Inspection on 17/09/07 for Stuart House

This inspection was carried out on 17th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stuart House 21/09/06

Stuart House 07/02/06

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

CARE HOMES FOR OLDER PEOPLE Stuart House 10 - 14 Eastbourne Road Hornsea East Yorkshire HU18 1QS Lead Inspector Diane Wilkinson Key Unannounced Inspection 17th September 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 DS0000065228.V351176.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 DS0000065228.V351176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stuart House Address 10 - 14 Eastbourne Road Hornsea East Yorkshire HU18 1QS 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) 01964 534011 Ian Bernard James Margaret James Miss Johanne Thorley Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On completion of Phase 1 alterations to the premises and subject to confirmation by the CSCI that evidence of compliance with all necessary regulations and standards has been received, the service may provide accommodation for a maximum of 14 (fourteen) persons in the permitted registration categories. On completion of Phase 2 alterations to the premises and subject to confirmation by the CSCI that evidence of compliance with all necessary regulations and standards has been received, the service may provide care and accommodation for a maximum of 17 (seventeen) persons in the permitted registration categories. On completion of Phase 3 alterations to the premises and subject to confirmation by the CSCI that evidence of compliance with all necessary regulations and standards has been received, the service may provide care and accommodation for a maximum of 19 (nineteen) persons in the permitted registration categories. 21st September 2006 2. 3. Date of last inspection Brief Description of the Service: Stuart House is a privately owned care home that is situated in the seaside town of Hornsea. It is registered to provide care and accommodation for nineteen older people, including those with dementia. Information about the home is provided to service users and others in the home’s Statement of Purpose and Service User’s guide. Fees paid range from £334.00 to £384.00 per week and there is an additional charge for hairdressing and chiropody. On the day of the inspection there were 17 service users accommodated at the home. It is expected that occupancy levels will increase to 19 when the two remaining bedrooms are available for occupancy. Communal accommodation is provided in two lounges, a dining room and a conservatory. All private accommodation is provided in single bedrooms. The home is close to the centre of the town and the sea front, and shops and other local amenities are within easy reach. At the rear of the property, there is a landscaped garden that includes a patio area, flowerbeds and a raised pond. This provides a very safe area for service users to sit out in the fresh air or to take a walk. There is a small private car park at the rear of the premises. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last Key Inspection of the home on the 21st September 2006, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 9.55 am and ended at 4.20 pm. On the day of the site visit the inspector spoke on a one to one basis with four residents, two relatives, a senior carer and the registered manager. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered manager submitted information about the service in advance of the site visit by completing and returning an annual quality assurance assessment (AQAA). Survey forms were sent out prior to the inspection; five were returned from residents, four were returned by staff and four were returned by relatives. Comments from returned surveys and from discussions with residents, staff and others were mainly positive, for example, ‘There is a cheerful and welcoming atmosphere in the home. It seems clean and light and the residents seem comfortable and happy’ and ‘the staff are very kind and considerate’. Comments from surveys and from discussions on the day of the site visit will be included, anonymously, throughout the report. The inspector would like to thank residents, relatives, staff and the registered manager for their assistance on the day of the site visit, and to everyone who completed a survey. What the service does well: People are provided with clear and thorough information that assists them with their decision-making about admission to the home. People are only offered accommodation at the home if an assessment evidences that their needs can be met. Care planning at the home is good and people are involved in developing their own care plan via monthly one to one discussions that are recorded and signed. Meal provision at the home is good; people get a choice at every mealtime and mealtimes are a social occasion. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 6 People living at the home are supported to maintain their chosen lifestyle, and are encouraged to take part in activities inside and outside of the home. Visitors are made welcome. The home provides people with attractive, comfortable, well-furnished, welldecorated and clean accommodation. Staff recruitment policies and procedures are robust and this results in only staff that are suitable for the post being employed. There is an effective quality assurance system in place at the home that gives residents and others the opportunity to affect the way in which the home is operated. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Stuart House DS0000065228.V351176.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 DS0000065228.V351176.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): 1 and 3. Standard 6 was not assessed on this occasion, as there is no intermediate care provision at the home. