Care Home: St Andrews Care Home

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Key inspection report CARE HOMES FOR OLDER PEOPLE St Andrews Care Home 16 St Andrews Road Bedford Bedfordshire MK40 2LJ Lead Inspector Katrina Derbyshire Unannounced Inspection 14th April 2009 08:00 DS0000072823.V374976.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews Care Home Address 16 St Andrews Road Bedford Bedfordshire MK40 2LJ 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) 01234 350110 01234 262402 www.standrewscarehomes.co.uk St Andrews Care Homes Ltd Vacant Care Home 19 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 19 Not Applicable 2. Date of last inspection Brief Description of the Service: The home is located in a pleasant residential suburb of Bedford within walking distance of the town centre and a park. The town has many amenities including links to national bus, rail and road networks. The home provides both long term and respite care services to people over 65 years of age including those with a diagnosis of dementia. The home is also able to offer care to five people between the ages of 65 and 55 years with dementia. The building has three stories with access via a shaft lift to the first floor. Rooms on the second floor are used for administrative purposes only. Single room accommodation with washbasin and call bell facilities is provided. Bedrooms are situated on the ground and first floor with convenient access to bathing and toilet facilities. Two lounges and an all weather conservatory are located on the ground floor. The home has attractive, well-maintained gardens to the front and rear of the property. Further information can be obtained by contacting the home direct by phone or email, or by visiting. There is also a website. The following information about fees was obtained on 14th April 2009:St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 5 Weekly fees are £600.00. When people require additional support for example support on a one to one basis then additional charges are made for this. The following items are not covered by the weekly fee: Private chiropody; Hairdressing; Toiletries; Newspapers. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This service submitted an application to the Commission for Social Care Inspection in 2008 to change an element of its registration to reflect a change in its ownership to a Limited company. As a result of this in accordance with our registration guidance the service from 15th October 2008, was considered a new service. However it should be noted that the home had previously been inspected and it’s rating at it last inspection on 26th May 2007 was rated a 3 star excellent service. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection carried out on the 14th April 2009. The care of three people was looked at in detail and this is known as case tracking. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The management’s submission of documentation was also considered prior to the site visit. The focus of this inspection was to look at the key standards. What the service does well: The standard of food and the way it is served to people living at the home is very good. Everyone spoken with confirmed that they enjoyed their meals. The owners have shown a commitment to achieving an excellent standard in this area, through using specialist tools available to health and social care professionals to help them ensure that people receive a good standard of nutrition. A breakfast cook is employed as well as a cook who has responsibility for preparing the lunchtime meal and evening meal. The breakfast cook makes sure everyone receives what he or she wants and when he or she wants it, according to the time that they choose to get up in the St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 7 morning. We observed her at this visit and her rapport with everyone living at the home and commitment to ensuring people received and ate their meals was commendable. A new manager has been appointed and took up her post in October 2008. Prior to her appointment there had been changes to the standard of care that had previously been offered, in these areas she has been changing practice of staff since she took up her position. The owners in support of this had arranged for an outside agency to assist in staff accepting the changes. The manager shows a commitment to improving standards for the people living at the home. The manager and staff are good at managing medication on behalf of the people living at the home. The staff orders and manages medication on behalf of the people at the home in a safe way. They are organised in the way they order so there is always a stock of medication for each person that has been prescribed. The medication is also stored correctly making it safe and the records that the home keeps are of a good standard, to show when a medicine has been given. Also if this is an error this is picked up and rectified immediately showing that the auditing system of the home is working. What has improved since the last inspection? What they could do better: Management have re decorated and made some improvements to the environment. However there remains some areas in the home that still need to be decorated and carpets in some places are worn, and these still need to be replaced. The manager showed that this is part of her business plan and that she had already identified this. This is important so all people have a pleasant environment to live in. Acknowledgement is given that the owners have made arrangements to employ a person to manage and oversee training and they are due to take up their role later in April 2009. However at the time of this visit not all staff had received the training updates that they need. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 8 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Andrews Care Home DS0000072823.V374976.R01.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 St Andrews Care Home DS0000072823.V374976.