The approach to the house has been cleared of overgrown shrubs and bushes and now gives a clear outlook to the road. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 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 Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 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): 1, 2, 3, 4, 6 Service users and their representatives know what the terms and conditions of residence are. All service users are assured that their care needs can be met before moving into the home. Strathmore house does not offer intermediate care. Service users do not have current information prior to moving into the home. EVIDENCE: All service users have a clear statement of terms and conditions of residence in addition to any care contract issued by the funding authority. All service users have a needs led assessment carried out by a senior member of staff. The result of this assessment forms the basis of the plan of care. However the acting manager was unable to confirm that a letter is routinely sent to each prospective service user as stated in regulation 14 (1(d)) of the Care Homes regulations 2001. There is not an up to date statement of purpose and service user guide available to current or prospective service users. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 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, 9, 10, 11 Service users health and personal care needs are met with respect and dignity and policies and procedures are in place to ensure that all care is appropriately delivered. EVIDENCE: Care plans are currently under review and being rewritten to transfer them to the parent Company format. They are reviewed at least monthly and more regularly as required. Service users are registered with a local surgery of their choice and access to other medical input such as dentist and opticians are arranged. Policies and procedures are in place for the care and administration of medication. The acting manager was advised to ensure the name of the dispensing pharmacist was entered in the controlled drug record book. Senior staff are currently undertaking a distance learning programme in the custody and administration of medication. The acting manager does a monthly audit of medication records plus spot checks in between. The inspector reviewed a sample of medication record sheets and found them to be appropriately kept. All nursing and personal care is done in the privacy of individual rooms or the bathroom and screens are used in share rooms. The activities co-ordinator assists service users with their personal mail if needed. Service users preferences for their final illness and after death are recorded. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 10 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, 15 Service users are able to lead as full a lifestyle as their frailty will allow and their choices and wishes are considered at all times. Service users have a choice of meals from a menu presenting a well balanced diet. EVIDENCE: Routines of daily living are flexible to each individual. An activities organiser plans activities according to the preferences of the service users and gives individual attention to those unable to participate in group activities. Those living in Jasmine wing have activities planned according to their needs and are also able to join in the activities of the main house if appropriate. Relatives and friends are able to visit as they wish and service users are able to go out and about if their frailty will allow. Service users are able to exercise choice over their daily lives and service users spoken to over the course of the day. confirmed this. Service users are able to select meals from a menu choice. However it should be noted that the inspector was concerned to note that the last meal of the day was being served in the dining room at 4pm. From that time until 8 am the following morning apart from a hot drink and biscuits there is a gap of 15 hours. National minimum standard 15.2&3 clearly states that the gap between meals should not exceed 5 hours and the interval between the evening meal and breakfast should not exceed 12 hours. The registered person must urgently review the meal times and if a gap of 15 hours is not avoidable then service users should be offered something more substantial than a drink and biscuits during the evening. One service user stated she took extra sandwiches from tea to eat in the evening. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 11 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, 17, 18 Service users, their family and friends are confident their views will be listened to and that the service users are protected from abuse. However the complaint procedure needs to be enhanced to include minor complaints. EVIDENCE: There is a clear complaint procedure displayed in the entrance hall that informs service users and their representatives on how to make a complaint. However there is no method of recording and reviewing anything other than formal complaints. The inspector and the manager discussed the need to record concerns raised verbally to the care staff and how the ensure they were recorded and responded to appropriately, and the need to involve all staff in training on how to respond to complaints. Service users are enable to vote in elections and will be supported in contacting legal representatives. Staff have had training in service user welfare and all staff will have training in Protection of Vulnerable Adults over the coming months. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 12 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, 24, 25, 26 Service users live in a clean environment with appropriate facilities, adaptations and equipment to meet their needs. However some attention is needed to several areas of the home internally and externally to ensure the home is safe and well maintained EVIDENCE: The home was clean and fresh throughout. General tidying of the gardens is underway but urgent attention is needed to the garden areas to be used by the service users in the summer. The ramp from Jasmine wing to the garden is a hazard and has been identified as such for over a year. Any further delay will result in legal action being taken. The doormat well in snowdrop cottage presents a hazard. This also has been identified previously but no action has been taken to rectify it. The carpet in the dining room is unacceptably stained. Some furniture around the home was noted to be damaged and shabby. The inspector noted dips in flooring in some areas that could present a tripping hazard. The radiator covers are inadequate to protect service users from burns with exposed hot pipe-work and the metal covers not reaching the bottom of the radiators so if a service user fell they would be at risk of burns on the hot metal. A fire exit door from a room on the first floor has daylight showing Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 13 around it when fully closed. Another fire exit door was blocked by service users furniture. The bedrooms that have been redecorated have been done to a high standard. There are no locks on service users doors denying the choice to lock their doors. The home has bathrooms that are not in use due to the layout and the acting manager hopes to adapt one to a shower room and one to a clinical room. The registered person must ensure that sufficient bathrooms remain to meet the minimum standards. The home has more than adequate moving and handling equipment and any aid and adaptations are provided as required. The flat roof access to the fire escape on the first floor is covered in moss and may present a hazard. The whole home is in need of a general audit of furniture, fixtures and bed linen. Also there should be health and safety risk assessments of the whole home both internal and external, with attention paid to fire exits from the first floor and the implications of door locks on bedrooms where there is a fire exit. