Inspection on 05/07/05 for Stuart House

This inspection was carried out on 5th July 2005.

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 05/01/06

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 Judith Kent Unannounced 05.07.05 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 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 I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Stuart House Address 149 London Road St Albans Hertfordshire AL1 1TA 01727 858200 01727 851143 pearl@caremore.org.uk Caremore Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Pearl Agard-Smith Care Home 39 Category(ies) of Op - OP Old Age - 39 registration, with number of places Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are none. Date of last inspection 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 I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5.5 hrs and was conducted by two inspectors. A tour of the house was taken, several members of both care and domestic staff were spoken with. About nineteen service users, both in small groups and individually, offered their views about life in the home,. Some records were looked at. What the service does well: 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. Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 7 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 standard(s) 1 &3 (Standard 6 is not applicable as the home does not offer intermediate care) Prospective service users are given information about the home and are invited to visit so as to be able to make an informed choice. An assessment of their needs is completed to make sure that their needs can be met at the home. EVIDENCE: Although pre-admission assessments have been completed for each service user, the manager has recently developed the process further to meet National Minimum Standards (NMS) requirements. This will make sure that the home is able to meet the needs of service users to whom it offers a place. The Statement of Purpose and Service Users’ Guide are in the process of being reviewed and amended to ensure that the information given to service users is current and correct. Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 8 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 standard(s) 7, 8, 9 &10 There has been a great improvement in the development of care plans and risk assessments and the manager acknowledged that these need to be completed for all service users as soon as possible. Medication administration practice seen could put service users at risk and there is a need for good practice to be reinforced to care staff so that sound methods are always used. EVIDENCE: At previous inspections had raised concerns about the lack of detail and information on care plans – this has now been addressed by the new manager and those seen at this inspection were comprehensive, clearly set out and detailed. They include identifying all health, personal and social care needs and setting out how these will be met. Care plans for all service users at the home will be reviewed and transferred to the new format within the next few weeks. The home was able to show its commitment to giving appropriate care by agreeing to continue to provide care, with support from the medical services, to a seriously ill person who had chosen to remain at Stuart House rather than seek hospice care; it was recommended that the care plan and risk assessment review for this person should be a priority. Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 9 Medication records and administration were looked at; the large majority of medication is administered from a Monitored Dose System (MDS) prepared by the home’s pharmacist, but several points were raised with the manager at the end of the inspection in respect of recording opening dates on non MDS tablets; and the advisability of carrying out a weekly audit on those medicines that are not pre-packed by the pharmacist. It was noted at the inspection that medications were signed for by a staff member on the Medicines Administration Record (MAR) sheet before it had been given to service users – this is contrary to the guidance issued in the Royal Pharmaceutical Society’s publication ‘The Administration and Control of Medicines in Care Homes’ Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 &15 Service users are able choose how to lead their lives and are assisted by the home staff to make their decisions. EVIDENCE: The home employs a full-time activities organiser and there was an enthusiastic response by service users when the activities in the home were discussed – they enjoy exercise groups, music, table games and small group discussions; a new croquet set was particularly mentioned as being enjoyed. Some service users attend church on Sundays. The activity programme for the month is posted on the home’s notice board and offers something on most days – one service user, though, said that weekends were ‘a bit boring’. The catering arrangements in the home were commended by most people, and although there is no choice offered at the main meal, the catering staff are aware of people’s likes and dislikes and offer an alternative. Comments from service users included that the food is ‘fine’ and ‘freshly-cooked’. One person mentioned the ‘very nice home-made cakes’. The cook on duty confirmed that fresh meat and vegetables are used. The rapport between service users and staff seemed to be relaxed, there was friendly but respectful banter between them. One service user volunteered that ‘if you have a problem they listen and put it right’ and gave an example of when this had happened. Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home’s procedures protect service users from abuse; concerns are listened to and action is taken to resolve them. 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 I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 23, 24 25 &26 The home offers comfortable, well-maintained accommodation. EVIDENCE: The home is in excellent decorative order - the proprietor reported that decoration and maintenance are on-going and are done by the home’s handyman. The domestic staff keep the home clean and there were no unpleasant odours. Individual bedrooms have been personalised with service users own pictures and ornaments and small pieces of furniture. The en-suite facilities include a bath with shower facility, toilet and wash basin in each room and in addition there are five assisted baths around the house. The proprietor reported that there are plans to convert one traditional bathroom to a walk-in shower room which would enable the construction of ensuite facilities in the one room that has none. Communal areas in the home are comfortably furnished in homely style and service users are able to enjoy the well-maintained extensive garden Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 Service users benefit from a workforce which offers continuity of care. The procedure for recruiting new staff is not sufficiently robust which could result in unsuitable staff being employed. EVIDENCE: Staffing is maintained at a level which meets service users needs and allows time for unhurried individual attention. The home does not use agency staff and sickness and holidays are covered by the existing staff group with help from bank staff, thus providing continuity for service users. Several staff members have completed National Vocational Qualifications (NVQs) Level 2 in Care and some others are currently training, with another five staff planning to start the course in September. Examination of recruitment files for two new members of staff showed that one person’s file held only one written reference and that a POVA First check had not been completed before she started working in the home, although the Criminal Records Bureau (CRB) disclosure had been applied for. Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 & 38 The home is managed effectively by the new manager; policies and procedures are in the process of being reviewed and revised to ensure best practice. Health and safety guidelines were not followed in one instance, and could result in service users’ welfare being compromised. EVIDENCE: Both service users and staff members spoken with said that the manager is approachable and supportive. She proposes to start a keyworker system in the home, where each service user will have a member of staff assigned to him/her who will be responsible for reviewing care plans and risk assessments, and being aware of the service user’s needs and welfare. There are plans to provide specialist training for the deputy manager and senior care staff to support the keyworker scheme. There has been little in the way of staff supervision in the home, but the manager is developing a supervision and appraisal scheme for staff. Staff Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 15 meetings are held regularly – minutes are written and distributed for staff information. The breach of health and safety guidelines seen in the home was in respect of a cupboard with no lock which had cleaning materials stored in it. Fire safety records were checked and found to be in order, although it was recommended that a list of staff on duty during fire drills is kept, to ensure that all staff are present at some time during drills to reinforce safe practice. Moving and handling training for the domestic staff was discussed at the inspection. Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 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 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 x 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 x x x 3 x 2 Stuart House I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 17 yes Are there any outstanding requirements from the last inspection? 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. 2. Standard 9 29 Regulation 13 (2) 19(1)(b) (i) & Schedule 2 19(1)(b) (i) & Schedule 2 13(4)(a) Requirement That medication is signed for on the MAR sheet only after service users have been seen to take it. That two written references are obtained before staff are employed at the home That a POVA First check is completed before staff can work in the home under supervision until the CRB disclosure is received. Cleaning materials must be stored in locked cupboards Timescale for action From 05.07.05 From 05.07.05 From 05.07.05 3. 29 4. 38 From 05.07.05 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. Refer to Standard 7 9 9 Good Practice Recommendations That the review of care plans to the new format is prioritised according to service users needs; and that the programme is completed as soon as possible That opening dates are recorded on all medication not in the MDS system. That an audit of all medication not in the MDS system is carried out at least monthly I52_s19558 Stuart House v213212 050705 stage 4.doc Version 1.40 Page 18 Stuart House 4. 5. 36 38 That the supervision ans appraisal programme is implemented as soon as possible That staff attendance at fire drills is recorded. 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