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Thorough and up to date information is provided about the service to assist people to make a decision about admission. People are only offered accommodation at the home if an assessment evidences that their needs can be met. EVIDENCE: The registered provider recorded in the Annual Quality Assurance Assessment (AQAA) that the Statement of Purpose, the Service User’s Guide and the previous inspection report are now available on their website. The website also includes a section entitled ‘What People Say about Us’ that records comments from residents, relatives and others. The same information is also available at the home should people call in to make enquiries about the service they offer. This provides information to prospective residents and their family Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 9 about the service offered by the home and assists them in the decision making process. In addition to this, the registered manager informed the inspector that there is a copy of the Service User’s guide and the last inspection report in every bedroom. Records at the home evidence that people are visited by the registered manager when they initially make enquiries about admission, and that the assessment process commences at this stage. A full assessment of needs is completed and prospective residents are only offered accommodation at the home if this assessment evidences that their needs can be met by staff. Prospective residents and their relatives are invited to look around the home as part of the assessment process, and some people initially attend the home for day care or respite care to assist them in making a decision about permanency. The registered manager informed the inspector that they now contact the GP of a prospective resident to ensure that they have up to date medical information to include in the assessment process. The inspector observed in care plans that the initial assessment is not dated or signed; this could lead to confusion if the assessment is updated at any time, and does not evidence that the assessment process commenced prior to the person’s admission to the home. The registered provider has recorded in the AQAA that they propose to invite prospective residents to spend an afternoon at Stuart House prior to their admission to allow them to meet other residents and ‘feel the atmosphere of Stuart House’. Community care assessments and care plans are obtained from Social Services for anyone who is placed at the home by them, and this information is used along with the assessment undertaken by the home to develop an individual care plan. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people are met in a way that respects their privacy and dignity. Medication is not administered, recorded and stored safely and people are therefore not full protected from harm. EVIDENCE: The inspector examined three care plans; these included a copy of the home’s own assessment and a community care assessment and care plan undertaken by the local authority Social Services Department, where appropriate. Care records included a general risk assessment that covered all areas of personal care including some specific to individuals, such as use of the stair lift and use of a walking aid. However, these details were very brief and the inspector recommends that a thorough risk assessment should be undertaken for such areas as moving and handling, pressure care and nutrition. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 11 Personal profiles record quite specific information about a person’s individual care needs, such as ‘is able to wash and dress self but needs a few pointers and supervision when dressing’. People living at the home have a formal review of their care plan every year, and in house reviews are held every six months. Monthly in-house reviews also take place; these take the form of a one to one discussion with residents that are recorded on separate review sheets with headings ‘motivation’, ‘social needs’ and ‘physical needs’. An additional sheet records any comments or concerns expressed by the resident that month; this is good practice. A record is kept of all contact with health care professionals; these include the reason for the contact and any outcome. Continence care and pressure care are promoted at the home. A person’s individual needs regarding continence care and pressure care are recorded in assessments and care plans, and reviewed appropriately. Some residents have been provided with special pressure care equipment such as mattresses and cushions. Weight charts are used to monitor a person’s weight as part of nutritional screening. Medication is stored in a medication trolley and a cabinet in the dining room – both are securely attached to the wall. The cabinet is used to store surplus medication as well as controlled drugs. The registered manager was informed that separate storage is needed for controlled drugs, and that ideally, medication should be locked in a separate medication room or cupboard away from communal areas of the home. The registered provider contacted the CSCI the following day to inform us that work has already started on building a medication cupboard near to the manager’s office and that a controlled drugs cabinet has been ordered. Administration records for controlled drugs do not meet current guidelines, i.e. the date, time and two signatures are recorded but the number of tablets administered and the ‘running total’ are not recorded; advice was given to the registered manager about this. The inspector advised that disinfection or hand-washing facilities need to be provided for staff close to the medication cabinet or cupboard to promote infection control. Medication that requires refrigeration is stored in a separate labelled container in the fridge in the kitchen. The inspector advised that a separate lockable fridge should be purchased to enable medication to be stored securely; fridge temperatures would need to be taken daily and recorded. There are separate records of all medication that is held on the premises; one to record medication received and one to record the total amount of medication ‘in stock’. Unused medication is returned to the Pharmacist as required, and the Pharmacist signs the returns book. The inspector observed medication being administered at lunchtime – people were provided with a drink with which to take their medication, and all were observed by staff to ensure that they actually took their medication. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 12 Medication administered records were checked; there were occasional gaps in signing when residents refuse medication. Records should be checked by the manager on a regular basis to ensure that they are completed consistently. There were photographs for some residents but not for others; the registered manager informed the inspector that these photographs have already been taken and are ready to attach to medication administration records. The manager informed the inspector that the eight members of staff that are responsible for the administration of medication have undertaken accredited training; certificates to evidence this were stored at the front of the medication book. There were no sample signatures recorded to enable medication records to be checked. On the day of the site visit the inspector observed that staff treat people with respect and that their privacy is maintained as far as is possible; the inspector observed that people were assisted with eating their meals and with personal care in a sensitive manner, and people told the inspector that staff respect their privacy. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 13 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 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in activities both inside and outside of the home and are encouraged to maintain relationships with family and friends. Visitors to the home are made welcome and meal provision at the home is good. EVIDENCE: Care plans record details of a person’s previous lifestyle, including leisure and social interests. Daily diary notes record how a person has spent their day, including meals taken, visitors seen and any activities taken part in. There is a record of activities that take place in the home, including who has taken part, such as ‘xxx went to Sewerby Hall’, ‘xxx played dominoes’, ‘xx went out with daughter’ and ‘xx went out for a walk’. In addition to this, care plans include an individual summary of activities undertaken during a three-month period. Residents showed the inspector the new budgies that have been purchased following a request made at a resident’s meeting and one resident has the job Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 14 of feeding the fish in the outside pond and is happy to take on this responsibility. The mobile library visits the home every six weeks and the activities board displayed a notice for a clothes party that took place on the 14th August 2007. The inspector spoke to some relatives who were visiting the home; they said that they were always made welcome by staff and that staff always kept them informed about their relative’s health. They said that they had been to some ‘open days’ at the home and that it was evident that residents have a good rapport with staff and that they are ‘all comfortable together’. One relative said in a survey, ‘there is a cheerful and welcoming atmosphere in the home. It seems clean and light and the residents seem comfortable and happy’. The inspector observed that people had personalised their bedrooms to the extent chosen by them; some people had brought several items of furniture into the home. Details about advocacy services are displayed in the entrance hall of the home. People told the inspector that they can choose what time to get up and what time to go to bed, whether or not to join activities and where to take their meals. People told the inspector that this changes from day to day; they are not expected to have a set routine. A weekly menu is displayed in the home and this evidences that there are two choices of main meal at lunchtime, although on the day of the site visit everyone had the same meal. A change had been made to the dessert menu as the hairdresser had brought in some plums from a customer’s garden and these were prepared for lunch. The menu also records that there is a choice of a hot or cold meal at teatimes, and that this includes ‘fruit of the day’. People told the inspector that they enjoy the meals at the home and that there is always a choice. A member of staff recorded in a survey, ‘good home cooked food and a choice of menus’. There is a cook on duty for 3 or 4 days per week; care staff prepare meals on the other days of the week. Extra care must be taken with infection control when care staff are undertaking both personal care and catering or domestic duties. Some people ate their lunch in the dining room and some ate their lunch in the lounges or in their bedroom; small tables were provided to assist people with this. The inspector observed that people were assisted in a sensitive manner with eating and drinking, and that ample drinks were provided throughout the day. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 15 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 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are aware of the complaints procedure and relatives state that they know how to make a complaint; there is evidence that complaints are dealt with professionally and effectively by the home. There are appropriate policies and procedures in place on safeguarding adults to alert staff to the importance of this issue, and most staff have undertaken training on this topic. EVIDENCE: The inspector observed that the complaints procedure is displayed in the entrance hall. The registered manager informed the inspector that the home’s handyman is in the process of making a comments/concerns/complaints box to be placed in the entrance hall; they feel that this will be more productive than displaying the complaints form. The Service User’s Guide includes a copy of the complaints procedure and this is made readily available to residents, prospective residents and family/friends. Three of the four relatives stated in the survey that they know how to make a complaint and four of the five residents said the same; one service user did not respond to this question. The home has received two complaints since the last inspection of the home; one of these was via the CSCI and the other was from a resident. The complaint received by the CSCI referred to a lack of protective clothing, poor Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 16 management of the home, lack of confidentiality, poor medication practices and concerns re: personal care practices. The complaint was investigated in a very professional manner by the registered providers and an action plan was developed as part of the outcome. The registered provider has updated the inspector periodically on improvements made to care practices and management systems at the home as a result of the complaints investigation. The other complaint is recorded in the complaints log and there is recorded evidence that the complaint was investigated and acted upon appropriately by the registered manager. In addition to the complaints log a ‘comments and requests’ book is kept that records concerns expressed by residents and others. A record is kept of the action taken by staff and/or the manager in response to these concerns. This is good practice. Nine care staff have attended safeguarding adults training and the registered manager and care manager have attended training designed for managers of care services. There are appropriate policies and procedures in place that are designed to alert staff to safeguarding issues and to inform them of what action should be taken. The AQAA completed by the registered persons states that two placements have ‘broken down’ during the last year. This was discussed with the registered manager, who informed the inspector that the mental health of two residents had deteriorated to the extent that other people were put at risk. Community Psychiatric Nurses and other health professionals were involved in a reassessment process and this resulted in their eventual move to other accommodation. The CSCI were informed of this situation via notifications made under Regulation 37 of the Care Homes Regulations 2001. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 17 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 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides residents with attractive, comfortable, well-furnished, clean and hygienic accommodation. The programme of refurbishment continues and the home is well maintained, with the exception of two carpets that needed to be made safe. One door was held open by unauthorised means at certain times of the day, creating a fire hazard. EVIDENCE: There was a domestic assistant on duty on the day of the site visit and the home was clean, tidy and there were no unpleasant odours. The unpleasant odour that was present in one bedroom at the last inspection of the home had been alleviated by the provision of a new carpet. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 18 There is ample access to sunlight – there is a conservatory and a very safe enclosed garden, and bedrooms have large windows that make them feel light and airy. Some changes have been made to plans for bedroom accommodation but these do not increase the numbers of people that the home is registered to accommodate. One of the rooms upstairs originally intended as a bedroom has been made into an office for the manager and a staff room. The office downstairs is currently being converted into an en-suite bedroom; one of the residents told the inspector that the room had been promised to them. This room is being extended via the provision of a bay window to ensure that size requirements are met. A small smoking room has been created for residents, although they continue to use the garden area when the weather is fine. It is planned that the home will eventually become a ‘no smoking’ home. The inspector saw a wooden door wedge in one bedroom. The registered manager informed the inspector that this person likes to have their supper in their bedroom, but that they like to be able to hear staff and staff like to be able to hear them. This creates a fire hazard and the inspector informed the manager that they would have to arrange for an automatic door closer that is attached to the fire alarm system to be fitted to this door; some doors are already fitted with these. The registered manager agreed to this. Alterations to the premises continue; there are still two attic rooms that the providers hope to convert into bedrooms and the registered persons intend to contact the registration team when work is due to commence. One relative recorded in a survey, ‘a passenger lift should be installed as some service users are afraid of the stair lift’. This is no longer an area of concern as a passenger lift has now been provided; this enables all residents and visitors to access the first floor of the building easily. The inspector noted that the