Care Home: St Andrew`s, Cullompton

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What the care home does well St. Andrews is a care home benefiting from dedicated staff who provide good quality care. The manager maintains good relationships with community health care professionals and with relatives and visitors to the service. The environment is pleasing and there is a homely atmosphere at the service. What the care home could do better: We have identified some areas for improvement in this report. All areas relate to record keeping and we are confident that these areas will be improved if the manager rearranges her shift pattern to include more time for office based tasks. Her vacant care shifts will need to be covered by an additional care worker. Random inspection report Care homes for older people Name: Address: St Andrew`s, Cullompton 1-5 Pye Corner Church Street Cullompton Devon EX15 1JX two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Judith McGregor-Harper Date: 0 7 0 6 2 0 1 0 Information about the care home Name of care home: Address: St Andrew`s, Cullompton 1-5 Pye Corner Church Street Cullompton Devon EX15 1JX 0188432369 0188432369 barryjwise@googlemail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Angela Beryl Cunningham Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Brenda Wise,Mr Barry James Wise care home 23 Number of places (if applicable): Under 65 Over 65 23 23 23 23 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 0 The Manager must gain an NVQ level 4 in care by April 2006 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home St. Andrews Care Home comprises of a main building, which can accommodate up to 19 residents, and a smaller house situated in the grounds, which can accommodate up to 4 residents. The home provides personal care together with accommodation and board for up to 23 older people who may also have a physical disability and /or mental disorder such as Alzheimers Disease or a related disorder. The home is situated within a short level walk from the main street in Cullompton, which offers a wide range of shops, cafes and the local health centre. The home is approached by way of a level paved area and there are ample facilities for car parking. The homes statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at the home. A copy of the most recent inspection report is available on request. At the time of the last key inspection in 2007 the home told us their fee levels were between £295 and £420 weekly. Services not included in this fee include hairdressing, chiropody, newspapers and magazines and personal items. Care Homes for Older People Page 3 of 11 What we found: This was an unannounced routine inspection. We reviewed the one requirement made at the last key inspection of the home on the 24th July 2007 and we focused the remainder of our inspection on records in relation to assessment and admission, on-going and changing care needs, risk assessment of the individual, medication administration, the homes environment, management of the home and health and safety measures. Choice of Home. On the day of the inspection 19 people were residing at the home. We looked closely at care plans for two people who had recently moved in to the home. We looked at the assessment records of people before they moved in. We saw that the manager ensures that peoples needs are assessed in detail prior to admission to ensure that the home can met their needs.This included gathering information from placement authorities to gain other professional assessments of need. Health and Personal Care. In the two care plans we read we saw that assessment tools were used and people were assessed monthly for clinical indicators such as, to illustrate, handling assistance requirements, falls risk, pressure area damage risk, eating and drinking indicators of risk. These tools demonstrate a risk based approach to care planning. We saw that there were plans of care written as a result of assessment tools, which were personalised. Social care plans lacked detail and there was evidence of a care plan not being updated to reflect a change in respect of mobility status. Prior to the inspection we sent surveys to people who live at the service and some to relatives to complete. We received 8 responses from people living at the home and 3 from relatives of people who live at the home. The tone of all responses was positive and praiseworthy with regard to health care support provided by staff working at the home. We also sent surveys to community based health care professionals with links to the service. We received 5 replies. In all these returns the surveys indicated that visiting health care professionals view the home as maintaining good working relationships with health professionals. Health professionals also told us that they consider the service responsive to the diverse needs of individual people living at the home (such as disability, gender, age, race, ethnicity, faith and sexual orientation). We looked at how peoples medication was managed in the home and how complete medication records were. We saw that medication was stored securely and the the dispensing pharmacist provided training for staff at the home in the administration of medication. We discussed with the manager whether the current system for hand transcribing medication records needed to be more robust to prevent possibility of hand transcription errors. We saw that variable dose recording was not consistent. We told the manager that we would highlight the need for consistency as a recommendation in this report; in order to establish a therapeutic dose of a medicine. Care Homes for Older People Page 4 of 11 Daily life and Social Activities. In survey responses it was remarked upon by people living at the home, a relative and two staff members that people lacked opportunities to go out and access the community, for example on trips. We saw that in the Annual Quality Assurance Assessment (AQAA), completed by the registered manager and sent to us prior to the inspection, that the manager had recognised this as an issue to be addressed. During the inspection we spoke with the manager about the lack of outside activities and we have been assured that increased opportunities for accessing the community have been sought and organised trips out are being arranged. During the inspection we saw people moving about the home unrestricted and engaging in activities such as knitting or reading or watching