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information on the home is sufficient to ensure people can make an informed choice as to whether to move into the home or not. EVIDENCE: The statement of purpose was seen to be displayed in the home and a copy was examined. It provided an update on the change of registration and also advised the reader of the appointment of an area manager since its previous edition. The document provided information on the staffing, accommodation and services available at the home. Feedback from people using the service when possible indicated that they felt they had been given enough information, before they decided to move into the home. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 11 On examination of three care files it was noted that all had an assessment of need in place. The principle model in use was the same within all folders, however the standard of entries were not of the same standard and had depended upon which staff member had completed them. Nonetheless there was sufficient information within all of them for staff to determine if they had the skills and experience to meet the persons needs. On speaking with staff they confirmed that they were aware of the content of these documents. Prospective clients are provided with a service user guide to help them in their choice of home. In addition we ask that prospective clients to visit the home prior to admission and we will offer them choice of spending a day or half a day at the home, this will include meals so they can make an informed judgement. Any relevant assessment information from other professionals was present where appropriate and subsequently an appropriate plan of care was developed with due regard to the individuals needs. Intermediate care is not provided at the home. St Andrews Care Home DS0000072823.V374976.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Successful systems are in place to ensure people receive the support from medical professionals to maintain the highest level of health and well being achievable for each person. EVIDENCE: The manager advised that since taking up post she has been working with staff to improve upon the standard of care records in the home. Within the files that were examined each contained a care plan based upon the person centred approach. Each assessed need identified within the assessment had a plan in place alongside a holistic picture of the life of the person including childhood, adolescence and later years. On examining the daily notes over a significant St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 13 period, it showed that improvements to the entries made by staff were being made. The actual entries were of value in being able to know the type of day a person had and what their current level of well being was. The manager uses the information gained from their initial assessment as a basis to prepare initial care plans nutritional assessments and if appropriate pressure relief equipment prior to admission. If the home was unable to meet the needs of the individual then an explanation as to why the placement would be unsuitable would be given. If the referral is from social services then a copy of the care plan would be requested and this copy held on file, this would not replace their pre-admission. The home offers a settling in period of one month and both parties are able to reassess the placement. A formal review is undertaken between six and eight weeks when care plans will be agreed. The home uses the Alzheimers Society method of strength based, person centred care planning which looks at the whole person and includes spiritual and holistic care planning. This is continually evaluated throughout the persons stay at St Andrews. The manager feels it important to liase closely with relatives as placing a person in the care of others can be very worrying time and she likes to make herself available to help alleviate any concerns they may have. The home also encourages prospective clients to bring personal belongings into the home. The staff team have developed excellent links and liase with the multi disciplinary team to gain their advice and support to ensure people receive the specialist care that they need. Documents viewed showed that regular appointments are made at hospitals, General Practitioners are called upon when needed and nursing staff. The home adapts to the needs of the clients and can accomodate individual choices such as smoking. Medication systems were looked at and a random audit undertaken. All records and balances of medication were noted to be correct. Storage of medication was secure and the amount of stock held within the home was minimal. Staff who administed medication had all received training in this area. An observation of the morning medication round was undertaken. The member of staff was noted to follow safe practice in the administration of medication throughout. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 14 The home has a new website to promote the homes aims and objectives along with the facilities and services we offer St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to partake in activities and to be part of the community and this ensures that their individual social needs are met. EVIDENCE: Information on display on a board in the hallway showed that a range of opportunities are available for people to go out shopping or to the local park. One member of staff spoken to confirmed that people were given the opportunity to go out most days if they wanted to. A range of other activities are also available, for example during this inspection many people were having a manicure given by staff. An observation was made at breakfast time. This meal was given to people when they woke; there was not a set time that it was given, so providing St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 16 flexibility. A breakfast cook employed at the home maintained an encouraging interaction with everyone, whilst serving them their breakfast, it was very clear that she had developed very supportive relationships and the reaction of people living at the home to her was very positive. The stocks of food held at the home were looked at, and it was noted that there was sufficient amounts and types to provide the menu available. Fresh salad, fruit and vegetables are provided at the home alongside protein and carbohydrates providing a nutritionally balanced diet. Options available to people in maintaining control, independence and choices in their lives included, choice of meals, voting, choice of clothing, access to a complaints procedure and access to community healthcare support. People living at the home and records confirmed that the choices associated with people’s daily lives were available to them whilst living there. St Andrews Care Home DS0000072823.V374976.