Care Home: St Andrews House Nursing Home

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What the care home does well People were given enough information about the services and facilities available at St Andrews House; this helped them to make a choice as to whether their needs could be met. Senior staff collected detailed information about prospective residents before they were admitted to ensure people`s needs and aspirations could be met. Individual plans contained useful information about resident`s personal, social and healthcare needs and had been updated to reflect current care needs; this helped staff to look after people properly. One visitor said `my father is well looked after and seems to be happy` another said `they make them as comfortable as they can in every way`. Each resident had a designated key worker to assist them with personal tasks and some residents had developed special friendships with their key workers. Residents said they were encouraged to make decisions and choices about their care and that staff listened to them. They said they were able `to do what they wanted`. Visitors said residents were `supported to live the life they chose`. Residents participated in the day-to-day running of the home including meetings, individual and group discussion, satisfaction surveys and in the interview and selection of new staff. Residents were provided with and supported to take part in a range of suitable activities that were suited to their diverse social and physical needs. Family and friends were welcomed into the home and could visit in any area of the home. Privacy was respected in a number of ways; staff were seen knocking on doors and waiting for permission to enter, one room had a doorbell in place and others had `please knock` or `do not enter` notices. The meals were varied and nutritious and alternative meals were offered; it was clear from records and discussions with residents that they had been involved in decisions about menus. The staff group was balanced to allow residents to choose male or female staff of various ages to assist them with personal care. The complaints procedure was clear and people knew how to make a complaint. A record had been maintained which showed that complaints and concerns were dealt with appropriately and within the agreed timescales. The home was comfortable, safe, bright, clean and homely and met people`s individual needs; a range of technical aids and equipment were available to help them to maintain their comfort, mobility and independence. The home had a qualified physiotherapist, physiotherapy aides and qualified nursing and care staff; there was also a gym and therapy pool to ensure resident`s specialised needs were met. Staff were competent, qualified and sufficient in numbers to meet resident`s diverse needs. Visitors commented that staff were `skilled and experienced`. People`s views and opinions were sought about whether the home was meeting their needs and expectations. Records showed the home was safe and people`s health, safety and welfare had been protected. One resident said `I find the care very good` and a visitor said the care was `excellent`. A member of staff commented that they gave `a good standard of care and a lot of support to each individual` another commented that `quality care is provided`. What has improved since the last inspection? The information about services and facilities at St Andrews House had been made available in different formats including large print and DVD so that everyone could read them. The medication policies and procedures had been reviewed to ensure staff had clear and safe guidance. Records showed that resident`s medicines were managed safely. It was clear that areas of the home had been improved although there was still no plan to support further improvements. Recruitment records showed that a safe recruitment practices had been followed; this could protect residents from being cared for by unsuitable people. There was evidence that residents were involved in decisions about whether new staff would be suitable to care for them. Policies and procedures had been reviewed and updated to provide staff with safe guidance and systems had been introduced to monitor whether staff were following policies and procedures in their daily work. Most of the staff had received safeguarding training to help them to respond appropriately to any suspicion or allegation of abuse; this would make sure residents were protected form harm. CARE HOME ADULTS 18-65 St Andrews House Nursing Home 37 Rainhall Road Barnoldswick Lancashire BB18 5DR Lead Inspector Mrs Marie Matthews Key Unannounced Inspection 6th May 2008 10:00 St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 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 St Andrews House Nursing Home DS0000022474.V358969.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 Adults 18-65. 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. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews House Nursing Home Address 37 Rainhall Road Barnoldswick Lancashire BB18 5DR 01282 816701 01282 816508 standrefitzpa@btconnect.com 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) Oakfoil Limited Ms Jean Harriet Shaw Care Home 24 Category(ies) of Physical disability (24), Physical disability over registration, with number 65 years of age (3) of places St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing will be in accordance with the Notice issued on 9th November 1998 30th April 2007 Date of last inspection Brief Description of the Service: St Andrews House is a large detached property located in the centre of Barnoldswick. It is registered to provide both nursing and personal care for twenty-four people who are physically disabled. Both men and women live in the home. The majority of rooms are single and all bar two include en-suite toilet and hand basin. There are three shared rooms that also have en-suite facilities. All rooms meet the minimum size requirement to allow people who use a wheelchair to be accommodated. There is a passenger lift to the first floor. The home is well provided with communal space. This includes a small gym and hydro pool that is open five days a week and managed by the physiotherapist and physiotherapy aide. There is limited outdoor space with a small garden area to the front of the building and a patio to the rear. However Barnoldswick is well adapted to the use of wheelchairs with many pavements being wheelchair friendly and local shops and facilities being easily accessible. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £585.29 to £1073.50. Items not included in the fee include newspapers, toiletries, hairdressing, private chiropody and dental fees. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The key unannounced inspection, including a visit to the home, took place on 6th May 2008. The inspection process included looking at records, a tour of the home, and discussions with the registered provider, registered manager, two care staff and three residents who lived in the home. Information was also included from survey forms filled in by fourteen residents, six visitors and eight staff. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were eighteen residents living in the home on the day of the inspection. What the service does well: People were given enough information about the services and facilities available at St Andrews House; this helped them to make a choice as to whether their needs could be met. Senior staff collected detailed information about prospective residents before they were admitted to ensure people’s needs and aspirations could be met. Individual plans contained useful information about resident’s personal, social and healthcare needs and had been updated to reflect current care needs; this helped staff to look after people properly. One visitor said ‘my father is well looked after and seems to be happy’ another said ‘they make them as comfortable as they can in every way’. Each resident had a designated key worker to assist them with personal tasks and some residents had developed special friendships with their key workers. Residents said they were encouraged to make decisions and choices about their care and that staff listened to them. They said they were able ‘to do what they wanted’. Visitors said residents were ‘supported to live the life they chose’. Residents participated in the day-to-day running of the home including meetings, individual and group discussion, satisfaction surveys and in the interview and selection of new staff. Residents were provided with and supported to take part in a range of suitable activities that were suited to their diverse social and physical needs. Family St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 6 and friends were welcomed into the home and could visit in any area of the home. Privacy was respected in a number of ways; staff were seen knocking on doors and waiting for permission to enter, one room had a doorbell in place and others had ‘please knock’ or ‘do not enter’ notices. The meals were varied and nutritious and alternative meals were offered; it was clear from records and discussions with residents that they had been involved in decisions about menus. The staff group was balanced to allow residents to choose male or female staff of various ages to assist them with personal care. The complaints procedure was clear and people knew how to make a complaint. A record had been maintained which showed that complaints and concerns were dealt with appropriately and within the agreed timescales. The home was comfortable, safe, bright, clean and homely and met people’s individual needs; a range of technical aids and equipment were available to help them to maintain their comfort, mobility and independence. The home had a qualified physiotherapist, physiotherapy aides and qualified nursing and care staff; there was also a gym and therapy pool to ensure resident’s specialised needs were met. Staff were competent, qualified and sufficient in numbers to meet resident’s diverse needs. Visitors commented that staff were ‘skilled and experienced’. People’s views and opinions were sought about whether the home was meeting their needs and expectations. Records showed the home was safe and people’s health, safety and welfare had been protected. One resident said ‘I find the care very good’ and a visitor said the care was ‘excellent’. A member of staff commented that they gave ‘a good standard of care and a lot of support to each individual’ another commented that ‘quality care is provided’. What has improved since the last inspection? The information about services and facilities at St Andrews House had been made available in different formats including large print and DVD so that everyone could read them. The medication policies and procedures had been reviewed to ensure staff had clear and safe guidance. Records showed that resident’s medicines were managed safely. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 7 It was clear that areas of the home had been improved although there was still no plan to support further improvements. Recruitment records showed that a safe recruitment practices had been followed; this could protect residents from being cared for by unsuitable people. There was evidence that residents were involved in decisions about whether new staff would be suitable to care for them. Policies and procedures had been reviewed and updated to provide staff with safe guidance and systems had been introduced to monitor whether staff were following policies and procedures in their daily work. Most of the staff had received safeguarding training to help them to respond appropriately to any suspicion or allegation of abuse; this would make sure residents were protected form harm. What they could do better: All residents should have copies of contracts or statement of terms and conditions to ensure they were aware of their rights and obligations whilst residing at the home. Healthcare needs were regularly assessed and action to be taken to meet those needs had been recorded in the individual plans; however staff needed to ensure, where appropriate, that the plans included full details in respect of care. The home had procedures for safeguarding adults but these did not give staff clear, specific guidance regarding whom to refer incidents to; the lack of clear procedures could put residents at risk. The recruitment procedure did not provide clear guidance to be followed to ensure residents were protected from being cared for by unsuitable people. It was clear that some areas of the home were still in need of improvement; there was no formal plan to support ongoing work to improve the home for the residents who lived there. One visitor said they ‘need to make the home more inviting’ and suggested decorating, new carpets, new furnishings and new bedding. Staff also indicated that the home could be improved by improving the décor. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 8 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. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had the information they needed to make an informed choice about where to live. Detailed assessments about residents were completed, prior to admission, to ensure their needs and aspirations could be met. EVIDENCE: Information about the home was provided in the form of a service user guide and a statement of purpose. The service user guide was available in suitable formats (large print and DVD) to residents and their families and friends and displayed in the entrance at wheelchair height; the information was clear and informed people about the services available at St Andrews House. Survey information indicated that people were given enough information about the home and this helped them to make a choice as to whether their needs could be met. There had been no new residents since the last key inspection. However it was clear from the records that care was regularly reviewed and residents and significant others had been involved in this process. The registered manager said that all residents would have a detailed assessment of their needs prior to admission, followed by a letter confirming their needs could be met. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 11 Nursing care was provided by qualified nursing staff and residents rehabilitation and qualified health professionals assessed therapeutic needs; the physiotherapist and physiotherapist aide who were employed at St Andrews House provided ongoing treatment. Records showed that staff had the skills and experience to meet resident’s needs. Two of the three residents had been given copies of contracts or statement of terms and conditions; this would ensure they were aware of their rights and obligations whilst residing at the home. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans contained information about personal, social and healthcare needs and had been updated to reflect current care needs. Residents were able to make decisions about all aspects of their lives and in the day-to-day management of the home. EVIDENCE: Three residents individual plans were looked at in detail. The plans had been developed from assessment information and included details about all areas of the resident’s life with evidence that the individual, their family, friends or advocate had been involved in this process. The individual plans were not available in any other format or held by the resident although the registered manager said they could have access at any time. There was evidence to support residents and their relatives had been involved St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 13 in decisions about care and the individual plans had been reviewed and updated to reflect their current care needs. Visitors commented that they were kept up to date and informed of any changes to care. Each resident had a designated key worker to assist them with personal tasks; residents had developed special friendships with their key workers and were able to talk to them about all aspects of their care. Advocates were provided for residents who needed advice and support from someone other than a family member; information about advocates was made available to residents. Residents said they were encouraged to make decisions and choices about their care and that staff listened to them. They said they were able ‘to do what they wanted’. Visitors said residents were ‘supported to live the life they chose’. Records showed that residents were able to manage their own finances with support from staff at the home. Clear records were maintained of any assistance given and these were audited regularly. Residents participated in the day-to-day running of the home including meetings, individual and group discussion, satisfaction surveys and in the interview and selection of new staff. Any restrictions on choice and freedom had been fully discussed and documented in the plan and risk assessments were in place to minimise any risk of harm to people. Residents were able to take responsible risks and had been involved in discussion about those risks. The use of bed rails was fully documented and there was evidence to support this had been discussed with residents and their relatives to make sure it was an appropriate method to use. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents had access to and were supported to participate in a range of appropriate leisure activities that met their diverse social and personal needs. The home promoted resident’s independence, choice and decision-making. Meals were nutritious and varied and alternatives were offered to ensure everyone received a healthy diet. EVIDENCE: From observation, records and talking to residents it was clear that every effort was made to help them to take part in a range of suitable activities that were suited to their diverse social and physical needs. Residents chose how to spend their day; staff supported them with their decisions. An activities person was employed and support was given either in small groups of residents with similar interests or individually for those who were unable to and preferred not to participate in group activities. Records of activities and entertainments were St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 15 unavailable; the registered manager was advised all records should be available for inspection to determine whether people’s social needs were being met. Residents were seen playing dominoes whilst others were sat outside enjoying the sunshine and talking to staff, visiting the local shops or in their rooms watching TV. One visitor had commented that more activities were needed but said that the provision of activities and trips out had improved; another said staff ensured her son was provided with the stimulation he needed she said ‘he is occupied to keep his mind alert’. None of the residents were employed although they made full use of the facilities in the local community. Residents would be supported to attend the local churches or arrangements could be made for the local minister to visit them to ensure their religious needs were met. Information about local facilities and activities was displayed on the notice board to enable residents to become more involved in the local community. Residents were supported with their right to vote and were able to vote by post or helped to visit the polling station. Individual records did not include a detailed social history that would be useful in planning suitable activities although the current residents were able to make their needs known; this was discussed with the registered manager. A number of residents were planning to go on holiday during the summer months and said they were looking forward to going; one resident had organised a holiday for himself and another resident. The registered manager said holidays would be arranged in small groups of residents with similar interests or who had special friendships. There were no restrictions on visiting and people were welcomed into the home; residents were able to meet and make friends with people in the community. Resident’s privacy was respected in a number of ways; staff were seen knocking on doors and waiting for permission to enter, one room had a doorbell in place and others had ‘please knock’ or ‘do not enter’ notices. Residents would open their own mail or would be supported by their key worker; preferred names and nicknames were recorded on the individual plans and were used by staff. Staff chatted with residents and visitors to the home in a friendly manner and there was a relaxed friendly atmosphere. The daily menus were displayed in the dining room. The menus did not detail a choice of meal however other records supported that alternatives meals were provided at each mealtime. Residents said they enjoyed the food and could dine in the dining room or in other areas of the home. The meals were varied and nutritious and it was clear from records and discussions with residents St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 16 that they had been involved in decisions about menus; the cook was aware of residents likes and dislikes and every effort was made to provide them with meals that they enjoyed. Nutritional needs were regularly reviewed and dieticians had been consulted if someone was thought to be nutritionally at risk. Staff were seen assisting and supporting residents at mealtimes when needed. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual plans contained enough information to ensure staff met resident’s personal and healthcare needs. Medication policies and procedures provided staff with safe guidance and staff had managed medicines safely. EVIDENCE: Three individual plans were looked at in detail. The plans contained detailed information about the personal support and nursing care that residents needed and preferred and included a range of assessments of risks affecting their safety. The plans included information about how residents were moved and transferred ensuring safety was maintained and a range of specialised aids and equipment were available to help them to maintain their comfort and independence. One visitor said ‘my father is well looked after and seems to be happy’ another said ‘they make them as comfortable as they can in every way’. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 18 The home had a qualified physiotherapist, physiotherapy aides and qualified nursing and care staff to ensure resident’s specialised needs were met; the home also had a gym with therapy pool to meet residents rehabilitation needs. Additional support was provided from other specialist and health professionals when required to help maintain resident’s health and well being. One visitor said ‘they always call the GP if there is a problem’. Healthcare needs were assessed and action to be taken by staff to meet those needs had been recorded in the individual plans; however staff needed to ensure that if a risk had been identified there should be sufficient information in the care plan to guide staff and that more frequent reviews should be undertaken if there was a high risk identified. The staff group was balanced to allow residents to choose male or female staff of various ages to assist them with personal care. Residents confirmed they were able to choose and shop for their own clothing and that the routines of the home were flexible. The medication policies and procedures had improved and provided staff with clear and safe guidance. Records showed that resident’s medicines had been managed and stored safely. Regular management checks had been introduced to monitor whether staff were following policies and procedures. There were procedures to support staff with ageing, death and dying. The registered manager said that extra carers were made available so that key workers could sit with a dying resident. Most residents and staff attend funerals and one resident performed the reading and chose hymns for his friend who died recently. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People knew how to make a complaint and felt their concerns would be responded to appropriately. The adult protection procedures needed to be improved to ensure staff had appropriate guidance to recognise and respond to abuse. Staff had the skills and knowledge to ensure residents were protected from harm. EVIDENCE: The complaints procedure was clear and accessible. Surveys indicated that people knew how to complain and were confident their issues would be responded to appropriately. There had been no complaints made in the last twelve months. The safeguarding adults (abuse) procedures had been improved although still needed minor adjustment to ensure they reflected clear guidance. The registered manager was given advice on how to develop the procedure. Most of the staff had received safeguarding training and further updates were to be arranged; this would ensure they would respond appropriately to any suspicion of abuse. Staff were able to discuss how they would recognise and respond to abuse; this confirmed they had understood the training and residents would be safe from harm. In the last twelve months there had been one incident of abuse referred through the Protection of Vulnerable Adults procedures; at the time the incident had not been dealt with according to the safeguarding St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 20 procedures but the registered manager had since responded to guidance and improved staff awareness and protected residents. Staff said there was a procedure to support them with reporting any concerns about bad practice; this ensured residents would be safe from harm. Financial records were looked at and showed that the home followed safe procedures to protect resident’s finances. Procedures need to be developed to ensure staff had clear and safe guidance when dealing with resident’s monies. A policy was in place to guide staff with the safe use of any restraint measures such as bed rails or wheel chair lap straps; the use of restraint or restrictions were supported by risk assessments and had been discussed with the residents or their relative. Records showed staff had attended training to help them to respond appropriately and safely to verbal and physical abuse although procedures need to be developed to support staff with this aspect. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was comfortable, safe, bright, clean and homely and met resident’s individual needs although there was no formal plan to support further developments and ongoing improvements. EVIDENCE: The home was comfortable, safe, bright, clean and homely and met resident’s individual needs. Disabled access and adaptations and equipment were provided to assist residents with comfort, mobility and independence. It was clear that some improvements had been made since the last key inspection although some areas of the home were still in need of improvement. The registered manager said there was a plan to support ongoing improvements although this was not available at the time of the visit. One visitor said they ‘need to make the home more inviting’ suggestions St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 22 included decorating, new carpets, new furnishings and new bedding. Staff also indicated that the home could be improved by improving the décor. All bedrooms had en-suite facilities and were pleasant, comfortable and homely; residents were happy with their rooms and had personalised them to enhance the homely feel. One resident said he had been consulted about the décor and had chosen the furniture and wallpaper; rooms had been decorated with consideration for the individual persons needs and preference. Only one bedroom was shared and this was with the agreement of the residents concerned. Bathrooms and toilets were fitted with appropriate aids and adaptations to meet resident’s needs and all rooms had en-suite facilities to enhance resident’s privacy and dignity. Communal areas were clean and bright although the conservatory was still in need of blinds as the temperature was very hot in the sunshine. The registered manager had introduced regular audits of areas of the home; this would ensure the home was pleasant for people to live in. Residents and visitors to the home said the home was always bright, clean and odour free. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team were experienced, supported, competent and sufficient in numbers to meet resident’s needs. Recruitment practices had improved although the lack of clear recruitment procedures could put residents at risk. EVIDENCE: The training plan supported that staff were competent and qualified to meet resident’s diverse needs and that a range of training had been provided to develop and maintain staff skills and to ensure people were safe. Visitors commented that staff were ‘skilled and experienced’. Staff confirmed they received supervision and support from senior staff and this helped to identify any training and development needs. Staff meetings were held regularly and staff said they were able to voice their opinions and felt they would be listened to. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 24 New staff had completed inductions within the first three months followed by a review of performance to determine whether they were suitable to care for residents at St Andrews House. Staff duty rotas were clear and showed staff were provided in sufficient numbers to meet resident’s needs; there was a low use of temporary staff which ensured residents received care from staff who were aware of their needs. Residents and staff said there were sufficient staff. The home also employed a qualified physiotherapist and aide to meet resident’s rehabilitation needs. Male and female staff of various ages were employed to reflect the ages, cultures and genders of residents who lived in the home. The recruitment procedure was in the form of a checklist and did not fully detail a safe procedure that would protect residents. Three staff files showed that safe recruitment practices had been followed although the reasons for gaps in employment should be recorded clearly on the staff file to evidence that these had been discussed. All the required checks were in place prior to employment as this would help to determine whether the person was suitable to work at the home. However the ‘character’ reference form did not include details about the referee or the date on which the reference was supplied. Records showed that residents had been involved in decisions about whether new staff would be suitable to care for them. One resident said ‘I find the care very good’ and a visitor said the care was ‘excellent’. A member of staff commented that they gave ‘a good standard of care and a lot of support to each individual’ another commented that ‘quality care is provided’. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a well managed home and their health, safety and welfare was promoted and protected. People’s views and opinions were sought and they were involved in decisions about how the home was run. EVIDENCE: The registered manager is Jean Shaw. Ms Shaw is a registered nurse with experience to manage the home; she has achieved the registered manager award that will support her with the management aspects of her role. One resident said ‘I find the management easy to talk to about any problems’. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 26 The home had achieved the Investors In People award; this was a recognised quality assurance system that measured whether the home was meeting some of its aims and objectives. People’s views and opinions had been sought by regular satisfaction surveys; the results had been collated and made available to people. Regular meetings for staff, residents and their relatives had taken place; this enabled people to be involved in decisions about the day to day running of the home and to voice any concerns they may have. Policies and procedures had been reviewed and updated although some procedures needed to be reviewed or developed to ensure staff had clear and safe guidance in all aspects of their work. Formal systems had been introduced that would monitor whether staff were following policies and procedures in their daily work. The registered manager was advised that names and details should be included in the records to provide a clear audit trail. Action had been taken to respond to any requirements and recommendations from the last key inspection. The AQAA had been returned when it had been asked for and gave us clear information about the current situation in the home. Records showed St Andrews House was safe and people’s health, safety and welfare had been protected. Staff had received regular safety updates that would ensure they were able to keep themselves and others safe. St Andrews House Nursing Home DS0000022474.V358969.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 Adults 18-65 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 3 2 3 3 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 2 3 3 3 X 3 X X 3 X St Andrews House Nursing Home DS0000022474.V358969.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 YA19 Regulation 13 Requirement Any risks to residents health must be recorded in the individual plan and include details of any action to be taken to reduce or remove the risk. The safeguarding adults procedure must provide staff with clear and specific guidance regarding whom to refer incidents to. Timescale 25/06/07 not met. 3. YA34 13 The recruitment procedure must detail a safe and robust procedure for staff to follow. 07/07/08 Timescale for action 07/07/08 2. YA23 13 07/07/08 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. 2. Refer to Standard YA5 YA14 Good Practice Recommendations All residents should have a copy of their contract on file. Records should be available to support all residents have had access to suitable activities. DS0000022474.V358969.R01.S.doc Version 5.2 Page 29 St Andrews House Nursing Home 3. 4. YA19 YA23 More frequent reviews of assessments should be undertaken if any risks to resident’s health are identified. Procedures need to be developed to ensure staff had clear and safe guidance when dealing with resident’s monies. Procedures need to be developed to support staff with dealing appropriately with verbal and physical abuse. There should be a formal plan to support ongoing improvements to the environment indicating timescales for completion. The registered person should consider fitting suitable blinds in the conservatory. 5. YA24 6. YA34 The reasons for any gaps in employment history should be recorded. The ‘character’ reference form should include the name, address and capacity of the referee and the date on which the reference was supplied. St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI St Andrews House Nursing Home DS0000022474.V358969.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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