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 14 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, 30 A good skill mix and number of staff with appropriate qualifications care for all client groups are in place. Recruitment methods and training ensures the service users are kept safe and well cared for EVIDENCE: The home has an adequate staff team with qualified nurses, senior carers, carers, domestic and laundry staff. They are supported by an activity organiser and an administrator. Jasmine unit offers dementia care and has a unit manager who has specific training in dementia care. 10 care staff have NVQ level 2 or above in care and 5 are working toward it. All recruitment follows a policy to ensure that only appropriate people are employed and pre employment checks are rigorous. All staff have an enhanced criminal record bureau check and a protection of vulnerable adults register check. Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 15 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, 34, 35, 36, 37, 38 Service users live in a home that is managed by someone fit for the purpose Not all records are kept in line with regulations. More regard must be paid to health and safety and the monitoring and supervision of staff. Quality assurance monitoring is not currently in place EVIDENCE: There is an appointed manager who has not yet applied to be registered with the CSCI. The acting manager is approachable and known to the staff and service users. The acting manager states that a quality assurances programme is almost ready but has not been used yet. However relative and resident meeting do take place to gain the views of the service users. The acting manager has a budget to work to and has the support of an administrator and an area manager for this. The administrator has responsibility for any service users money managed by the home and all appropriate records are kept and regular checks made. Regular staff supervision is not taking place although it is Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 16 planned. However on the day of inspection there were no supervision records in place and the home was not meeting the NMS 36. There is no current statement of purpose or service user guide and the health and safety records are not up to date and those prior to April 2006 were not available. There are contracts in place for the maintenance and monitoring of fire safety equipment. There has been no recent hot water monitoring. The maintenance person is new in post and did not appear to have had the training to enable him to do his job. Strathmore House DS0000066352.V288373.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 1 3 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 1 3 2 3 X 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 1 3 3 1 2 1 Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? yes 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 OP1 Regulation 4,5,6 Schedule 1&4 Requirement Timescale for action 10/06/06 2. OP3 14(1(d)) 3 OP15 16(2(i)) 4 OP16 22 Schedule 4(11) The registered person must ensure there is an up to date statement of purpose and service user guide available to all service users and prospective service users The registered person must 10/05/06 ensure a letter is sent to all prospective service users stating the home is able to meet their needs prior to them moving into the home. The registered person must 10/05/06 review the times and content of meals to ensure they meet NMS 15 A method of recording and 01/05/06 investigating minor and verbal complaints must be established to ensure all complaints are acted on. Staff must all be aware of this method and ensure all complaints are recorded appropriately This requirement is outstanding from the previous report and the date of 30/12/05 has not been met. Any further delay in meeting this requirement DS0000066352.V288373.R01.S.doc Version 5.1 Strathmore House Page 19 may result in regulatory action being taken. 4. 5. OP19 OP20 23(2(b)) 23(2(b)) All areas of the home must be well maintained and decorated The gardens must be maintained and kept safe and accessible to all service users. The gardens must be accessible to service users before Summer 2006 with safe ramps to access the garden. This is outstanding from the last 2 inspections with a completion date of 30th July 2005 not being met and a date of 01/05/06 being the date given at the last inspection. Failure to meet this date will result in regulatory action being taken. All service users must be able to lock their doors from both within and out if they wish to. The Registered person must provide a programme of action to the CSCI to demonstrate this is in hand. This requirement is outstanding from the last inspection with a date of 30/01/06 not being met. Any further delay will result in regulatory action being taken The appointed manager must submit an application to register with the CSCI The registered person must provide the CSCI with a copy of the quality assurance programme and the latest report. This is outstanding from the last inspection with a requirement date of 30/01/06 not being met. Any further delay will result in DS0000066352.V288373.R01.S.doc 30/12/06 01/05/06 6. OP24 23(2(e)) 10/05/06 7 8 OP31 OP33 8 24 30/05/06 30/05/06 Strathmore House Version 5.1 Page 20 9 10 11 OP36 OP37 OP38 18(2) 17 Schedules 3&4 13(4) 11 OP38 24 regulatory action being taken The registered person must ensure that all staff are appropriately supervised The registered person must ensure that all records are kept as required The registered person must ensure that all health and safety checks are carried out and recorded and that all relevant legislation is met with specific attention to NMS 38.3 5 6 8 & 9 The registered person will notify the CSCI how they intend to meet these requirements 30/05/06 30/05/06 30/05/06 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Strathmore House DS0000066352.V288373.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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