television. Complaints and Protection. The AQAA informed us that in the last 12 months the service has received no complaints and has had no reason to make any safeguarding referrals. We have received no complaints directly about the service. We spoke to the manager about her knowledge of safeguarding processes and the Mental Capacity Act. The manager has undertaken training in these areas this year. In staff survey returns all 6 staff told us that they knew what they should do if someone had a concern about the service. In survey returns from people living at the home all 8 indicated that they knew how to raise a complaint about the home and had someone they could speak with informally if they had a concern. We saw that the complaints policy was prominently displayed in the home for people to read. It did, however, display out of date contact details for the Commission. The policy therefore needs updating. Environment. We conducted a tour of the environment. Since the last inspection an upgrade regarding fire door protection had taken place. On the day of the unannounced inspection the environment was clean, inviting and homely. We had a discussion with the manager regarding simple ways to make bathrooms more appealing to the bather so that bathrooms are viewed as inviting spaces. We saw laundry facilities and discussed infection control measures with staff. The laundry does not have a hand washing sink although alternative hand washing sinks are available in the home. For best practice, should a review of laundry facilities be undertaken in the home this needs to consider future laundry facilities that have sufficient space for the installation of a hand washing sink for staff use. Staffing. On the day of the unannounced inspection 3 staff were supporting the 19 people living at the service. People seemed to be well cared for and staff had time to stop to chat with people. The manager was working as a carer as one staff member had called in sick that Care Homes for Older People Page 5 of 11 day. In survey returns from people living at the home all respondents told us that staff listen and act on what they say. Of the 8 respondents, 7 people told us that staff are always available when they need them, 1 person said that staff are usually available when they need them. Nobody indicated staff being available sometimes or never. Management and Administration. The registered manager is Mrs. Cunningham who is an experienced manager. Mrs. Cunningham works mostly with the care staff providing hands on care and in close working supervision of the care team. She works Monday to Fridays. Prior to this unannounced inspection an AQAA was completed for us. It gave us statistical information about the service. We also asked the home to consider what it does well and we asked the service to consider what improvements it had made for outcomes for people living at the home in the last year, and where further improvements need to be made. We discussed with the manager the need for more evidence in future quality assurance returns to the Commission in order to support statements of opinion made in the AQAA of good outcomes for people living at the service. We also need to see how the service is able to reflect upon where the service could improve, in order to demonstrate that the management is able to adopt a self-critical approach to quality assurance processes. We cross checked notifications we had received about significant events in the home with records kept in the home. We had not been notified of events that we should have been. We have given the home advice to where our guidance documents regarding Regulation 37 notifications can be found. We looked at accident records. We saw that staff were taking appropriate action to record accidents in the home but that completion of accident records was incorrect with staff recording that accidents had been reported under RIDDOR legislation when this had not happened and was not applicable. This is a training issue and the manager assured us that this would be acted upon. We asked the manager how accidents were audited to look for trends or patterns and them to take action to prevent accidents re-occurring. It was clear that the manager carries out this process and reports verbally to staff to make changes to peoples care regimes to keep them safer, however, accident auditing is not recorded. We strongly recommend that this is done on a monthly basis. We discussed with the manager that we were finding a pattern of improvements needed at the home that all related to record keeping. We discussed the managers ability to devote time to office tasks when most of her working hours are dedicated to care. We had the opportunity to discuss this briefly by telephone with the proprietor following the inspection and it is our recommendation that the managers hours be reviewed with the aim of providing her with additional office based hours. Her hours free from caring duties should be covered by an additional care worker. What the care home does well: Care Homes for Older People Page 6 of 11 St. Andrews is a care home benefiting from dedicated staff who provide good quality care. The manager maintains good relationships with community health care professionals and with relatives and visitors to the service. The environment is pleasing and there is a homely atmosphere at the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be kept under review reflecting changes in need. This is to enable staff to provide care that is relevant and suitable for the individual. 01/08/2010 2 38 37 The Commission must be notified, without delay, of death, illnesses and other significant events in the home. So that the Commission is aware of events that impact upon the well-being of people in the home. 01/08/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 16 The amount of a medication given under a variable dose prescription should consistently be recorded. The complaints policy should be updated to reflect current Page 9 of 11 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations contact details of the Commission. 3 4 37 38 Accident records should be accurately completed. The managers shift pattern should be reviewed to allow greater time for office work to complete records required for the purpose of Regulation. A monthly audit of accidents in the home should be recorded. 5 38 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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