Inspection on 08/12/06 for The Stratfords Residential Home

This inspection was carried out on 8th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Stratfords Residential Home 17/06/08

The Stratfords Residential Home 20/06/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Stratfords Residential Home Anthony Court Russell Street Stony Stratford Milton Keynes Bucks MK11 1BT Lead Inspector Jane Handscombe Unannounced Inspection 09:30 8 December 2006 th 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 Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Stratfords Residential Home Address Anthony Court Russell Street Stony Stratford Milton Keynes Bucks MK11 1BT 01908 262621 01908 262621 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) Vulcan Residential Limited vacant Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The Stratfords is a two-storey residential care home, proving care for up to eleven older people, over the age of 65 years. The home is situated in a quiet residential area of Stony Stratford and is within a short walking of the town centre that offers a variety of shops, restaurants, public houses and other local amenities. The Stratfords residential care home is a two-storey building that provides single room accommodation. Service user bedrooms are located on the ground floor and upper floor. Access to the first floor is via a shaft lift. A cook provides freshly cooked meals on site and special diets can be catered for. Public transport is accessible to service users if they wish to use this. The fees for this home range from £435.00 - £455.00 per week. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Baseline Inspection’ ie/ the first inspection since registration with the new proprietors. The inspection involved one inspector, which took place over two days. It was a thorough look at how well the service is doing. It took into account detailed information provided by the registered provider, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Comments received from residents during the inspection included: ‘the food is very good…..’ ‘the meals are good. If off colour I can take it in my room’ ‘the staff are wonderful…..’ ‘I love this room, I have everything I need’ ‘ I have talking books from the library’ ‘there’s no rules and regulations in here, you can go to bed when you like’ Comments from staff include: ‘staff are very supportive, I feel valued…..’ ‘…they are very nice to work for’ ‘when you ask for something to be done, they will sort it.’ The inspector would like to thank the residents, their families, staff members and other health professionals for their assistance during this inspection The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas in which the home could improve upon and whilst a number of requirements and recommendations have been made within this report, the registered provider has been addressing these issues and is The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 7 working towards improving procedures to ensure the health safety and welfare of the residents in their care. The registered provider has only recently acquired the home as an ongoing business and has acknowledged that there were some poor practices and procedures taking place, which he is currently reviewing and addressing to ensure the health safety and welfare of the residents and care staff at the home. Each service users file must contain a comprehensive plan of care detailing all the assessed needs and a detailed plan as to how these needs are to be met. Any risks associated with these needs must be included with actions as to how the risks can be minimised and managed and evidence that service users/their representatives have been involved in the assessment and care planning process. All staffs personnel files must contain evidence that a thorough recruitment procedure has been undertaken and evidence must that all staff have received suitable training to undertake their role competently. Likewise staff must be provided with appropriate supervision and records held to evidence this. Policies and procedures must be produced to address the issues identified within this report in order to protect the health, safety and welfare of the residents and care staff. 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 Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 8 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 Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. All prospective service users are provided with information about the home and undergo an assessment of needs prior to being offered a place at the home. However, the information provided needs to be accessible to all and therefore offered in different formats when the need arises. Evidence that service users have been consulted with during the assessment process is lacking and should therefore be gained. All prospective service users are invited to visit the home to enable them to make an informed choice. EVIDENCE: All prospective service users are provided with a service users guide which contains comprehensive information about the home. The information The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 10 contained in the Statement of Purpose and service user guide needs to be reviewed and updated to ensure it meets Care Homes for Older People National Minimum Standards and the Regulations. The Prior to being offered a place prospective users of the service undergo an initial assessment of needs to ensure both parties are confident that the home can meet those assessed needs. The registered provider must ensure that the service users and/or their representatives signatures are gained to evidence they have in fact taken part in the assessment process. The home encourages prospective service users to visit the home where they can spend some time meeting with fellow service users, meeting the care staff and experiencing life at the home to enable them to make an informed choice when deciding upon a home suitable for their needs. Whilst speaking to one service users who is registered blind, it became apparent that the service user guide had not been made available in an accessible format for this particular client. The service user was unaware of its contents and was not sure of the complaints procedure if the need arose. The proprietor agreed that time would be spent with the client discussing the contents and it would be made accessible in an audio tape format in order that the service user had access to a copy. From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. However, care must be taken to ensure all service users have equal access to the service users guide and any other relevant information in an accessible format where the need arises. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are shortfalls in some areas of care planning that could result in residents not receiving the care they need. Care plans viewed on the day were incomplete and inconsistent; short term and long term goals were not always sought, inventories of valuables were found to be left blank and unfilled, where nutritional assessments had been undertaken, they were found to be very basic. EVIDENCE: All service users have an individual plan of care drawn up from an assessment of needs, including manual handling risk assessments although were found to be inconsistent and incomplete. The registered provider must ensure to The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 12 undertake risk assessments in all situations that could present as a potential risk as in the case of a service user who smokes. Whilst viewing the service users file, it was noted that the review of care clearly stated the resident was very confused and needs supervision with cigarettes. Whilst care staff are aware of the risk and strategies are clearly in place to minimize any apparent risks, these need to be written into the care plan in the form of a risk assessment. All care plans viewed on the day of inspection, failed to evidence that service users had been involved in the assessment and care planning process. The registered provider must ensure that the service users and their families/representatives are included in the process and gain signatures to evidence this. Care plans viewed were incomplete and inconsistent; short term and long term goals were not always sought, inventories of valuables were found to be left blank and unfilled, where nutritional assessments had been undertaken, they were found to be very basic. Current good practice recommends that care homes have a procedure for dietary assessment and nutritional screening using a nationally validated screening tool, such as MUST (Malnutrition Universal Screening Tool). This should be undertaken on admission and at appropriate intervals thereafter, with a record of nutrition, weight gain or loss and appropriate action taken. Further concerns were raised around a coding system used within the care planning system. The inspector enquired into what the coding system meant and of the two carers asked, neither were sure of the meaning. Concerns were raised regarding the care planning systems in use, that they were not clear and consistent to provide staff with information they need to meet the service users needs. This was discussed with the registered provider who acknowledges that service user files need to be reviewed to ensure that all required documentation is filed appropriately to ensure the health, safety and welfare of those in their care. The registered provider informed the inspector that they were aware of these shortcomings resulting in the production of a new care planning system and service users details were to be transferred to this new format. That the new format would give a clearer picture of the service users needs, any risks associated with their needs and how these needs were to be met. Requirements have been made within this report to address these findings. The home has policies and procedures in place to ensure that service users are able to maintain responsibility for their own medication, within a risk management procedure, where the need arises. Medication is stored in a lockable trolley, which is kept in a lockable cupboard. Only senior carers, who have undergone appropriate medication training, have access to the keys and undertake administration of medication. The inspector accompanied a senior carer on the medication round and found good procedures taking place. Whilst no service users required medication that The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 13 needs storing in a refrigerator, such as eyedrops, the inspector asked where these are kept if a service user should require them. It became apparent that these would be stored in the kitchen’s refrigerator which it was noted was not lockable. It was recommended that should the need arise, medication requiring storage in a refrigerator should be stored appropriately. There was one discrepancy found around the recording of one service users medication. The registered provider has agreed to investigate the issue and forward a summary of the outcomes and actions taken to CSCI The inspector acknowledges that the proprietors have been in post for a short period of time and have made great efforts to ensure that outcomes for service users and their needs are met. Acknowledgement is also given to the timescales required to review and update information to ensure accuracy. The acting manager acknowledged that the files need to be reviewed to ensure that all required documentation is filed appropriately and safely. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Contact with family, friends and the local community is encouraged and support is given where required. Generally, the meals offered to residents are very good, offering choice and variety, However concerns were raised around the presentation and nutritional value of pureed food and advice should be sought from the community dietician. Opportunities for daily activities within the home need more consideration to ensure that service users wishes and needs are met appropriately. EVIDENCE: Residents informed the inspector that they are able to receive visitors in their rooms or the shared communal rooms and that they are welcomed at any time. Visitors who were in attendance during the day verified this. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 15 Discussions with both the service users and the proprietor informed the inspector that the home ensures that individuals are able to exercise their choice around their lifestyles That the lifestyle experienced in the home generally satisfies their social, cultural and religious needs. There are few routines at The Stratfords and these are centred around meals and mealtimes. On the day of inspection, residents were seen to be enjoying shepherds pie with assorted fresh vegetables followed by a choice of dessert. Where a resident does not wish to take the main meal offered, further options are always made available. Feedback around meals offered at The Stratfords was very positive The inspector was informed that there is always a choice of menu for residents to choose from and specialist diets are catered for. Meals can be taken in either the communal dining rooms or can be served in the residents room if required. Whilst touring the kitchen the inspector was concerned about the nutritional value and presentation of pureed food available for one resident and recommends that advice is sought from a community dietician. The home does not employ an activity organiser, relying instead on carers to deliver activities during the afternoon periods. This does raise concerns about the staffing levels, since only 2 carers are employed during the afternoon and whilst expected to deliver activities it raises questions as to whether they are able to deliver their care roles appropriately, and in a timely manner, when the need arises. Notices are displayed within the home informing of activities provided by the home although whilst inspecting, there was no evidence of any taking place during either of the two days of the inspection. Feedback gained from5 residents questionnaires which asked if activities were arranged by the home that they could take part in, clearly indicated that activities need to be developed to suit the residents needs; three answered sometimes, one answered usually and a further resident stated that they were not applicable due to age. One resident informed the inspector that there was nothing for her to do and that she was bored and another states that ‘activities are rather intermittent’. The TV was on in the lounge throughout the inspection, being watched by a minority of residents. Whilst the home does not have the provision of weekly church services, they do celebrate the major Christian festivals to which service users may attend. Every effort is made to arrange transport to local places of worship, if required and the home will contact and arrange for a minister to visit a service user if required. The home stocks a number of books from the local library, including talking books and talking newspapers are also acquired for those who require. The inspector was informed that a Christmas party has been arranged for residents and their families to attend if they so wish. Local schoolchildren will be in attendance providing musical entertainment. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 16 Service users have access to a visiting podiatrist and a hairdresser regularly visits the home for those who require. Residents should be given opportunities for both mental and physical stimulation through leisure and recreational activities in and outside the home, which suit their needs, preferences and capacities. Likewise serious consideration should be given to either increasing the staffing numbers or employing an activities co ordinator to enable these opportunities. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. All service users are provided with a copy of the complaints procedure and feel confident in making a complaint if the need arose, although this needs to be in formats which enables equal access to all. Procedures are in place to safeguard service users from abuse. EVIDENCE: All service users are provided with a copy of the complaints procedure within their service users guide. A copy of the procedure is also accessible to families and visitors and is posted on the notice board within the home. Discussions with service users informed the inspector that if the need arose, they felt confident in approaching the proprietors/carers and their complaint would be taken seriously and acted upon appropriately. A number of complaints have been recorded within a centralised file, as well as electronically, all of which were dealt with in a timely manner. Whilst the records detailed the actions taken they did not record the outcomes of the investigation and did not always follow the homes policy, namely that of responding to the complainant in writing, acknowledging what action had been taken. The proprietor acknowledged this shortcoming and assured the inspector that any further complaints would be addressed in accordance with the homes complaints procedure. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 18 The home has details of independent advocacy services and is able to facilitate access to advocacy services for those who require. The homes policies and procedures ensure to safeguard service users from abuse. Staff members spoken to during the inspection, were aware of the homes procedure concerning any allegation or suspicion of abuse and their responsibility to ‘whistle blow’ on any poor practice or concerns that come to their attention. Since the last annual inspection the Commission has received no such notification of any concerns, allegations or instances of abuse and neither has the service itself, and no staff needed to be referred for inclusion on the Protection of Vulnerable Adults [POVA] list. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides comfortable surroundings, which are equipped to meet the residents needs. EVIDENCE: All parts of the home are accessible to the service users, with the use of grab rails and a lift to facilitate mobility around the home. The inspector noted the cleanliness was generally very good, which residents confirmed was always the case, The home provides sufficient toilet and washing facilities for the number of residents, however one bath was damaged. It contained a deep chip which could cause wounding to service users when taking a bath. A requirement has The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 20 been made to ensure this hazard be removed and safe bathing facilities be provided ensuring the service users health and safety. The bathroom was found to contain soap bars and the proprietors were reminded that they should remove these and continue to use liquid soap in all communal WC and bathing facilities so as to avoid cross infection. The home encourages residents to bring small items of furniture and memorabilia to personalise their rooms and take into consideration individual preferences around matters of decoration and furnishings. A recently admitted service user, who chose the colour she would like her room to be painted, prior to moving into the home, verified this. All residents rooms are provided with a telephone point, TV point and a call system with an accessible alarm facility to call staff in the case of an emergency. Residents spoken to were very happy with their rooms and found them to be spacious, furnished to a good standard and meeting their needs appropriately. On the day of the inspection, the home was generally well maintained and clean with a homely atmosphere. Whilst inspecting the homes lift was undergoing a routine service and all the electrical equipment was being tested for safety. It was noted that a recent visit by the Environmental Health Officer had been undertaken, however a report had not been left with the provider detailing the findings. The provider informed the inspector that requirements had been made and these would be dealt with within the required timescales. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Overall, the numbers of care hours provided are adequate but staffing levels were found to be poor. Extra members of staff are needed during mealtimes, activities and at other peak times, to ensure residents receive the care they need in a timely way. EVIDENCE: Rotas provided to the inspector demonstrate that staffing levels consist of two care staff for the morning shift, two for the afternoon and two for the night shift. On most occasions this includes the acting manager. The staffing levels do raise concerns in that during busy periods of the day, in which two carers may need to assist a service user, such as moving the individual with a hoist, the remaining service users are left unsupervised with no carer available to deal with their needs promptly. Likewise whilst care staff are delivering activities they are unable to deliver their care roles appropriately when the need arises. It is recommended that the registered provider gives serious consideration to increasing staffing levels during the busy peak periods in order that the service users health, safety and welfare is not compromised. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 22 A selection of staff personnel files were viewed and found to be of poor quality. The registered provider is presently reviewing staff files and working towards updating them. Three staff files failed to contain a recent photograph; two were addressed immediately and the registered provider assured the inspector that a photograph of the remaining member of staff would be taken the following day and placed in the file accordingly. The registered provider must ensure to undertake thorough recruitment checks, to ensure the health, safety and welfare of the service users who are in their care. All relevant clearance checks must be undertaken, a full employment history gained and held on personnel files and two appropriate references sought. In cases where references are provided on unheaded paper or without a with compliments slip, these must be followed up and verified and evidence held that this has been undertaken. Copies of contracts were not available for the inspector to view; the registered provider explained that these were with the solicitor being redrafted to reflect the staff members new employer but would confirm with CSCI when these were in place in each staff members personnel file. The inspector was informed that all newly recruited staff undergo a structured induction training and shadow senior staff members until both parties feel comfortable. They are provided with the General Social Care codes of practice and are provided with relevant mandatory training and any further training deemed necessary to undertake their roles competently. All staff are encouraged to undertake the National Vocational Qualifications in Care and the registered provider is working towards all care staff undertaking the relevant NVQ awards. The registered provider is presently undertaking the NVQ level 4 in Care and the acting manager has recently undertaken the Registered Managers Award. Training provided during the past 12 months have included manual handling, basic food hygiene, first aid, Protection of vulnerable adults, safe handling of medicines and continence training. Concerns were raised regarding a newly appointed cook who had not undertaken any food hygiene training. On the second day of the inspection, the registered provider had acted appropriately and a trainer was on the premises providing food hygiene training to the member of staff appointed to cook during that day and was to return to the premises later that week to provide training to all the remaining members of staff who had not undertaken the food hygiene training. With regard to the cook, and training to be undertaken, it is recommended that the registered provider seeks advice from environmental health. Certificates evidencing training that had been undertaken was not held on all personnel files viewed. From evidence held on personnel files it appears that not all staff have received appropriate training. The registered providers is currently putting a training matrix into place, in order that training and due dates for updating of relevant training can be identified easily. A requirement The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 23 has been made within this report to ensure that all staff have the skills and competency to undertake their roles and that service users health safety and welfare is not compromised. The registered provider assured the inspector that appropriate recruitment checks and auditing of staff files will be undertaken to ensure the safety of service users. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The acting manager has the qualifications needed for her role, and since her recent appointment is developing her management skills. Both the acting manager and registered provider have shown a good understanding of where the home needs to improve and have the commitment to carry through the changes to improve the service. EVIDENCE: The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 25 The staff and relatives spoken to said they felt able to approach the acting manager or proprietor about any concerns they had. The proprietor intends on registering a manager with the Commission for Social Care in the new year. Whilst the acting manager presents as a caring, competent and dedicated manager of the Home, with a sound knowledge of the issues relating to the elderly, score of 2 has been assigned to this standard since registration is not yet in process and therefore does not fully meet the standard. During the inspection process, the inspector became aware of shortfalls within the homes policies and procedures which could compromise the residents and care staffs health, safety and welfare. Daily fire exit checks were not being undertaken on a daily basis. Likewise the weekly fire systems checks had not been undertaken regularly, the last check having been undertaken three weeks prior to the inspection. The proprietor assured the inspector that these would be attended to. There was no evidence of policies and procedures around racial harassment occurring between service users, between staff, by staff or by service users on staff. Likewise the home does not have any policies and procedures