Care Home: St Anne`s (Holsworthy)

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What the care home does well One of the people who responded to the survey said "Generally very happy and satisfied with the home, staff and care received. Staff and owners are extremely kind and helpful. I feel safe and well looked after". Comments from relatives of people at St Anne`s, when asked about what they thought the home did well, include: "Always friendly and welcoming to myself and my mother", "Make it feel like their home and part of a family", and "They make my mother happy and comfortable, in fact since her decision to go to St Anne`s she`s happier than I can ever remember". St Anne`s provides a good standard of accommodation. The bedrooms are spacious enabling people to take items of their own furniture. All of thebedrooms have en-suite facilities. The lounge and dining rooms are large and there is level access to an outside paved area. The people at St Anne`s are well supported, they feel that staff listen and act upon what they say. If they have concerns or complaints they, or their relatives, feel confident to raise these. Staff have received training about how to protect people from abuse. A range of activities are provided and people who respond to the surveys thought that there were sufficient. Relatives felt that they are kept up to date with important issues and that the home helped their relative to keep in touch. The meals are of a good standard, and generally enjoyed by the people at St Anne`s. Tea time is early, 4.30pm for people who eat in their rooms and 5pm for those who eat in the dining room. However we are reassured that this suites the people at St Anne`s and that supper is provided later in the evening. Staff are competent and receive training to ensure that they are safe in their work. The people who live at St Anne`s feel that there are staff available when they need them, and that staff are friendly and polite. The home is generally well managed, and the views of the people who visit or live at St Anne`s are sought and taken into account. What has improved since the last inspection? Changes have been made to both the complaints procedure and to the policy about protecting people from abuse. The complaints procedure is now displayed in the hallway, and the policy relating to protection of people from abuse has been amended as was required. The Registered Manager noted in the quality survey that one of the areas of improvement was in the promotion of awareness of adult protection. A system has been set up to survey the views of the people living at St Anne`s, and these views have been collated so that it can easily seen where people are happy or dissatisfied with the service. Improvements have been made in the daily recording. These records are now more complete and contain useful information about the care provided. People are now being weighed, thought this is not always on a regular basis. People need to be weighted on a regular and frequent basis when there are concerns about their weight. What the care home could do better: We found that everyone received an assessment to determine their care needs, however for people visiting the home for respite care this assessment could be as they arrived at the home. Pre-admission assessments need to beboth completed, and written down in sufficient time to allow both the person thinking of moving and the care home to determine if care needs can be met. We found that whilst medication was generally well managed improvements needed to be made in relation to the storage of controlled drugs, in relation to determining the risk and support needs for people who self medicated, and in relation to only using medication (lactulose) for people for whom it is prescribed. We found that one of the conditions of registration was that there should be two care staff on waking night duty, however whilst there are two staff on night duty, one of these may sleep for part of the night. The home was well maintained and checks had been made of fire safety however we found that some areas of safety had not been assessed or checked as is required, such as electrical appliances. CARE HOMES FOR OLDER PEOPLE St Anne`s (Holsworthy) Whitstone Holsworthy Cornwall EX22 6UA Lead Inspector Helen Tworkowski Unannounced Inspection 14th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Anne`s (Holsworthy) Address Whitstone Holsworthy Cornwall EX22 6UA 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) P/F01288 341355 P/F01288 341355 Mrs Helen Medland Mr Herbert John Medland Mrs Dawn Parnell Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 28 adults of old age (OP) Two waking night care staff must be available on the premises Total number of service users not to exceed a maximum of 28 Date of last inspection 17/7/07 Brief Description of the Service: St Annes offers care and accommodation to people in need of care by reason of old age. It is situated in the village of Whitston that is midway between Launceston, Bude & Holsworthy. The home, which is privately owned, is relatively new having been created from redundant farm buildings. It provides rooms of a good size, all with ensuite facilities for the service users. There are large communal areas in different parts of the home for the use by all. Externally the courtyard around which the home is built is tarmacd with a water feature. There is good car parking available. A copy of the Statement of Purpose and Service User Guide, documents that tell me people about the home and the services provided, are available from the office at the home. The fees for the home vary between £365 and £400, and do not include: clothes, toiletries, chiropody, hairdressing, newspapers and other personal items. St Anne`s (Holsworthy) DS0000009221.V365338.R02.