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Inspection on 18/10/06 for The Royal Star and Garter Home

Also see our care home review for The Royal Star and Garter Home for more information

This inspection was carried out on 18th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Provides excellent care, delivered by staff who understand residents` needs well. Records good written information on the delivery of individual care, which results in an individualised and consistent approach from staff. Provides an excellent range of activities, events and outings. Provides good support for residents to remain involved with the local community. Enables residents to maintain contact with their military backgrounds if they wish. Meets residents` healthcare needs well and liaises effectively with other healthcare professionals when necessary. Consults residents about decisions that affect them. Makes relatives welcome when they visit. Fosters an open environment in which residents, relatives and staff feel comfortable in raising issues. Keeps residents safe through maintaining robust recruitment procedures. Promotes and facilitates effective communication amongst staff. Keeps staff informed about issues that affect them. Provides clear guidance for staff about working practices. Provides excellent training and support to staff.

What has improved since the last inspection?

The information recorded on residents` care plans has improved, particularly in the areas of life history, background and identifying areas of individual importance to residents. The standard of daily care notes has improved. Staff feel that communication from senior management has improved.

What the care home could do better:

Ensure that written information regarding the care and cultural preferences of residents is clear and consistent. Ensure that any areas of concern identified through the care planning process are followed up. Record the administration of all medication accurately. Ensure that care plans reflect residents` wishes and demonstrate that residents (and their representatives where appropriate) are consulted and involved in decisions that affect their lives. Use footplates at all times when pushing residents in wheelchairs.

CARE HOMES FOR OLDER PEOPLE The Royal Star and Garter Home Richmond Hill Richmond Surrey TW10 6RR Lead Inspector Simon Smith Unannounced Inspection 18th October 2006 11:00 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 The Royal Star and Garter Home DS0000034157.V318464.R03.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. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Royal Star and Garter Home Address Richmond Hill Richmond Surrey TW10 6RR 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) 020 8439 8000 020 8439 8002 enquiries@starandgarter.org The Royal Star and Garter Home Mrs Pauline Shaw Care Home 99 Category(ies) of Physical disability (8), Physical disability over 65 registration, with number years of age (91) of places The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10 February 2006 Brief Description of the Service: The home provides nursing, residential and respite care to men and women who have served in Her Majestys Forces. The charitys motto is Enhancing the lives of those who served. The home occupies a commanding position on Richmond Hill. The location provides fine views from many of the communal and private rooms and affords easy access to Richmond Park and the shopping and transport facilities of the town centre. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a wide range of sources when making judgements about the home. These included two visits to the home by two inspectors and discussion with residents, relatives, staff and visiting healthcare professionals. The inspectors also joined residents for a meal. A sample of records was examined, including staff and residents’ files. The inspectors were made welcome during the visits and wish to thank residents, staff and all those who gave their views about the home. Surveys were given to residents, relatives and staff. Twenty residents, 23 relatives and 21 members of staff returned surveys, which provided a good source of evidence for this report. The feedback from surveys was generally very positive. Residents highlighted the care provided by staff as one of the strengths of the home. One resident said of the staff, “they can’t be beaten”. A number of residents said that they sometimes have to wait longer than they would like when they need staff. One resident said, “I sometimes have to wait for staff as they tend to be busy”. 45 of residents said that staff are “always” available when they need them while 45 said staff are “usually” available. Residents feel that they are able to contribute to decisions that affect them and are confident that any concerns that they raise will be addressed. One resident stated, “The whole place is marvellous”, whilst another resident said, “Best decision I ever made, to come here”. Several residents commented that the home is improving. One resident said, “I am happy with the home and it is getting better”. Another resident said, “The home has improved for the better. Before the carers were not as helpful”. Residents said that the home provides good activities and events and that they are able to maintain contact with their regiments and service colleagues. Several residents said that they really enjoy the trips provided by the home, although some residents noted there are fewer opportunities to go on long trips than in previous years. Residents and relatives said that the meals provided are generally good but that there are some inconsistencies in quality. For example a number of people said that the food served at supper is poor compared to that provided at lunchtime. 45 of residents said that they “always” like the food provided by the home while 45 said that they “usually” like it. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 6 Relatives’ said that they are made welcome when they visit and that staff are friendly, professional and caring. Relatives were generally happy with the home’s communication with them and several identified this as a strength. However some stated that the home did not keep them informed about specific issues, especially healthcare matters. For example one relative said that she had not been informed when a healthcare appointment had been cancelled, while another said, “Its taken some time for the RSG to contact me about some key things”. The home should take this on board and consider how performance could be improved in this area. When asked what the home does well, relatives’ identified the following: “Takes healthcare responsibilities seriously and keeps up with current practices” “The [unit] manager fosters an open and caring atmosphere” “Good, open dialogue” “Welcomes visitors at any time” “Having his best interests in mind” “Good care and carers – not patronising” “Helps residents to keep in touch” When asked what the home could improve, some relatives said that they would like to see more trips and activities at weekends and one relative highlighted “liaison with relatives” as an area for improvement. Staff surveys demonstrated that they are enthusiastic about their work and that they feel well supported by their managers. One member of staff said, “I am proud to work for this home – I love my job”, while another stated, “I am appreciated by my manager and receive good support”. Perhaps inevitably, staff reported some anxieties about the home’s planned closure. However there is a real commitment from the staff team to ensuring that these concerns do not affect the service provided to residents. In addition, staff feel that the home’s management has tried hard to keep them up to date with events. One member of staff said, “Management has done their best to keep us informed”. Another member of staff stated, “Senior management has worked hard at improving communication with staff – they need to continue working on this”. The staff interaction with residents observed during the inspection was good and a number of staff showed excellent skills in this area. Staff engaged residents positively, demonstrated a good knowledge of their needs and found time to stop and chat. The care practice observed was also good but some improvements in practice are highlighted later in this report. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 7 The home met 18 of 27 National Minimum Standards assessed at this visit. Five Standards were exceeded, three Standards were almost met and one Standard was not applicable. Five Requirements were made. The home had taken action to address all Requirements made at the last inspection. What the service does well: What has improved since the last inspection? The information recorded on residents’ care plans has improved, particularly in the areas of life history, background and identifying areas of individual importance to residents. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 8 The standard of daily care notes has improved. Staff feel that communication from senior management has improved. 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. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 9 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 The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 10 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): Standards 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the service. Good information about the home is available to residents. Residents’ individual needs are effectively assessed at the time of admission. EVIDENCE: The home has produced a Statement of Purpose, which gives details of the facilities provided and the aims and objectives of the service. A Service User Guide is issued to all residents. Residents’ surveys confirmed that they had been given good information about the home before deciding to move there. Comprehensive assessments were in place on all residents’ files examined. Assessments record residents’ strengths and needs and identify any specialist adaptations or equipment needed. Inspection confirmed that the assessment The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 11 process is used effectively to inform the individual plan of care developed for each resident. Due to the charity’s plans to close the home and develop three purpose built facilities, no permanent admissions are being made, although respite admissions are still considered. The home does not admit residents for intermediate care. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the service. The quality of information on care plans is generally very good, but some plans contained inconsistencies that need to be addressed. Residents’ healthcare needs are well met, although the home must follow up any medical needs identified through the care planning process. Residents feel that staff provide excellent care. Staff liaise effectively with other healthcare professionals when necessary. Medication is stored appropriately and there are clear procedures governing administration. Residents have access to privacy when they want it and feel that staff treat them with respect. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 13 EVIDENCE: An individual plan of care is in place for each resident. A sample of care plans across the units was examined. The quality of information was generally very good and reflects the hard work put in by staff to improve this area. Care plans now contain good life history work and background information about each resident and detail residents’ individual preferences about their care. Care plans also record each resident’s moving and handling requirements and regularly assess the risk of pressure ulcers, falls and malnutrition. Individual care plans are developed where specific needs are identified. The home plans to introduce an electronic care planning system and was working with the software provider at the time of inspection to ensure that the programme meets the home’s needs. Whilst the overall standard of care planning and recording was high, a number of care plans contained inconsistencies in information that need to be addressed. A risk assessment on one resident’s care plan, completed in July 2006, regarding use of the kitchen states that the resident “now does not do anything independently in the kitchen” and “never uses kitchen equipment”. However the resident’s care plan (also dated July 2006) reports that the resident “gets up independently in the morning and goes to the kitchen to make a cup of tea”. Another resident’s care plan ‘information sheet’ records the resident’s religion and confirms that he “wishes to practice”. However the resident’s care plan states, “He does not practice any religion”. The home must ensure that information provided to staff regarding the care of residents, and their religious/cultural preferences, is clear and consistent. See Requirement 1. Another resident’s placing authority review identified factors that suggested the resident may be suffering from depression but there was no evidence that this had been followed up. Each resident’s care plan contains a baseline geriatric depression assessment. The assessment pro forma was present but not completed in this resident’s care plan. The home must ensure that the care planning process effectively identifies residents’ healthcare needs and that any areas of concern identified are followed up. See Requirement 2. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 14 Some information recorded on care plans also raised issues about how the home involves residents in making decisions about their lives. These issues are addressed in more detail in the next section of this report. Staff record details of care provided in daily notes for each resident. Guidance is available for staff on the completion of daily notes and the quality of recording observed was generally very good. However the home must improve the recording of fluid intake for residents who use PEG (Percutaneous Endoscopic Gastrostomy) feeds. It was noted that care plans for residents who use PEG feeds contained details of fluid intake targets but no supporting documentation to indicate whether these had been achieved. See Requirement 3. Discussion with staff demonstrated that carers have a good knowledge of residents’ individual needs. Residents’ care plans illustrate that staff liaise well with other professionals when necessary, including district nurses and palliative care specialists. Care plans also provided evidence that staff from the home liaise effectively with hospital staff if a resident is admitted to hospital. Visiting healthcare professionals spoken to during the inspection gave good feedback about the home and staff. One healthcare professional said that the standard of care provided by the home is “excellent”. Whilst residents said that staff provide very good care, some residents said that they sometimes have to wait longer than they would like for attention when they need it. One resident said, “I sometimes have to wait for staff as they tend to be busy”. 45 of residents said that staff are “always” available when they need them while 45 said staff are “usually” available. All medications were found to be stored appropriately and there were clear directions for their use. All medication coming into or leaving the home is recorded. There are clear protocols governing the administration of medication. The Practice Development Nurse reported that he conducts spot checks on medication. Nursing staff confirmed that they are assessed in this area before being authorised to administer medication. Medication was given to residents correctly and safely during the inspection. Thirty one Medication Administration Records were examined across the units. All recorded details of allergies and included a recent photograph of the resident. Authorised homely remedies were recorded and separate record sheets for PRN (‘as required’) medications. Medication Administration Records indicated three instances in which medication had been administered but not recorded by signature and three instances in which creams had been administered but not recorded by signature. See Requirement 4. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 15 Residents’ surveys confirmed that they have access to privacy when they want it and that staff treat them with respect. Staff were observed to maintain the privacy and dignity of residents throughout the inspection. Personal care needs were met promptly and with discretion. Staff knocked before entering private accommodation and addressed residents with respect. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including visits to the service. The programme of events and activities is stimulating and varied. There are excellent in-house facilities for activities. Residents are encouraged to pursue individual hobbies and to maintain their military links if they wish to do so. Residents receive good support to maintain links with their friends, families and the local community. There must be evidence that residents (and their representatives where appropriate) have been involved in decisions that affect their lives, particularly where restrictions on individual choice are in place. There is a range of options available at mealtimes and residents have opportunities to comment on and contribute to the home’s menu. EVIDENCE: The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 17 The home provides an excellent range of in-house activities and events and regular outings to places of interest. The programme of events is supported by a team of committed volunteers. There are also good facilities for arts, crafts, cooking, gardening and IT and residents are encouraged to pursue individual interests and hobbies. Residents are encouraged to maintain their military links where they wish to do so and regimental events feature prominently in the programme of activities. Religious services are also held at the home regularly. The monthly programme of activities was distributed to residents by staff during the inspection, in large print where necessary. Staff were observed talking through the list with some residents in order that they could make choices about events they would like to attend. Many residents remain involved with their local community. One resident said that he attends a local church regularly whilst others reported that they visit Richmond Park during good weather and make use of the local pub. Residents relatives. bedrooms to keep in receive good support to maintain contact with their friends and Many choose to have a private telephone line installed in their and several residents told the inspector that they regularly use email touch with their friends and families. Family members said that staff welcome them when they visit and make time to speak to them about issues affecting their relatives. However some relatives reported that the home had not informed them about specific issues, especially healthcare matters. For example one relative said that she had not been informed when a healthcare appointment had been cancelled, while another said, “Its taken some time for the RSG to contact me about some key things”. The home should take this on board and consider how performance could be improved in this area. As highlighted in the previous section of this report, some information recorded on care plans raised issues about how the home involves residents in making decisions about their lives. For example one resident’s care plan notes that his consumption of alcohol has been limited and outlines restrictions on how much alcohol he can purchase each day. However there is no evidence that the resident was involved with or consenting to this decision. Another resident’s care plan states that the resident must agree to a programme of weight reduction. Once again there was no evidence of the resident’s involvement with this decision. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 18 The home must ensure that care plans reflect residents’ wishes and that residents (and their representatives where appropriate) are involved in decisions that affect their lives. Where restrictions on individual choice are in place, there must be evidence that appropriate consultation has taken place prior to the authorisation of these restrictions. See Requirement 5. There is a range of options available to residents at mealtimes. Each meal has a vegetarian option, a healthy eating option and an easy eating option. Residents also have opportunities to comment on and contribute to the home’s menu, for example through residents’ committee meetings and the home’s Quality Assurance system. Residents and relatives said that the meals provided are generally good but that there are some inconsistencies in quality. For example a number of people said that the food served at supper is poor compared to that provided at lunchtime. 45 of residents said that they “always” like the food provided by the home while 45 said that they “usually” like it. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 19 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the service. The Complaints procedure is clear and readily available. Residents and relatives know how to complain and feel confident about doing so. Staff are given guidance about what to do if they receive a complaint. EVIDENCE: The home has a clear Complaints procedure, including timescales for action and response. A copy of the Complaints procedure is included in the Residents’ Handbook. The Complaints policy states, “Anyone who wishes to make a suggestion, register a concern or make a complaint should feel confident to do so and know that their suggestions, comments and complaints will be listened to, taken seriously, investigated and acted upon”. Surveys indicated that residents and relatives know how to complain and feel confident about doing so. Those who had complained in the past reported that they were happy with the home’s response. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 20 Details of independent advocacy services are available for those who may find this service useful when raising concerns and the Complaints procedure contains details of the local CSCI office. Staff are provided with guidance about what to do if they receive a complaint. All staff attend training in the Protection of Vulnerable Adults and there is a Whistle-blowing procedure, which enables staff to raise any concerns they have about poor practice. The home has demonstrated a willingness to work co-operatively with other, statutory agencies, including the local authority, placing authorities and CSCI, in the investigation of any allegations received about the experience of residents. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 21 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): Standards 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the service. The home is attractively decorated and well maintained. The home provides excellent facilities for social and leisure activities. Communal spaces are welcoming and well used by residents. Residents’ bedrooms reflect their individual tastes and interests. EVIDENCE: The home occupies a commanding position on Richmond Hill and is opposite Richmond Park gate. The location provides fine views from many rooms and affords easy access to the park and the town centre. A high standard of The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 22 decoration has been achieved throughout the home and the terraces and grounds are well maintained. The home provides a range of communal rooms, including some suitable for hosting large events. The main dining room provides a focus for socialising at mealtimes and smaller dining rooms are situated on each floor. The home runs a small library and has a licensed bar. Residents are encouraged to personalise their bedrooms and many bedrooms provide evidence of hobbies and interests. Residents are able to bring personal items, including furniture, with them on admission. 80 of residents returning surveys said that the home is “always” fresh and clean, whilst 20 of residents reported that the home is “usually” fresh and clean. There is a commitment to maintaining high standards of infection control and all areas of the home were clean and hygienic at the time of inspection. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including visits to the service. Residents value the care and support provided by staff. Staff have the skills required to do their jobs well. Staff are encouraged to deliver care in a manner that is individualised and resident-focussed. Residents are protected by the home’s recruitment practices. Staff receive good support from their line managers. The home provides excellent programmes of induction and training for staff. Staff are encouraged to achieve relevant National Vocational Qualifications. EVIDENCE: There were enough staff on duty to meet the needs of residents during the inspection. Residents spoke highly of staff and highlighted the care provided as one of the strengths of the home. One resident said of the staff, “they can’t be The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 24 beaten”. Another resident said, “The little things are attended to, which makes such a difference”. Several residents said that they sometimes have to wait longer than they would like when they need staff. One resident said, “I sometimes have to wait for staff as they tend to be busy”. 