Inspection on 22/04/08 for Stratton House [Burnham-on-Sea]

This inspection was carried out on 22nd April 2008.

CSCI found this care home to be providing an Poor service.

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

Stratton House [Burnham-on-Sea] 14/12/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Stratton House 15 Rectory Road Burnham-on-Sea Somerset TA8 2BZ Lead Inspector Jane Poole Unannounced Inspection 22nd April 2008 9:45 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 Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stratton House Address 15 Rectory Road Burnham-on-Sea Somerset TA8 2BZ 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) 01278 787735 Angels (Stratton House) Ltd ****Post Vacant**** Care Home 24 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (24) of places Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 24. 14th December 2007 2. Date of last key inspection Brief Description of the Service: Stratton House is a large and extended detached property, which is situated in a pleasant residential area not far from the town of Burnham-on-Sea and the sea front. The home is owned by Angels (Stratton House) Ltd. The responsible individual in Mr M Pattani. The home does not currently have a registered manager. The home is registered with the Commission to provide personal care only to a maximum of 24 people who require care by means of old age or dementia. The home is not registered to provide nursing care. The Commission was provided with the following information about the home’s fee range and charges. Fees are between £390 & £450 per week. Extra charges are met by service users for hairdressing, personal toiletries, chiropody, newspapers, private opticians/dentist. Full details can be found in the home’s brochure. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Since the last key inspection the Commission for Social Care Inspection has met with the owner and acting manager and carried out a random inspection. This inspection was carried out by two inspectors over a one day period. The inspectors were able to meet with people living and working at the home, tour the building, observe care practices and view records. There is no registered manager for the home but an acting manager is in place who was available throughout the day. Prior to this inspection one completed questionnaire was received from a member of staff and one from a relative of someone living at the home. At the time of the inspection there were 21 people living at the home, one of whom was in hospital. The following is a brief summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Staff observed on the day of the inspection were well motivated and cheerful in their roles. Staff spoke to, and assisted, people in a kind and polite manner. People who move into the home are able to bring personal possessions with them and this gives many rooms an individual and homely feel. Communal areas seen were clean and adequately furnished and decorated. Visitors are welcome at the home at anytime to enable people to keep in touch with friends and family. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 6 Medication is well managed and ensures the safety of people living at the home. What has improved since the last inspection? What they could do better: 8 requirements remain outstanding from the inspection carried out in December 2007. Although the home is registered to provide care to people who have a dementia staff have not received ongoing, up to date, training in this area and many have received no training at all. This means that the staff group, Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 7 although enthusiastic and kind, do not have the skills needed to provide high quality appropriate care. Staff have still not received training in health and safety issues such as moving and handling. The environment has not been adapted to encourage people to maintain independence or enable them to orientate themselves. A requirement made that signage be put in place by the end of January 2008 has not been complied with and there continues to be no appropriate signage to assist people to move around the building. At this inspection it was concerning that although there had been improvements in care plan documentation it was evident that these were not always being followed. People were not receiving appropriate support with some aspects of personal care. The inspectors observed the main meal of the day which was very chaotic. It did not encourage people to eat a nutritious diet and in some instances compromised the dignity of people. Recording of nutrition and weights is poor which potentially places people at risk. The home need to involve outside professionals in the assessment of people who have complex healthcare needs to ensure that they receive appropriate care. Issues around recruitment records were again highlighted at this inspection and immediate requirements were issued to ensure that no one was working in the home without having appropriate checks in place. The home has no formal quality assurance measures in place that involve seeking the views of people living or visiting the home. This does not allow the registered person to plan ongoing improvements in line with the wishes of people who use the service. 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. The summary of this inspection report can be made available in other formats on request. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4 & 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who have a dementia can not be certain that the home will be able to meet their needs due to a lack of staff training in this area. The statement of purpose gives misleading information about the skills and qualifications of the staff who work at the home. Intermediate care is not provided. EVIDENCE: The home has a Statement of purpose, and a copy was given to the inspectors at this inspection. The statement of purpose states that people are encouraged to visit the home before deciding to move in. The first month of a persons stay is a trial period to allow the home to make sure that they are able to meet the Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 10 persons needs and to ensure that it meets the expectations of the person hoping to make it their home. No one has moved into the home since the last inspection, however the acting manager states that they would assess anyone prior to offering a placement. Some information in the statement of purpose, about the training of staff needs to be amended to ensure that it gives an accurate picture of the staff skills and qualifications. The home is registered to care for people who have a dementia, however many staff working at the home have not received training in dementia care. Some staff spoken to at this, and the random inspection carried out in February, stated that they felt they would benefit from training and guidance in this area. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are comprehensive but are not being followed by staff to ensure people receive appropriate care and support. People’s physical and mental healthcare needs are not being fully met. EVIDENCE: During the inspection the inspectors viewed 6 care plans. All contained personal profiles that gave good information about the individual and their likes, dislikes and lifestyle. The care plans have improved since the last inspection and now give much more comprehensive information to enable staff to assist people in their chosen manner. It was apparent that staff were not always following care plans when they assisted people living at the home. For example one care plan stated that the person required ‘prompting with oral Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 12 hygiene’, another said ‘staff to assist to brush teeth am and pm’ In both cases toothbrushes seen in bedrooms were hard and had obviously not been used for some days. Particularly concerning was the fact that staff did not appear to be following care plans in respect of diet and nutrition. Two care plans seen stated people were at high risk and needed to be weighed on a weekly basis. Neither of these people had been weighed for eleven weeks. One persons care plan, which gave the expected goal as ‘ensure a good diet and stable weight’ had been reviewed and no changes made even though the person had not been weighed and therefore there was no way of telling whether the expected goal had been achieved. Two people had been prescribed nutritional supplements with the instructions ‘to be given as directed.’ There was no information in care plans to state how often these should be given. People living at the home are registered with local GPs and have access to District Nurses and Community Psychiatric Nurses in line with their individual needs. The chiropodist visits the home on a regular basis. Two people living at the home have complex healthcare needs and the home needs to ensure that their needs are reassessed by professionals outside the home to ensure the placement remains suitable. Some people are having their fluid and food intake monitored by staff. The inspectors looked at these charts for two people. Recording was inconsistent. There was no information to indicate what quantities the person was expected to consume and therefore no instructions for what to do if this level was not met. Daily totals were not totalled and could not be easily identified. Charts seen for one person indicated varying daily totals. On one day the only recorded fluid intake was between 8-9am and then nothing until between 9 & 10pm. Charts kept in respect of assisting people, who were at high risk of pressure damage, to change position were also inconsistent. The home uses a Monitored Dosage System for medication. Only senior staff, who have received specific training, administer medication. Medication Administration Records (MARs) were viewed and found to be correctly signed when received into the home and when administered or refused. The controlled drugs register was viewed and records kept correlated with stocks held. Some people are prescribed pain relief on an ‘as required’ basis. There are no protocols in place to indicate when these should be given or how to recognise when people, who may be unable to express themselves verbally, are in pain or discomfort. Throughout the day staff were seen to interact with people living at the home in a pleasant and polite manner. Some issues regarding privacy and dignity were raised with the acting manager during the inspection. At lunchtime some people were assisted to put on blue plastic aprons, which did not promote Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 13 dignity. One bathroom door does not close properly, meaning that peoples privacy is not fully respected. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The busy atmosphere in the dining room does not provide a relaxed environment or encourage people to eat a nutritious diet. Visitors are welcome at the home at all reasonable times. Some people living at the home have limited choices about the food they eat, the time they get up or the items that they are able to buy. EVIDENCE: Staff stated that there are no strict routines in the home and people are able to choose how they spend their time. It was observed that, due to their dementia, many people living at the home were unable to occupy their time or initiate social interaction without staff support. Staff were observed to interact in a kindly manner but not all staff have the skills or experience to provide appropriate social stimulation for the people living at the home. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 15 Staff and people living at the home said that they are able to have visitors at anytime and some people go out with friends and family. Daily records showed that one person was assisted to get washed and dressed at between 5.20 and 5.40am on five separate occasions. There was no evidence that this was the persons’ choice. Since the last inspection the home have employed a dedicated activities worker who is available in the home for 8 hours a week. The inspectors were able to speak with the activities worker who stated that they spend time undertaking group activities and with individuals on a one to one basis. The activities worker has no previous experience of working with people who have a dementia but is enthusiastic about their role and keen to undertake training courses and make contacts with appropriate people. One lounge in the home has become an activities room and there are various games, puzzles and videos available. There is an activities programme on the wall and some outside entertainers have been booked for the coming months. The provider acts as a financial appointee for one person living at the home, records in relation to this were not inspected on this occasion. The home does not hold money for anyone else living at the home. This means that the majority of people do not have regular access to money so are unable to make purchases which would allow them to make choices. People are able to bring personal possessions and small items of furniture with them when they move to the home. Rooms seen had been personalised to reflect their occupant. The main meal of the day is at lunchtime and there is a choice at each course. The inspectors observed the lunchtime experience. People were shown a choice of meal and asked to choose which one they wanted. Meals were plated meaning that people were not able to choose which vegetables they wanted and there were no sauces or condiments on the tables. People were given a choice of cold drinks but these were not available on tables for people to help themselves to. The mealtime was chaotic; everyone sitting on the same table were not served at the same time and staff were coming and going. This distracted many people from their meal meaning that they ate very little. The main meal was served on a side plate rather than a dinner plate and portions appeared small. No second helpings were offered. Two people were physically assisted to eat by staff. The staff began assisting people then left to undertake another task elsewhere making the meal very disjointed for the people receiving help. At one point one carer was assisting two people at opposite ends of the table. The care plan for one person, which had been reviewed the day before the inspection, stated that they needed Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 16 ‘discreet supervision with meals.’ This person was being physically assisted in an indiscreet manner. As previously stated personal weights are not regularly recorded in line with the needs identified in care plans and the recording of food and fluid for those at risk is inconsistent. In the main lounge there was a jug of cold drink but there were no cups or glasses so people could not help themselves. The menu is not displayed in the home. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home have unrestricted access to indoor communal areas and their personal rooms. Recruitment practices do not adequately protect people. EVIDENCE: The home has policies and procedures in recognising and reporting abuse, making a complaint and whistle blowing. The complaints procedure is now displayed in the entrance hall. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. People living at the home moved freely around the inside of the home and had unrestricted access to their personal rooms. The main garden of the home is at the front of the house and the front door is kept locked. This means that people living at the home have no unrestricted access to any outdoor space. The acting manager stated that they are currently looking at ways to make the garden safe so that people are able to access it without restriction. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 18 All staff have received training in the protection of vulnerable adults and are due to undertake training in the Mental Capacity Act and its implications for practice. No new staff have been employed since the last inspection but the inspectors viewed recruitment records of three current members of staff. One file did not contain evidence of a Criminal Records Bureau check or any indication that the person had been checked against the Protection Of Vulnerable Adults register. This potentially places people at risk of abuse. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment has not been adapted to meet the needs of the people who live at the home. Improvements are needed in communal bathrooms, toilets and the laundry to reduce the risk of the spread of infection. Bedrooms have been personalised to reflect the personalities of their occupants EVIDENCE: Stratton House is a large older style house set in a quiet residential area of Burnham on Sea. Accommodation is spread over two floors with a passenger Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 20 lift between. Seven bedrooms can only be accessed by steps meaning that people need to be physically mobile to occupy these rooms. Since the last inspection a maintenance person has been employed on a part time basis. There are two lounges and a dining room on the ground floor, these rooms are decorated and furnished to an acceptable standard. People living at the home do not have unrestricted access to any outside space. Some adaptations such as grab rails and assisted bathing facilities have been put in place but the environment has not been adapted to take account of the needs of people who have a dementia. A requirement of the last key inspection was to ensure that signage was in place to assist people to find their way around the home. The date for compliance was the 31/01/08 but no signs had been put in place at the time of this inspection. Carpets throughout the home are heavily patterned and wallpaper is very busy, which can be disorientating for people who have a dementia. One member of staff stated that some people living at the home find the carpet very confusing to walk on. There are no points of reference around the home and all doors are the same colour with no pictorial signs. The inspectors viewed a large sample of bedrooms and noted that people had been able to personalise their rooms with pictures and ornaments. Many of the bedrooms would benefit from refurbishment, wallpaper was