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. This inspection included a site visit that started at 9.30am and finished at 6.10 pm on 14th July 08. The Manager Mrs Dawn Parnell was on site during the afternoon of the visit. As part of this inspection we looked at the care of three particular individuals. We looked at care records, accident files, risk assessments, and other recording. We talked with care staff about care and met with the three individuals. We also looked at the way medication is managed and watched medication being administered. We looked at the staff recruitment and training and talked with staff about their experience of working in the care home. We looked around the home and talked with some of the residents about their experience at St Anne’s. As part of this inspection we sent also surveys to the people who live at St Anne’s, six surveys were returned. Surveys were also sent to staff, (one survey was returned), to relatives, (five were returned) and to a visiting health care professional. In addition the Commission received a quality assurance questionnaire completed by the Registered Manager that gave information about the home and changes in the previous twelve months. What the service does well: One of the people who responded to the survey said “Generally very happy and satisfied with the home, staff and care received. Staff and owners are extremely kind and helpful. I feel safe and well looked after”. Comments from relatives of people at St Anne’s, when asked about what they thought the home did well, include: “Always friendly and welcoming to myself and my mother”, “Make it feel like their home and part of a family”, and “They make my mother happy and comfortable, in fact since her decision to go to St Anne’s she’s happier than I can ever remember”. St Anne’s provides a good standard of accommodation. The bedrooms are spacious enabling people to take items of their own furniture. All of the St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 6 bedrooms have en-suite facilities. The lounge and dining rooms are large and there is level access to an outside paved area. The people at St Anne’s are well supported, they feel that staff listen and act upon what they say. If they have concerns or complaints they, or their relatives, feel confident to raise these. Staff have received training about how to protect people from abuse. A range of activities are provided and people who respond to the surveys thought that there were sufficient. Relatives felt that they are kept up to date with important issues and that the home helped their relative to keep in touch. The meals are of a good standard, and generally enjoyed by the people at St Anne’s. Tea time is early, 4.30pm for people who eat in their rooms and 5pm for those who eat in the dining room. However we are reassured that this suites the people at St Anne’s and that supper is provided later in the evening. Staff are competent and receive training to ensure that they are safe in their work. The people who live at St Anne’s feel that there are staff available when they need them, and that staff are friendly and polite. The home is generally well managed, and the views of the people who visit or live at St Anne’s are sought and taken into account. What has improved since the last inspection? What they could do better: We found that everyone received an assessment to determine their care needs, however for people visiting the home for respite care this assessment could be as they arrived at the home. Pre-admission assessments need to be St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 7 both completed, and written down in sufficient time to allow both the person thinking of moving and the care home to determine if care needs can be met. We found that whilst medication was generally well managed improvements needed to be made in relation to the storage of controlled drugs, in relation to determining the risk and support needs for people who self medicated, and in relation to only using medication (lactulose) for people for whom it is prescribed. We found that one of the conditions of registration was that there should be two care staff on waking night duty, however whilst there are two staff on night duty, one of these may sleep for part of the night. The home was well maintained and checks had been made of fire safety however we found that some areas of safety had not been assessed or checked as is required, such as electrical appliances. 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 Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable in this home) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People coming to stay at the home, particularly for a short stay, cannot always be assured that all their needs will be recorded, known, and therefore met from the start of a stay at St Anne’s. EVIDENCE: People come to stay at St Anne’s for long term and care and for respite stays. We looked at what the home knew about people who had recently come to stay at the home. These people were staying for respite visits. We found that assessments had been done on these individuals, and that these provided information about what their particular needs were. However these written assessments were made on the day the individuals started their stay at St Anne’s. We asked staff about when this happened and they confirmed that people staying for respite stays were assessed on admission. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 10 Before someone moves to a care home they must be assessed to see if their needs can be met. The home must confirm to them that this is the case. By carrying out the assessment at the time the person is just arriving to stay at the home there is little opportunity to prepare for any particular needs the person might have or to conclude that the home is not suitable. This may also be a stressful time for a person, so not the best time to carry out an assessment. Pre admission assessments also give the prospective resident a chance to find out about the home and if it will suit them. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at St Anne’s can be confident that their care needs will be met and that staff will listen and act upon what they say. Medication is generally well managed however areas were identified where improvements must be made. EVIDENCE: The six people who responded to surveys about the help they receive said that they always (five) or usually (one) got the help and support they need. All six people responding said that staff listened and acted upon what they said. One person commented that the staff are friendly and polite. One healthcare professional responding to a survey said that peoples’ health care needs are usually met by the service. Of the six relatives responding to a survey three thought that their relatives always got the care they expected or had been agreed, whilst three thought that this was usually the case. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 12 We looked at the way care and support is provided to three people in the home. We looked at the documents about their care, talked with staff and with met with the individuals. Information about the help a person needs is contained in a care plan or service user plan. We found that each person had a care plan that contained information about the sort of help that was needed. These documents had been reviewed to keep the information up to date. The information was sufficient to provide care, though were not particularly detailed. We asked staff what they knew about particular people and they were able to explain what needs were and the help that was needed. We asked staff if they had read the care plans and was told that they had not seen these documents. Information about what help people needed was passed on verbally. The Manager later told us that staff were expected to read care plans, though updates would be passed on verbally. We looked at the information that was recorded about each person each day. There had been a concern at the last inspection that the information was too general. We found that the recording had improved and there were much clearer records of how needs were being met. We also looked at a “bath book” which is also used for recording weights. We discussed with the Manager alternative recording systems so that information was kept separately for each individual. We discussed with the manager recording weights for people where there might be concerns, we talked about how it is important to weigh people more often if there are concerns about their weight. An individual record of weight, rather than one kept in the bath book, allows for better monitoring. We also saw a book that related to checks that night staff made on individuals in the night. We looked at how accidents were recorded and found that an accident report had been completed for each person who had fallen. These reports are left in the accident book. We discussed with the manager the systems she had in place for monitoring accidents. She said that she was satisfied that there were suitable systems in place to monitor the accidents, as she was aware of incidents as they occurred, and took action. There were risk assessments on file, these are documents that identify how risks will be minimised and managed. One area not risk assessed was the use of “bed-rails”. We discussed with the Manager the importance of a comprehensive assessment to ensure that these rails are only used when it is safe to do so. As part of this visit we looked at the way medication was administered. The home uses a monitored dose system where much of the medication is bubble packed by the pharmacist. There were records of medication being properly administered and records of the receipt of medication into the home. During the inspection we noted that a medication (lactulose) belonging to a person St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 13 who was no longer at the home was being administered to other people. Medication may only be given to the person it is prescribed for, and if no longer needed must be returned to the pharmacy. In looking at care plans we noted that one person administers their own medication. Where people are able to do this, this is considered as good practice, however a risk assessment must be completed to ensure that the individual has the necessary skills and support to do this safely. No risk assessment had been completed. We also looked at the way “controlled drugs” are kept. There was a proper record of this medication in a hardback book. The regulations in relation to the storage of such drugs has recently changed. Controlled drugs must now be stored in a proper cabinet, appropriately attached to a wall. Controlled drugs are not currently stored in this manner at St Anne’s. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at St Anne’s are provided with a good range of activities and interests. Meals are well cooked and are enjoyed by the people at the home. EVIDENCE: The surveys returned by people who live at St Anne’s showed that five out of the six people thought that there was always or usually enough activities arranged for them to take part in. People spoken with during this inspection said that there was enough to do, such as knitting, playing scrabble, and watching TV. There is a piano and a visitor to the home plays hymns or other songs at the request of residents. We asked the staff whether they felt that people had enough to do and they confirmed that this was the case, and that residents were able to join in activities such as walks, listening to music and poetry. It was noted in surveys that some people thought that the odd outing would be of benefit. We were told that many of the people who come to St Anne’s for respite or for day visits come from the local community. We were told that this provides an opportunity to see friends and acquaintances, and to keep up with news from St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 15 the local area. The information provided by the Manager says that church services are held regularly in the home, and that some residents also attend local chapel. We talked with the cook about the meals and was told that there is no fixed menu, and meals are planned on a day-to-day basis. We were told that people’s preferences are taken into account. The breakfast is generally toast and cereals although people can have a cooked breakfast if they