covering risk assessment and management, sexuality and relationships and record keeping therefore a requirement has been made within this report to address these issues to safeguard the health, safety and welfare of the residents and care staff within the home. Care staff receive informal supervision, however there are no arrangements in place to ensure care staff receive formal supervision at least six times a year, as is required in the Regulations and Standards laid down in the Care Standards Act 2000. The registered person informed the inspector that he is aware of this and is in the process of putting them into place. Very few of the residents are able to look after their own finances. Therefore, a resident’s next-of-kin, or representative, takes on this responsibility. The manager said the home has no involvement with resident’s personal finances Since the proprietors have recently acquired the home, there has not yet been a formal quality assessment of the service. Informal feedback is gained through speaking with service users and residents on a day to day basis and visitors are welcomed to approach the manager with any concerns or complaints they may have. A discussion took place in which the proprietor explained that whilst no residents meetings have yet been undertaken since acquiring the home, these were on the agenda, which would enable residents to voice any concerns they may have. The inspector was further informed that an annual quality assessment would be undertaken in the form of a questionnaire to gain feedback from service users, their families/representatives, visitors and any health/social professionals who visit the home. It was acknowledged that there could be occasions where some residents would prefer to make their voices heard anonymously and the proprietor is looking into ways that this The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 26 could be achieved, including the possibility of involving a local independent advocacy service . The CSCI is notified under Regulation 37 of The Care Homes Regulations 2001 of any occurrence affecting the welfare of service users, and the manager and staff showed an awareness of what events need reporting. The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 27 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 2 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 x 2 x 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 x 2 The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 28 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 Standard OP1 Regulation 4, 5 Requirement The registered person must ensure that the Statement of Purpose and Service Users Guide contains all the information required under Schedule 1 and is produced in different accessible formats where the need arises. The registered provider must ensure to provide each service user with a comprehensive plan of care detailing all the assessed needs and a detailed plan as to how these needs are to be met. Any risks associated with these needs must be included with actions as to how the risks can be minimised and managed. The registered provider is to provide CSCI with a summary of the investigation and actions taken, with regard to a medication discrepancy highlighted during the inspection. The registered provider must provide evidence that service users/their representatives have DS0000065902.V320628.R01.S.doc Timescale for action 28/02/07 2 OP7 12 and 15 31/01/07 3 OP9 13 31/01/07 4 OP3 OP7 14(1)c 31/01/07 The Stratfords Residential Home Version 5.2 Page 29 been involved in the assessment and care planning process. 5 OP21 23 The registered provider must ensure safe bathing facilities be provided at all times, ensuring the service users health and safety. All recruitment checks must be completed in accordance with the Care Homes Regulations. Two written references must be received and followed up with a telephone call. CRB checks must include a POVA first check. The proprietor must ensure that all staff are suitably trained to undertake their role competently, all mandatory training for staff is completed and is up to date and that records of this training are kept on staff personnel files. The registered manager must produce policies and procedures to address the issues identified in order to protect the health, safety and welfare of the residents and care staff. The registered manager must provide staff with appropriate supervision and hold records to evidence this on personnel files. The registered provider must provide appropriate training, to all staff members to ensure they have the skills and knowledge to undertake their roles competently and ensure safe working practices and the health, safety and welfare of the residents and staff. All training must be updated accordingly. 31/01/07 6 OP29 12 and Schedule3 31/01/07 7 OP30 18 31/03/07 8 OP38 13(4)c 31/03/07 9 OP36 18(2) 28/02/07 10 OP38 OP30 13(4) 28/02/07 The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 30 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 It is a good practice recommendation to implement a nationally validated nutritional screening tool that is completed shortly after admission and reviewed at appropriate intervals thereafter. It is strongly reccommended that a safe system for the storage of drugs which need cold storage be sought. One in which only designated persons have access. Complaints should be recorded consistently and be responded to in accordance with the homes written policy. It is a good practice recommendation to ensure tablet soap is not made available in communal bathing and toileting facilities, and the provision of liquid soap remains available. It is reccommended that a training matrix be developed and kept up to date to allow for identification of training needs and the due dates for updating of mandatory training. It is reccommended that serious consideration be given to increasing the staffing numbers of the home at peak times Residents should be given opportunities for stimulation through leisure and recreational activities in and outside the home, providing for both mental and physical stimulation.which suit their needs, preferences and capacities. Following concerns raised during the inspection process around the nutritional value and presentation of pureed food, It is strongly reccommended that advice be sought from the community dietician. 2 3 4 OP9 OP16 OP21 5 OP30 6 7 OP27 OP12 8 OP15 The Stratfords Residential Home DS0000065902.V320628.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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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