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place at this home for receiving and investigating complaints is positive and responsive to assure people that their concerns will be received, listened to and acted upon. EVIDENCE: The complaints procedure is clear and gives timescales in which the complainant will be responded to. This section is replicated within the other homes in the group in Bedfordshire. There is information on whom to contact if you wished to make a complaint. The management of complaints and concerns are seen to be important to the owners and management of the service as they felt it was another way that they could improve the service. The home had in place a policy on abuse and a copy of the most recent guidance for the Safeguarding of Vulnerable Adults that contained the correct reporting of any alleged abuse. Training records showed staff had received training in this area. During the interviewing of staff they were able to demonstrate that they knew how to report any concerns. In addition the St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 18 owner represents the independent sector on the Bedfordshire Safeguarding Adults Board. Information supplied by the service showed that people can be provided with advocacy service information and that people use the postal voting system. St Andrews Care Home DS0000072823.V374976.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The general standard of cleanliness is good so provides an appropriate environment for everyone living at the home. EVIDENCE: There had been a rolling programme of redecoration in the home since the last inspection. Since that time some carpets had been replaced and some re decoration in some areas. However further repair and redecoration is still required. Some of the ground floor corridor areas require re decoration as areas of the wall are scuffed and marked. The manager confirmed that she had identified areas that needed further improvement. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 20 There is a small enclosed garden to the rear of the building that has places to sit out in and a wooden structure that is used as a smoking area. There are planting areas and the garden is well maintained. All areas of the home were noted to be clean and free of any odours. Best practice in relation to infection control was seen to be carried out by the staff at both visits. Stocks of aprons and gloves were in place as was appropriate with the disposal of clinical waste. St Andrews Care Home DS0000072823.V374976.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment systems protect the people living at the home. EVIDENCE: Comments from people living at the home on this inspection included that the staff were kind, competent and caring and that they felt there were sufficient numbers on duty to meet their needs. Relatives comments received in the main also reported that they felt there to be enough staff to provide care to the residents. Sample checks of staff files were undertaken to look at recruitment practices it was noted all files contained application forms, references and photographic evidence of identity. In addition evidence was seen that a criminal records bureau check had also been undertaken on all staff. Training records and plans were examined. These showed that there was a deficit in some of the areas required. Information supplied by the service St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 22 stated that the new training manager is going to be working on a rolling training programme to support learning and development, with the assistance of this programme training will be more readily available and accessible for staff. The company have also invested in a new computer system that will assist to identify any shortfalls in this area. The rota available clearly identifies which staff are on duty, the staffing level and choice of staff relate directly to the clientele catered for. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are sufficent to reduce the risks associated with this area for the people living at the home. EVIDENCE: Staff spoke about an open and friendly management style at the home as they did at the previous inspection. The new manager took up her post in October 2008 and has made several improvements since her appointment. Her focus St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 24 has been within the health and social care section and the development of person centred care. The owner continues to undertake monitoring visits at the home in line with the regulations, concentrating on different standards each time, and reports back to the manager and staff afterwards. Staff spoken to were aware of these checks and viewed them positively. In addition there are other local quality assurance initiatives in place. Meetings are held for residents and families. Surveys of the views of people living at the home and their relatives had been carried out in November 2008. The maintenance person completes fire and other health and safety checks and records are kept. The owner is quick to rectify any problems identified by other regulatory bodies. No monies are kept for people living at the home. St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 25 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 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 23 Requirement Repair or redecoration must take place in the areas outlined by the manager to ensure all areas provide a homely environment in which to live. Timescale for action 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Andrews Care Home DS0000072823.V374976.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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