wish. We were told that lunchtime is at 12.30 to 1pm and teatime is at about 4.30pm for those who choose to eat in their room and 5pm for those who eat in the dining room. We discussed this timing with the Manager, as we were concerned that there was too long a gap between tea time and breakfast the next morning, this would be particularly inappropriate for people with diabetes. The Manager said that a supper, mid evening, was provided. Also that they had tried putting back tea time; however residents had preferred the earlier time. We spoke with one of the people who helps take around the meals, she said that at tea time people are not asked in advance what they want, but are provided a full choice so they can make a selection themselves, at the time. We were also told that fresh fruit is provided each day on breakfast trays. All six of the people responding to surveys said that they always or usually like the meals. One person commented that the food excellent and well presented. Another person said that you needed to specifically request if you want a hot meal in the afternoon or evening. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at St Anne’s can be confident that any concerns or complaints are treated seriously and they will be protected from abuse. EVIDENCE: All six of the of people who responded to the survey of relatives said that the home had responded appropriately if they had raised a concern about care, and five out of the six people said that they knew how to make a complaint if they needed to. All of the people who live at St Anne’s who responded to the survey said that they knew who to talk to if they were not happy and that they knew how to make a complaint. A copy of the complaints procedure is displayed in the hallway, this was a recommendation made at the last inspection. The Adult Protection Policy/Procedure has also been updated to include the role of the Adult Social Care Department. We talked with staff about their understanding of abuse and found that staff had received training in this area and were aware of what to report. We spoke with the Manager about what training staff received, and she confirmed that staff did receive training in relation to protecting people from abuse. Staff also covered this area of care as part of their National Vocational Qualification in Care. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at St Anne’s live in a spacious, clean and well-maintained home. EVIDENCE: St Anne’s has been converted from farm buildings to provide a high standard of accommodation. The bedrooms are of a good size and all have en-suite facilities. The size of the rooms means that people are able to bring in items of their own furniture, so that they can feel more at home. There is a lift to the first floor, and where there are steps, there is a stair lift. The lounge and dining areas are large and spacious. There is a central courtyard area, and there is a level access paved area that we were told is well used in fine weather. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 18 This inspection started at 9.30am, and the home was found to clean and tidy though homely. We looked at the laundry area, where there were sufficient washing machines for the task. There was tablet soap and no paper towels in the laundry for hand washing. We were told that the home did not use paper towels. We discussed the importance of proper hand washing facilities, particularly for staff. We noted that the advice of the Health Protection Agency had not been sought in relation to a recent outbreak of diarrhoea and vomiting. We recommend that the advice of this agency is sought and that hygiene procedures are reviewed to take into account any such advice, so that the spread of any infections can be minimised. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people at St Anne’s are cared for by competent staff who understand the needs of the people for whom they care. EVIDENCE: Five of the six people who responded to the survey said that staff were always available when they needed them, and sixth person said that they were usually available, and went on to say that when staff were busy they sometimes had to wait for a little while. We spoke with two of the staff about whether there were enough staff on duty, they confirmed that there were enough, though some days it could be busy. Only one staff member returned a survey and they also confirmed that there were usually enough staff. The rota showed that there were generally four care staff on duty between 8am and 1pm, 3 care staff from 1pm till 10pm and that there were two staff on duty at night. St Anne’s is registered for 28 people however at the time of the inspection there were 22 people in the home. It has been noted that one of the conditions of registration is that there are two waking night staff. Whilst there are two night staff, only one of the staff is awake all night. The home is required to comply with this condition of registration and must provide two waking night staff. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 20 We looked at the staff recruitment files for a new member of staff. We found that there was an application form on file and that references had been taken. A Criminal Records Bureau check had also been completed, however it was not possible to see if a further “Protection of Vulnerable Adults” check had been made before the individual had started work, as no record of this check was kept and the individuals start date was not readily available. We discussed with the Manager the importance of having well organised systems in relation to staff recruitment particularly in the light of a planned extension to the home. We were shown an induction checklist that had been completed in the first few days of employment, and was told that the individual had a copy of the more comprehensive induction, that they were working through. We looked at the training record for a member of staff who had been employed for more than a year, and saw that the individual had completed their Induction, and had received training