Inspection on 07/02/06 for Stuart House

This inspection was carried out on 7th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 17/09/07

Stuart House 21/09/06

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

CARE HOMES FOR OLDER PEOPLE Stuart House 12 - 14 Eastbourne Road Hornsea East Yorkshire HU18 1QS Lead Inspector Diane Wilkinson Unannounced Inspection 7th February 2006 10:30 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.V261651.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 DS0000065228.V261651.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stuart House Address 12 - 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 Mrs Linda Thorley Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (13) of places Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 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 thriteen older people, including those with dementia. Communal accommodation is provided in two lounges and a dining room - one of these lounges has recently been refurbished. All bedrooms are currently being used as single rooms. 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, flower beds 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. On street parking is available at the front of the home. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours, including preparation time for the inspector. The inspection consisted of a tour of the premises and examination of documentation, including care plans. The inspector spoke to three service users (one to one), several other service users, the deputy manager and the registered manager. What the service does well: What has improved since the last inspection? What they could do better: There is a strong odour in one of the bedrooms and this must be addressed to provide a pleasant environment for the service user. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 6 Recruitment polices and procedures must be adhered to at all times. Staff training on the protection of vulnerable adults from abuse would further protect service users. 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 DS0000065228.V261651.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 DS0000065228.V261651.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): None EVIDENCE: Stuart House DS0000065228.V261651.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): 8 and 10 The health care needs of service users are met by staff at the home. Service users say that their right to privacy is upheld and that staff treat them with respect. EVIDENCE: Very specific details are recorded in care plans in some instances, for example, around the psychological health needs of service users. This records the history of deterioration in psychological health, the signs for staff to look out for and how to manage this behaviour when it occurs. Not so much detail is recorded about the pressure care and continence care needs of service users. The inspector was informed that any concerns would be recorded in the handover book, and if needed, a specific goal would be developed around these needs. The inspector recommends that, if these are not areas of concern, this should be recorded in the care plan to evidence that they have been considered. Appropriate equipment for continence care is provided by community nurses, who assess service users at the time of referral and then reassess every six months. There are appropriate risk assessments in place and these include a record of a service user’s risk of falling. Monthly reviews of the care plan are undertaken and these are recorded. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 10 Service users informed the inspector that they feel they are treated with respect and that their right to privacy is upheld. Service users also report that any assistance with personal care is offered in a sensitive way. All service users are currently occupying single rooms so are able to see visitors and health professionals in private. Service users are allowed time on their own if this is appropriate. Medication was not assessed on this occasion but the inspector noted that all staff that administer medication have now completed accredited medications training. Stuart House DS0000065228.V261651.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 and 14 Service users are supported and encouraged to maintain their chosen lifestyle following admission to the home. Service users are supported to exercise choice and control over their lives to the extent of their capabilities. EVIDENCE: Care plans are a good record of a person’s social, cultural, religious and recreational interests and needs. There is evidence that service users are encouraged to continue to live how they lived prior to admission into residential care. Service users are supported to take part in the local community. Service users are able to spend their day how and where they wish to – some service users stay in their room most of the day and others choose to sit in one of the lounges with other service users. Some service users have written the ‘life history’ section of their care plan. The inspector observed that advocacy information is displayed in the home. Service users are encouraged to bring personal possessions into the home, and these items are listed in individual care plans. The inspector observed that service users are able to exercise their choice in relation to food, meals and mealtimes, social and leisure activities and routines of daily living – this was confirmed by service users. Stuart House DS0000065228.V261651.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): 18 There is insufficient evidence that staff are aware of and follow policies and procedures that are in place to protect vulnerable service users from abuse. EVIDENCE: There are appropriate policies and procedures in place that are designed to protect vulnerable service users from abuse. There are plans in place for staff to read the Hull and East Riding Protection of Vulnerable Adults policy and procedure and then to complete a questionnaire about what they have learned. Staff have attended an informal in-house training session with a community psychiatric nurse about dealing with aggressive behaviour, and other informal sessions have been arranged for staff about the specific behaviours of some service users. Stuart House DS0000065228.V261651.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 and 26 Service users live in a safe, well-maintained and comfortable environment. The home is consistently maintained to a clean, pleasant and hygienic standard, with the exception of one bedroom. EVIDENCE: The location and layout of the home is suitable for its stated purpose – it is accessible, safe and well maintained. One bedroom has been refurbished to include en-suite facilities, and a disused bathroom has been made into an ensuite bedroom. A new conservatory has been erected at the rear of the premises and the garden is being landscaped to include a raised pond, a patio area, flowerbeds and a secure area for service users to sit in or take a walk. The front of the premises have been ‘tidied up’ - new paving has been laid and potted plants have been placed at the front door. A room that was used by staff and by service users has been refurbished and is now a second lounge for service users. All of this work has been completed to a high standard. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 14 Domestic staff are employed on three days per week. The home is generally clean and hygienic but there was a strong odour in one bedroom on the day of the inspection. This was noted at the previous inspection and must be addressed. Laundry facilities are satisfactory and are due to be moving into a specially designed laundry room when the home extends into the premises next door. The registered providers are awaiting planning permission to extend into the adjoining property that they already own. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 There are sufficient experienced staff on duty to meet the needs of service users. Staff are well trained and have achieved or are working towards appropriate qualifications. Recruitment practices must improve to fully ensure the safety of service users. EVIDENCE: The staff rota is now a full record of all staff employed at the home. The rota evidences that there are always two care staff on duty during the day, and one ‘waking’ and one ‘sleeping’ member of staff on duty during the night. There is an arrangement in place with the commissioning authority for extra staff to be brought in to assist with the care of one service user due to her psychological condition – additional fees are paid for this purpose. The home is on target to meet the requirement for 50 of staff to have achieved a minimum of NVQ Level 2 in Care. There are eight care staff employed at the home. Three staff have achieved this award and four staff are enrolled on the training programme. The employment records for a newly recruited member of staff were examined by the inspector. These evidence that an appropriate application form is used by the home that records a person’s employment history. Copies of identification information are retained by the home. Records evidence that two written references were obtained prior to this person commencing work at the home, but that the POVA first check was obtained one week after they had Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 16 commenced work. A full CRB check has now been received. The registered person is reminded that a POVA first check or CRB check must be obtained prior to staff commencing work at the home. The inspector was informed that this person worked under supervision for one week but this should have continued until the CRB check had been received. All new staff receive an employee handbook. There are records in place to evidence that this new member of staff undertook an induction programme, and a staff assessment form (to monitor progress) was completed when she had been in post for 2 months. There is a training and development plan in place that records the training undertaken by all staff, including induction training and NVQ training. All staff (apart from managers) attended moving and handling training in January 2006 and two staff have attended first aid training for ‘designated first aiders’. The inspector was informed that health and safety and basic food hygiene training are to be arranged during the next six months. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 17 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): 31, 35 and 38 The home is well managed. Service user monies are held securely. Current arrangements for safe working practices ensure that the health, welfare and safety of service users are protected. EVIDENCE: The registered manager is experienced and skilled. She has achieved NVQ Level 3 in Care but has chosen not to undertake NVQ Level 4 in Care and Management. The deputy manager has achieved these qualifications and the decision has been made that the deputy manager will take over as registered manager and the registered manager will become the care manager. Both managers are happy with this decision. The proposed registered manager will be applying to the Commission for Social Care Inspection for registration. Some personal allowances are held on behalf of service users. Records of transactions undertaken on behalf of service users and the balances of monies Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 18 held were checked by the inspector. Records include receipts for monies paid in and any expenditure, and a running total is recorded. There were some very minor discrepancies in balances held – more care should be taken to ensure that balances are always accurate. Monies are held securely. There are health and safety risk assessments in place for topics such as COSHH, stair lifts, tripping or falling and laundry. There are health and safety policies in place and a new set of health and safety documentation has been purchased to ensure that information held by the home is up to date and meets current legislation. An annual test of the fire alarm system has taken place. Weekly in-house fire tests take place, although these lapsed for two weeks whilst the manager and the deputy manager were on leave. These have been brought up to date but the registered person must ensure that these tests take place on a weekly basis. Monthly fire drills take place. Fire extinguishers have been serviced. The nurse call system is checked in-house on a monthly basis. Accidents are recorded appropriately. Maintenance certificates are in place for the stair lift and the bath hoist, and there is a gas safety certificate in place. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 3 Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 20 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 OP18 Regulation 13 Requirement There must be evidence that staff understand and follow policies and procedures that are in place to protect vulnerable service users from abuse. There must be a CRB check or POVA first check in place prior to staff commencing work at the home. Timescale for action 31/03/06 2 OP29 19 07/02/06 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 Refer to Standard OP8 Good Practice Recommendations The inspector recommends that care plans should evidence that continence care and pressure care needs have been considered, even when not a specific area of concern. The strong odour in one bedroom should be addressed. The current deputy manager should apply to the Commission for Social Care Inspection for registration as the manager. More care should be taken when service user monies are DS0000065228.V261651.R01.S.doc Version 5.1 Page 21 2 3 4 OP26 OP31 OP35 Stuart House 5 OP38 balanced. Weekly fire tests must take place every week. Stuart House DS0000065228.V261651.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. 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