Inspection on 05/01/06 for Stuart House

This inspection was carried out on 5th January 2006.

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 10/01/07

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 5th January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 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.V276568.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 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. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection this year and was conducted by two inspectors over about 4 hours during the morning and early afternoon. There were thirtyone people living in the home at the time. A tour of the house took place and at least twelve service users, as well as several members of staff, spoke with the inspectors. Some records and procedures were looked at. The inspectors found that those people who spoke with them were content with the service provided and the care given by the home. Questionnaires left at the last inspection had been completed by three service users and seven relatives or visitors and sent to the CSCI local office. All the responses were positive and none raised any serious issues. Two further responses from relatives were received after the inspection – again both were positive. Where key standards have not been inspected on this occasion, refer to the previous report for comments. What the service does well: What has improved since the last inspection? What they could do better: Some care plans are brief and do not give staff guidance on service users’ needs; they must be reviewed and updated using the revised format. Recruitment practice does not always comply with regulations and must be improved. Mandatory training must be updated and records must be kept to show that it has been provided. Regular staff supervision must be put in place. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 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. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home offers a place only to those people whose needs it can meet. EVIDENCE: There have been only two new admissions to the home since the last inspection and examination of the files of both people showed that preadmission information had been gathered and the decision to offer a place made on the basis of this information. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 The medication administration and recording procedure has been revised to ensure satisfactory delivery of medication to service users. Many care plans are not yet written in sufficient detail to ensure that service users’ needs are being fully met. EVIDENCE: The home’s manager had redeveloped the care planning format prior to the last inspection and there was a recommendation in the last inspection report that all service users should have a new-style care plan in place as soon as possible. However, progress in transferring the care plans of existing service users to the revised system has been disappointingly slow and the manager is urged to complete the exercise as soon as possible, so that both service users and care staff can be clear about the care to be provided. One older style care plan looked at gave little information about the service user and there were no risk assessments completed. The manager said that new people have their plan written in the new, comprehensive and detailed format but there was no written plan for one Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 10 recently admitted person, although the other had a full care plan with clear guidance about how she wished to be cared for. Medication records and administration were looked at and found to be in good order. There had been a requirement in the last inspection report that has been met. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Friends and relatives of service users can visit the home at any time, ensuring that links are maintained. Service users are able to access local community facilities should they choose to do so. Catering in the home is of a good standard and provides a nutritious and wellbalanced diet for service users. EVIDENCE: Service users spoke highly of the catering in the home and added that the catering staff were aware of individual likes and dislikes. One inspector was in the dining room during lunch and reported that the meal was well-presented and that there was plenty available to eat with an alternative offered if required. There is a full-time activities organiser and people confirmed that there is a full programme of activities which is posted on notice boards around the home. People enjoyed the range of activities offered, which includes visiting entertainers, and made some suggestions which were passed to the manager at the end of the inspection. There were no reports of service user meetings being held – these are an ideal forum for finding out about things which people may be interested in. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 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, although there had 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. 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.V276568.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home offers comfortable, clean, well-maintained accommodation. EVIDENCE: The home is in excellent decorative order and is comfortably furnished and well-maintained. It is kept very clean and there are no unpleasant odours. The garden is extensive and accessible and service users at previous inspections have said how much they enjoy using it in good weather. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Staff are given the opportunity to gain qualifications, which will give them the skills to care for service users effectively. Mandatory training has not been updated for many staff which could result in unacceptable or unsafe care practice. Recruitment practice in the home needs to be tightened to protect service users from possible abuse. EVIDENCE: There were some concerns about the documentation relating to the recruitment of one careworker: the Criminal Records Bureau (CRB) disclosure was dated after she had started work at Stuart House and there was no documentary evidence that a POVA First check had been completed before she started; there was no identifying photograph on her file; one reference was undated and was from a personal friend. The staff rota showed that there are sufficient staff on duty at all times to make sure that service users’ needs can be met. It was noticeable that the gender mix of the staff does not reflect that of the people who live in the home - there are about eight male service users in the home at present but there are no male care staff. While this does not present significant problems, the manager and proprietor may wish to consider recruiting some male care staff. The training records for some staff members which the inspectors looked at showed that mandatory training, e.g. moving and handling, fire safety, infection control, has not been updated within the set timescale and must be made a priority to protect both service users and staff members. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 15 Several members of staff have completed or are currently engaged in the National Vocational Qualification (NVQ) Level 2 & level 3 in Care and the home is moving towards meeting the target of 50 qualified staff as set in the National Minimum Standards, although this should have been achieved by 2006. The need for the manager to keep an up-to-date record of training taken and required for each member of staff was discussed, along with the possibility of arranging more in-house training sessions on topics specific to the service user group and where a need is identified after the training assessments have been completed. The staff team in the home is stable with few changes - many people have been in post for several years. There is no use of agency staff. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36, 38 Service users and relatives have the opportunity to give their views on the standard of care provided in the home and are safeguarded from financial abuse. Health and safety guidelines are not always followed which could compromise service users’ safety. The introduction of a robust supervision system would enable staff to further develop their skills and knowledge. EVIDENCE: The manager reported that a survey of service users and relatives/carers had been carried out but that an analysis of the responses was not yet available. This should be forwarded to the CSCI as soon as it becomes available. The home’s quality assurance system will be looked at in more detail at the next inspection to assess whether it fully meets the relevant standard. The arrangements for looking after people’s money were looked at and several were sampled. These were found to be correct, with receipts in place and Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 17 transactions recorded. A recommendation is made in this report that service users sign for receipt of their money and that these cash accounts are formally audited at least annually to identify and trace any errors. Both staff and service users spoke of the support they receive and that the proprietor and the manager are approachable and ‘easy to talk to’. The supervision programme for staff members is not yet in operation and must be implemented as soon as possible. Several senior staff members have been nominated to receive training in staff supervision. This will enable them to supervise careworkers and other staff so that the standard and regulations are met. Health and safety records were looked at and were generally in good order, although again attendees at fire drills have not been recorded. The manager should also ensure that night staff are included in routine fire drills. Cleaning materials were again found in unlocked cupboards on the first floor. Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 2 x 2 Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 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 OP7 Regulation 15 Requirement Each service user must have a detailed written care plan, including risk assessments, setting out how their health and welfare needs are to be met A POVA First check must be completed and documented before staff can work in the home under supervision until the CRB disclosure is received. (This was a requirement of the last inspection report and has not been met) A recent photograph of each person working in the home must be kept on file. An assessment of training needed and a record of training received must be made for each staff member Mandatory training for staff must be updated within the set timescales. The programme of staff supervision must be developed and implemented. Cleaning materials must be stored in lockable cupboards. (This was a requirement of the DS0000019558.V276568.R01.S.doc Timescale for action 31/03/06 2 OP29 19(1)(b)(i )&Sch2 05/01/06 3 4 OP29 OP30 19(1)(b) (i) & Sch2 18(1)(c) 31/01/06 31/03/06 5 6 7 OP30 OP36 OP38 18(1)(c) 18 (2) 13(4)(a) 31/03/06 31/03/06 05/01/06 Stuart House Version 5.1 Page 20 last inspection report and has not been met) 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 Refer to Standard OP7 OP27 OP29 OP33 OP35 Good Practice Recommendations The transfer of care plans to the new format should be completed as soon as possible A mixed gender staff group could contribute positively to service users well-being. The manager/registered person should attempt to obtain references from people other than friends of the applicant. The manager should arrange consultation meetings with groups of service users. Service users should sign for receipt of cash held by the manager. Service users’ cash accounts in the home should be audited regularly. Staff attendance at fire drills should be recorded. 6 OP38 Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stuart House DS0000019558.V276568.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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