coming away from walls in some areas and paintwork was chipped. Bed-linen was tired looking and in some cases duvet covers and pillow-cases did not match meaning that beds did not always look comfortable and inviting. There are two bathrooms for communal use on the first floor and a shower room on the ground floor. In one bathroom the door did not close properly meaning that peoples privacy could not be protected. The sealant around the bath was split and some ceramic tiles were missing which has implications for infection control. This bathroom is also used as the hairdressing room and there was little room to assist anyone to access the bath. In the other bathroom things were being stored in front of the wash hand basin so that anyone using the toilet would be unable to access the sink to wash their hands. In the communal toilet on the first floor there was no floor covering and wallpaper was peeling from the walls. There are no assisted bathing facilities on the ground floor. The laundry was in a poor state of repair. Tiles were missing from the wall and floor and this has implications for the control of infection. The acting manager stated that they are awaiting a builder to refurbish the laundry area completely. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 21 Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have not been appropriately trained in meeting the needs of people who have a dementia. Recruitment files do not give evidence of a thorough and robust recruitment procedure. EVIDENCE: The home employs 20 care staff, 10 (50 ) have a National Vocational Qualification in care at level 2 or above. 9 ancillary staff are also employed. The acting manager gave copies of duty rotas to the inspectors and these show that there are 4 care staff on duty each morning and 3 each afternoon. Overnight there are two waking night staff. Staff spoken to felt that staffing levels were adequate. There is always a senior carer on duty throughout the day. Training records given to the inspectors show that many staff have not received up to date training in health and safety issues such as moving and handling, food hygiene and 1st aid. Staff spoken to confirmed this to be the case. The home is registered to provide care to people who require care due to Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 23 old age or old age and dementia. Currently 18 of the 20 people living at the home have a dementia but staff have received very little training in this area. Training records show that staff who have worked at the home for some time did receive training in dementia care in 2006. A dementia awareness training day is booked for next month. As people living at the home have specialist needs this training needs to be ongoing to ensure that all staff have a good understanding of how to care for people with a dementia and are up to date with current best practice. Staff spoken to at this, and the random inspection, felt that they would benefit from training in issues relating to dementia. One relative/carer who completed a questionnaire prior to the inspection raised concerns about staff training and knowledge in relation to dementia. The homes improvement plan states that all new staff undertake a comprehensive induction programme. Records of this were not viewed at this inspection. No new staff have been employed since the last inspection but the inspectors viewed recruitment records of three current members of staff. One file did not contain evidence of a Criminal Records Bureau check or any indication that the person had been checked against the Protection Of Vulnerable Adults register. This potentially places people at risk of abuse. The provider must audit all recruitment files to ensure that appropriate documentation is in place. Since the last inspection the job application form for the home has been up dated and now includes more space for employment history and a medical questionnaire. Staff observed and spoken with interacted in a kind and friendly manner. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is currently no registered manager at the home. There are no formal systems in place to audit the quality of care in the home or seek the views of interested parties. EVIDENCE: The home has not had a registered manager in post for over six months. There is currently an acting manager in place. The acting manager has limited experience of working with people who have a dementia and is therefore unable to offer good leadership and direction in this area. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 25 The acting manager stated that the provider visits the home on a regular basis but records of these visits and any recommendations made were not available although a requirement was made at the last inspection for these records to be available. There are no formal quality assurance measures in place and no surveys to seek the views of interested parties have been sent out since the last inspection. Staff stated that meetings are taking place in the home. There was no evidence of meetings being held with people who live at the home or their representatives. A fire risk assessment is in place and alarms are tested weekly. There were no records of emergency lighting being tested but the acting manager gave assurances that this was carried out when alarms were tested. The inspectors were unable to identify which members of staff had received fire safety training, as records were not available. The acting manager gave assurances that fire safety training was booked for next month (may 08) Hot water outlets in communal bathrooms were tested and found to be within the recommended limits. All lifting equipment was last tested by outside contractors in November 2007. Portable electrical appliances were tested in October 2007. Staff training records show that staff have not received up to date training in health and safety issues such as moving and handling, food hygiene, infection control and first aid. Staff spoken to confirmed that they had not received this training for some time. Up to date certificates of registration and insurance are displayed in the home. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 x x 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 1 x 2 x 1 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x x x x 2 Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 27 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 OP12 Regulation 12(4)(b) & 16(2)(n) Requirement Timescale for action The registered person must 30/05/08 ensure that service users are offered a regular and appropriate programme of activities which takes into account their preferences and ability. Special attention must be given to the ability of service users with dementia. (Previous compliance date of 01/02/08 not met.) The registered person must ensure that all parts of the home are kept in a good state of repair and reasonably decorated. A copy of the home’s planned maintenance and redecoration programme must be forwarded to the Commission by the given date. (Previous compliance date of 14/01/08 not met.) The refurbishment programme must include dates. The registered person must take appropriate steps to ensure that the home is suitable to meet the needs of service users as stated DS0000070059.V361934.R01.S.doc 2 OP19 23(2)(b) & (d) 30/05/08 3 OP22 12(1)(a) & 23(1)(a) & 30/05/08 Stratton House Version 5.2 Page 28 23(2)(a) in the Statement of Purpose. This relates to ensuring that signage is available and appropriate for service users with dementia. (Previous compliance date of 31/01/08 not met.) To reduce the risk of the spread 01/08/08 of infection, the registered person must ensure that the wall and floor tiles in the laundry area are replaced. (Previous compliance date of 14/01/08 not met.) The registered person must make suitable arrangements to ensure that staff have the skills and competence to meet the needs of service users at the home. This relates to the training of staff in dementia care. (Previous compliance date of 29/02/08 not met.) The registered person must not allow a person to work at the home unless all required information identified in this regulation has been received and deemed satisfactory. This is with immediate effect for future staff employed and by the given date for the staff member identified. (Previous compliance date of 24/12/07 not met.) IMMEDIATE REQUIREMENT ISSUED 30/05/08 4 OP26 13(3) 5 OP27 OP30 18(1)(a) & (c) (i) 6 OP29 13(6) & 19 & Schedule 2 22/04/08 7 OP33 26 The registered person is required 30/04/08 to conduct monthly unannounced visits to the home in accordance with this regulation and to prepare a written report to be DS0000070059.V361934.R01.S.doc Version 5.2 Page 29 Stratton House maintained at the home and made available to the Commission on request. (Previous compliance date of 31/12/07 not met.) 8 OP38 12(1), 13(4), 13(5) & 24(d) & (e) The registered person must provide the Commission with a training matrix which confirms that all staff have received appropriate and up to date training in moving and handling and fire safety. (Previous compliance date of 14/01/08 not met.) The registered person must ensure that the statement of purpose accurately reflects the skills and qualifications of the staff team. A copy must be forwarded to the CSCI. The registered person must ensure that staff follow care plans when providing care to people living at the home. The registered person must ensure that people living at the home have their healthcare needs assessed and met. The registered person must ensure that peoples privacy and dignity is respected. The registered person must ensure that people living in the home are assisted to make choices and such choices are respected. This includes times for getting up and going to bed. The registered person must ensure that everyone living at the home receives adequate quantities of suitable, wholesome and nutritious food. To minimise the risk of the spread of infection the registered person must ensure that bathrooms and toilets are DS0000070059.V361934.R01.S.doc 16/05/08 9 OP1 4 (1) [c] 30/05/08 10 OP7 12(1) [a][b] 15 (1) 12 (1) 14(1) 12 (4) [a] 12 (2) (3) 30/04/08 11 OP8 30/04/08 12 13 OP10 OP14 22/04/08 30/05/08 14 OP15 16 (2) [I] 12 (1) [a] 22/04/08 15 OP21 13 (3) 16 (2) [j] 30/07/08 Stratton House Version 5.2 Page 30 16 OP29 OP18 19 (1) 17 OP31 9 (2) [b] 18 OP33 24 (1) (3) maintained to a satisfactory standard. The registered person must audit 22/04/08 all staff files to ensure that satisfactory checks are in place for all staff working at the home. IMMEDIATE REQUIREMENT ISSUED The registered person must 30/06/08 appoint a person to manage the home who has the skills and experience to meet the needs of the people living at the home. The manager must apply to be registered with CSCI. The registered person must 30/05/08 ensure that there are quality assurance measures in place which involve seeking the views of people living at the home and other interested stakeholders. 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 2 Refer to Standard OP8 OP15 Good Practice Recommendations To ensure the health & well-being of service users, service users weights should be recorded at least monthly. Recommendation made at last inspection. The registered person should as appropriate, consider the use of serving dishes at meal times. Condiments and jugs of drinks should be made available at meal times and staff should ensure that that assist service users to eat in an appropriate manner. Recommendation made at last inspection. It is strongly recommended the home ensures that disposable gloves, aprons and plastic bags are securely stored away from service users, given the possible risk to the high number of service users with dementia. Recommendation made at last inspection. 3 OP38 Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 31 4 5 6 OP9 OP18 OP20 OP24 It is recommended that individual protocols are in place for the use of ‘as required’ medication. All people living at the home should have unrestricted access to safe outside space. Worn bed linen should be replaced. Stratton House DS0000070059.V361934.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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