45 of residents said that staff are “always” available when they need them while 45 said staff are “usually” available. Staff said that they are encouraged to deliver care and support in a manner that is individualised and resident-focussed. Staff reported that their managers are available to them for advice and support when necessary. One member of staff described their unit manager as “very professional”, whilst another staff member stated that the home has a policy of “open door management”. Staff also said that they have regular individual supervision and access to good opportunities for learning and development. Staff reported that they had received a good induction when they started work at the home. Staff files contained evidence of induction, including the support of a nominated ‘buddy’. The Practice Development Nurse reported that the home’s induction package meets the relevant ‘Skills for Care’ Standards. Staff files demonstrated that the home’s recruitment practices protect residents. Files contained proof of identity, contracts of employment and evidence of appropriate training, including NVQ qualifications. The home’s Human Resources department provided evidence that Criminal Records Bureau disclosures have been obtained for staff. The Director of Human Resources reported that the Criminal Records Bureau had recently visited the home to check compliance with Requirements relating to Criminal Records Bureau disclosures and had identified no concerns. Staff confirmed appropriate checks had been carried out when they started work. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 25 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): Standards 31, 32, 33, 35, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including visits to the service. The registered manager is suitably experienced and has achieved qualifications relevant to the role. Senior staff feel that the registered manager provides good support. There is a commitment to Quality Assurance and service monitoring. Staff work within clear procedures and receive good guidance in their work. Residents are consulted about issues that affect them in the home. There are appropriate procedures in place for recording residents’ finances. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 26 Standards of health and safety within the home are high. EVIDENCE: Systems of recording and administration within the home are clear and well organised. The registered manager has much experience of delivering services for older people and has achieved qualifications relevant to the role. Senior staff reported that the registered manager provides good support and appropriate leadership for the service. As highlighted elsewhere in this report, staff feel that their managers are available for advice and support when they need them. Residents and relatives reported that they feel confident in raising issues about the service. The home has a commitment to effective Quality Assurance and seeking the views of those who use its services. A Residents’ committee meets regularly and is attended by senior staff. The charity has previously commissioned independent practitioners to record and evaluate residents’ views about the services they use. There has been a reduction in the number of Nurse Care Managers since the last inspection due to diminishing resident and staff numbers. However there is no evidence to suggest that that this has affected the care provided to residents or the support available to staff. Further redundancies are planned for the coming year as the Charity’s plans progress. Almost inevitably this has led to some individual anxieties but comments made by staff and residents indicated that they feel well informed about the forthcoming changes. The home provides good written guidance for staff in their work. Records of care are regularly audited and the home’s operational policies are subject to annual review. There are appropriate procedures in place for recording residents’ finances. There is a commitment to ensuring that staff work consistently and within the home’s policies and procedures. Some residents choose to use their wheelchairs without footplates attached. The manager said that residents have been made aware that this is not best practice but that some feel strongly that their independence is enhanced when they use their wheelchairs in this way. The manager advised that staff will perform risk assessments regarding the use of footplates and will record individual decisions on residents’ care plans. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 27 The home was clean, hygienic and free of obvious health and safety hazards on the day of inspection. All COSHH products were stored appropriately. The home has appropriate Employers Liability insurance. The home has an appropriate fire detection system. Clear instructions for use in the event of a fire were displayed. Residents are encouraged to shut their bedroom doors at night but some choose to keep them open for ventilation. The home has consulted the London Fire and Emergency Planning Authority (LFEPA) about this issue and has considered their advice when emergency planning. . The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 28 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 3 X 3 X X N/A 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 4 13 4 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X X X 3 X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 29 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 OP7 Regulation 12(4) Requirement Information regarding the care and cultural preferences of residents must be clear and consistent. Any areas of concern identified through the care planning process must be followed up. The recording of fluid intake for residents who use PEG feeds must demonstrate that fluid intake targets have been achieved. Ensure that the recording of medication is accurate. Care plans must reflect residents’ wishes and residents (and their representatives where appropriate) must be consulted and involved in decisions that affect their lives. Timescale for action 30/12/06 2 3 OP7 OP7 12(1) Schedule 3(k) 30/12/06 30/12/06 4 5 OP9 OP14 13(2) Schedule 3(q) 30/11/06 30/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 30 No. 1 Refer to Standard OP13 Good Practice Recommendations Consider how best to maintain effective communication with relatives about residents’ care. The Royal Star and Garter Home DS0000034157.V318464.R03.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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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