Inspection on 10/01/07 for Stuart House

This inspection was carried out on 10th January 2007.

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

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

Other inspections for this house

Stuart House 05/01/06

Stuart House 05/07/05

Stuart House 11/02/05

Stuart House 14/09/04

Stuart House 19/01/04

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 Stuart House 149 London Road St Albans Hertfordshire AL1 1TA Lead Inspector Mrs Judith Kent Unannounced Inspection 10th January 2007 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 Stuart House DS0000019558.V327000.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. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stuart House Address 149 London Road St Albans Hertfordshire AL1 1TA 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) 01727 858200 01727 851143 Caremore Limited Pearl Agard-Smith Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Stuart House is a large residential house which has been converted and extended to provide residential care for up to thirty-nine people. The accommodation is offered in thirty-seven single occupancy rooms and one room which could accommodate a married couple or two people sharing, should they choose to do so. There are several lounges and small sitting areas, a conservatory and two dining rooms. The house is set in large well-maintained gardens and is on a main bus route into St Albans. The mainline train station is nearby. Fees at the home are from £400.00 - £640.00 per week Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over almost seven hours during the day and involved talking to service users both singly and in small groups, looking round the home and talking to staff, looking at records and care plans and discussion with the manager and proprietor. All the service users spoken with said that they were content living in the home and were very pleased with the service that the staff provided. They spoke warmly about the staff group. One relative spoken with, whose parent had been in the home for five years, said that they never had any concerns about the care in the home. What the service does well: What has improved since the last inspection? What they could do better: The pre-admission assessments, risk assessments and care plans for some people have not been completed and do not hold full information about them. Reviews have not always been carried out in accordance with the standards. Medication administration and records are not maintained accurately. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 6 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. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 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 Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Full assessments of each person’s care needs are not always completed and lack of information could lead to inappropriate care plans being developed or people not receiving the level of care they need. EVIDENCE: Pre-admission assessments for several service users were looked at, and while the new format is detailed and comprehensive there were some gaps in the completion of the information. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that service users have access to appropriate health care services, but medication procedures and practice in the home could lead to people being put at risk. Care plans and risk assessments do not always reflect service users’ current care needs. EVIDENCE: Service users’ health care records show that there are consultations with opticians, dentists and chiropodists as well as visits by GPs and district nurses when needed. There was some concern over the medication records and procedures which were looked at during the inspection - there were errors in recording administration and there were some discrepancies between records and the quantity of tablets left in the medication trolley. The need for an effective audit was discussed with the manager at the end of the inspection. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 10 Several care plans were seen at the inspection, and while the assessment and care plan format asks for full information about each person, there were gaps in the information recorded, mainly relating to risk assessments, life and leisure plans and social activities. Monthly reviews had not been completed in some cases. Service users had not signed agreement with their care plan and it was difficult to identify when they had been written as dates were not all recorded. Other information, such as records of service users weight, was intermittently recorded and seemed to have stopped around October last year. However, there were some examples of good report writing in the daily notes for each service user. Service users who spoke with the inspector said that they were confident that the staff team had their best interests at heart and that they felt secure and well-treated in the home. One staff member demonstrated her understanding of service users’ needs and said that she asked herself ‘How would I want to be looked after?’ Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a range of activities available for service users to take part in, which help to maintain old interests or encourage new ones. Service users benefit from a nutritious and balanced diet, which contributes to their overall health. EVIDENCE: The home employs an organiser who arranges a programme offering a wide variety of activities including gentle exercise with music, crafts, table games, outings to the local theatre, shopping trips and visiting entertainers. Service users who spoke to the inspector felt that there was a sufficient range of activities for those people who wanted to join in, although many were happy to spend time in their rooms or in the lounge areas. The exercise group which was taking place on the morning of the inspection was well-attended and time was given to each person by the organiser. Many service users received visitors on the day of the inspection and others said that they are able to welcome family and friends at any time and that they enjoyed outings with their families. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 12 Service users were generally very enthusiastic about the catering in the home; the chef offers a varied menu and uses fresh produce, including plenty of fruit for those who want it. While there is no formal alternative to the main meal of the day, the chef knows each person’s particular likes and dislikes and caters accordingly. However, one person with particular dietary needs said that they sometimes felt that their diet was rather repetitive and not very varied, and this was discussed with the manager at the end of the inspection, when she also said that consideration was being given to more variety at teatime. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s procedures protect service users from abuse; concerns are listened to and action is taken to resolve them. Complaints would be dealt with appropriately. EVIDENCE: The home has a complaints procedure in place, but there have been no recorded complaints since the last inspection. There is a copy of the Hertfordshire County Council Adult protection handbook in the home and staff members confirmed that they were aware of this and the home’s own whistle-blowing procedure. The manager reported that further training in adult protection had been booked for the whole staff group. Service users said that they would be confident in taking any concerns to the manager and that they would be dealt with. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers comfortable, clean, well-maintained accommodation. EVIDENCE: There is a rolling refurbishment programme which makes sure that the home is in excellent decorative order and well-maintained. The communal areas – lounges and dining rooms – are comfortably furnished and service users individual rooms are personalised with their own small items of furniture, photographs and pictures. One person was especially pleased that the room had been re-decorated to their own personal taste after they came to the home. The home is kept very clean and there are no unpleasant odours. The garden is extensive and accessible and service users said how much they enjoy using it in good weather. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are given training to ensure that they can meet service users’ varying needs. Service users can be confident that security checks are carried out by the home before staff are appointed. EVIDENCE: The home has at least 50 of the staff group trained to National Vocational Qualification (NVQ) Level 2 and two people are taking or have achieved NVQ Level 3 in Care. The manager is currently developing the home’s induction training to meet the Skills for Care standards and there is an ongoing programme of training, including adult protection, for all staff. There is little use of agency staff at the home, due to the low staff turnover; service users and staff all benefit from being able to establish ongoing relationships. Recruitment records for some newer staff members were looked at and seen to be in order, although the need to verify previous employment records and references was discussed with the manager. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and staff are supported by the manager who offers firm leadership in the home. The health and safety of both groups is safeguarded by the home’s practices. The home is at present unable to show clear evidence that service users are consulted about the care they receive. EVIDENCE: Although there is continuous informal consultation with service users about the service they receive, a full quality assurance system is not in yet place. The manager is currently developing a system based on the requirements of the National Minimum Standards and expects to implement it within the next few months. Service users, their relatives and other interested parties, such as Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 17 health care professionals, will be asked to complete satisfaction surveys twice annually and the resulting findings will be made available to interested parties. The arrangements for looking after service users’ money were looked at and several balances were checked – all were found to be correct. Staff members who spoke with the inspector said that while there had been initial uncertainty after the change of manager almost two years ago, they feel well-supported by the current manager who offers firm leadership in the home. The home maintains health and safety records and those seen, including the fire risk assessment, equipment checks and fire drills were up to date. Testing of electrical equipment is completed annually and testing of water, fridge and freezer temperatures is carried out. Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 18 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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 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 3 x 2 x 3 x x 3 Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 19 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 OP3 Regulation 14(1) & Schedule 3 15 Requirement The registered person must ensure that a full assessment of need is completed before a service user is offered a place in the home The registered person must ensure that each service user has a detailed written care plan, including risk assessments, setting out how their health and welfare needs are to be met (This requirement is brought forward from the last inspection as it has not been met) The registered person must ensure that medication records are maintained correctly and that administration of medication is in accordance with medical practitioners’ instructions. The registered person must ensure that the system for reviewing the quality of care in the home is implemented. Timescale for action 10/01/07 2 OP7 31/03/07 3 OP9 13(2) 10/01/07 4 OP33 24 28/02/07 Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 20 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 Stuart House DS0000019558.V327000.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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