carpet outside the new lift needed to be made safe, as did the carpet on the rear stairs. The registered manager informed the inspector that a new carpet is to be fitted to the rear stairs in November 2007 and the registered provider contacted the inspector on the day following the inspection to inform us that these carpets had been made safe by the handyman The door to the area of the home where refurbishment is taking place is not always locked. There is a possibility that this area could be accessed by residents and the registered persons must ensure that all areas of the home are made safe at all times. Laundry facilities at the home are satisfactory; the washing machine has a sluice facility and there are separate hand washing facilities for staff. This increases the controls in place to prevent cross infection. The inspector observed that good hygiene practices were used by staff throughout the day Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 19 and that there were ample supplies of protective clothing. The inspector noted that training records evidenced that some staff have attended training on infection control and that this topic is considered as ‘core training’ by the home. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 20 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff undertake training programmes that equip them to have the skills and knowledge they need to care for people living at the home, and staff recruitment policies and procedures are robust, ensuring that staff employed at the home are suitable for their post. EVIDENCE: There is a satisfactory staff rota in place. The registered manager informed the inspector that standard staffing levels are three care staff from 7.00 am until 5.00 pm, two care staff from 5.00 pm until 10.00 pm and two care staff overnight. In addition to this, the registered manager is on duty for five days per week. There is a cook on duty for 3 or 4 days per week and a domestic assistant for 12 hours per week (over three days). One member of care staff was absent from work due to sickness on the day of the site visit but the inspector noted that the care manager called into the building at 11.00 a.m. to deal with a food delivery that was expected. Responses in surveys and discussion with staff indicated that there are ‘usually’ enough staff on duty to meet the needs of residents but that staff have had to work a lot of extra hours to achieve this. Care staff are responsible for domestic and catering duties on several days of the week and the inspector recommends that staffing levels should be reconsidered to take account of this. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 21 Agency staff are used for one or two shifts per week on average. The registered manager said that this is usually a ‘regular’ person that has worked at the home before so is aware of the information in residents’ care plans and of how to care for the individual people living in the home. The AQAA form submitted by the registered persons recorded that eight care staff have completed NVQ Level 2 in Care and training records seen on the day of the site visit confirmed this. The registered manager informed the inspector that one member of staff is working towards this award and that three staff are working towards NVQ Level 3 in Care. The home has therefore met the target for 50 of care staff to have achieved NVQ Level 2 (or above) in Care. The recruitment records for two new members of staff were examined by the inspector. Application forms that include an employment history are completed by staff. These records evidenced that two written references and a POVA first check (quickly followed by a satisfactory CRB check) have been obtained prior to staff commencing work at the home. One member of staff recorded in a survey, ‘I was quite surprised to hear that the two people I gave as referees were contacted. I thought my employer did a very thorough job’. Employment records evidence that staff undertake an Induction programme although the inspector understood from staff surveys and discussions with staff that Induction is sometimes very brief. All staff should undertake a thorough Induction programme that meets Skills for Care specifications at the home so that the registered manager can determine the level of their skills and experience and any training and development needs. There is a training and development plan in place that records the dates that staff have completed training; this assists the registered manager in arranging refresher training where needed. In addition to this, individual staff training records are held – these include a copy of all training certificates held by staff. Most staff have undertaken training on safeguarding adults and all staff (apart from one new employee) have undertaken moving and handling training, including the handyman and kitchen staff. Most staff have undertaken training on health and safety topics and some staff have undertaken dementia care training; in view of the client group, the inspector recommends that all staff undertake training on dementia care. There is evidence in staff files that they receive a copy of the Code of Conduct and Practice set by the General Social Care Council and that they have read key policies and procedures at the time of their induction. Reviews take place following recruitment to ensure that staff are performing well and understand their role thoroughly – these take place after 2 week and 12 week periods of employment. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 22 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 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is well managed and the health, welfare and safety of service users and staff are protected. EVIDENCE: The registered manager is qualified and has the experience and skills to manage the home. There is evidence that she keeps her practice up to date; she recently attended training on the Mental Capacity Act and is due to attend Equality and Diversity training with Selby College. There is evidence that she shares this training with colleagues. The minutes of a staff meeting record that the manager is available for one to one discussions from 1.00 – 2.00 pm, Monday to Friday. This is to encourage staff to speak to her individually if they Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 23 have any suggestions or concerns. The registered provider told the manager that the skills of the manager have improved greatly since the complaints investigation of last year and this was supported by comments made in surveys and discussions with staff, and by residents. One member of staff stated in a survey, ‘The manager is good at passing information on’. There is a quality monitoring system in place at the home and the home has achieved QDS parts 1 and 2; QDS is the quality monitoring system of the local authority that commissions care at the home. Surveys are sent to residents and visitors to the home and the inspector examined the responses; it was noted that most responses to questions were good or excellent. Responses are collated and the outcome is displayed on the home’s notice board. The inspector recommends that this information be used to formulate an annual development plan. Staff meetings take place but not on a regular basis. Staff recorded in surveys that they would like to have more staff meetings. One person said, ‘We could have more staff meetings to allow issues and views to be brought up and discussed’. This was discussed with the registered manager who said that the management team have recently decided that senior care staff will organise and chair staff meetings. They hope that, by senior staff rather than the manager attending meetings, this will encourage open discussion. Monies held on behalf of residents and associated records were examined by the inspector; it was noted that these are held securely. Receipts are obtained for money that is handed to residents, money received from relatives and any transactions made on behalf of residents. The records and monies checked by the inspector were accurate and the inspector noted that these are checked by the registered manager on a regular basis. Those residents that hold their own money have a lockable facility in their bedroom. The inspector examined health and safety documentation in place at the home. This evidenced that equipment and appliances are serviced regularly and are well maintained, including an annual test of the fire alarm system and a gas safety inspection. In-house fire tests take place weekly and monthly fire drills are held; particular attention is paid to fire training for new staff. Hoists are serviced on a regular basis and a new vertical lifting platform has been installed to replace the stair lift to the first floor. The inspector saw the ‘certificate of testing and examination after installation’ in respect of this. There is written evidence that water temperatures at outlets in bathrooms and bedrooms are checked regularly to control the risk of scalding. Accident recording is satisfactory and meets the needs of the Data Protection Act. There are risk assessments in place for safe working practices, including a fire risk assessment and one for every room in the home. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 24 Staff are recruited in a way that protects residents from harm and most staff have completed training on health and safety topics. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 25 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 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 4 17 X 18 3 2 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 3 X 3 X X 3 Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Controlled drugs must be stored separately and appropriate records must be held for the administration of controlled drugs. Fire doors must not be held open by unauthorised means. Timescale for action 30/11/07 2. OP19 13 & 23 17/09/07 Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 27 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. 3. 4. 5. 6. 7. 8. 9. 10. Refer to Standard OP3 OP7 OP9 OP9 OP9 OP19 OP27 OP30 OP33 OP33 Good Practice Recommendations Assessment documentation should be dated and signed to evidence when the assessment process commenced and to enable any reviews of this information to be identified. Thorough risk assessments should be completed for areas such as pressure care, nutrition and moving and handling. There should be a sample signature held for every member of staff that administers medication to enable records to be checked. A separate fridge for the storage of medication should be considered. This would ensure that medication is stored at the correct temperature and would improve security. More care should be taken when recording in medication administration records to ensure accuracy. All areas of the home should be made safe for service users and staff during the period of refurbishment. Staffing levels should be reconsidered now that the home is almost fully occupied. All staff should undertake a thorough Induction programme that meets Skills for Care requirements, and all staff should undertake training on dementia care. Information gathered via service user questionnaires should be used to produce an annual development plan. Staff meetings should be held on a regular basis. Stuart House DS0000065228.V351176.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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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