in relation to first aid, and in relation to fire (on five occasions). The individual had also started their National Vocational Qualification in Care. Information provided by the Manager shows that out of the 22 permanent staff 12 already have an NVQ 2 or above in care. This demonstrates a reasonable level of competence in the home. The Manager said that she was trained to train staff in relation to moving and handling. We asked staff about moving and handling and they confirmed that they knew what to do. We discussed with the Manager additional training that would develop and keep skills up to date in other areas concerning the care of the elderly, for example in relation to the care of people with diabetes. At the last inspection a requirement had been made that staff must be regularly supervised. The Manager said that following that inspection she had set up a system of carrying out and recording supervisions, however because of pressures in the running of the home this had slipped and the records seen showed that staff had not received supervision since March 08. We discussed with the Manager the importance of setting up systems that would work given the pressures of her role, and that a planned extension to the home was near completion. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. St Anne’s is a well-managed Care Home where peoples’ views are taken into account. The home is generally safe, though some checks are not being carried out as is required. EVIDENCE: The Manager, Dawn Parnell, confirmed in information that she provided to the Commission that she has all the required qualifications in relation to her role. Ms Parnell was not at the first half of the inspection because she was attending training in relation to the Protection of Vulnerable Adults, however one of the owners, Mrs Medland, was available. One of the relatives commented in a survey that, “I am very happy with the standard of St Anne’s Residential Home. In particular the owners and manager are always available”. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 22 The Manager showed us a new quality assurance system that had been set up based on seeking the views of people who had contact with the home. The surveys had been collated and views noted. We discussed with the Manager simple systems for recording where actions had been taken as a result of the surveys. As has already been noted under the section on staffing, staff supervision has not be provided in recent months, the Manager said that this was due to the pressure of work. A new extension to the home is due to be completed in the near future. This will mean more residents and additional staffing. We discussed with the Manager and the owners the impact such changes would have, and that systems that might be suitable for a small home may not work in a larger home. Consideration should be give to developing systems of management that are robust and suited to the requirements of a larger service. We reminded the Registered Providers of the need to inform the Commission of events that affect the running of the home or well being of the people at St Anne’s, including outbreaks of infectious disease such as diarrhoea and vomiting. These reports are known as Regulation 37 notifications. The Manager had sought advice from the relevant medical professionals at the time. We were told that no money is handled on behalf of the people who come to live at the home. However should people not be able to look after their own money, the home is happy to pay for items and to invoice their account. We looked at the fire system, and found that regular checks had been made, and as has already been noted staff had received regular training updates. We were told a new copy of a Fire Risk Assessment was awaited. We talked to the owners about electrical appliance testing, and was told that only visual checks of equipment were needed. However whilst this is the case for most equipment additional more thorough checks are needed for some equipment that is earthed, such as kettles. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 23 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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 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 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14(1) Requirement Everyone who comes to stay in the home must be assessed before they move. This includes people who visit for respite care. Where people are returning for further respite visits, the assessment must be updated. The use of bed rails (cot sides) must be risk assessed to ensure that they are safe to use. Medication must only be administered to the person it is prescribed for, all surplus medication must be returned to the pharmacist. Controlled drugs must be stored in a lockable cabinet that meets the guidance of the Royal Pharmaceutical Society. Where an individual wishes to self medicate, then they must be provided with appropriate support based on a risk assessment. The conditions of registration must be complied with, and two waking night staff must be provided at night. The registered person shall DS0000009221.V365338.R02.S.doc Timescale for action 01/09/08 2. 3. OP8 OP9 13 (4) a 13 (2) 01/09/08 01/09/08 4. OP9 13 (2) 01/10/08 5. OP9 13 (2) 01/09/08 6. OP27 18 (1) a 15/08/08 7. OP36 18 (2) 01/09/08 Page 25 St Anne`s (Holsworthy) Version 5.2 ensure that persons working at the care home are appropriately supervised. This requirement was made at the previous inspection, and has not been met. 8. OP38 13 (4) a Risk assessments and checks must be completed in relation to electrical appliances. 01/11/08 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. 3. Refer to Standard OP8 OP26 OP29 Good Practice Recommendations The recording systems for weights and bathing should be reviewed so that information is kept on an individual basis. The advice of the Health Protection Agency should be sought to review the hygiene practices in the home that might reduce the spread of any infections. The system for recording recruitment checks should be sufficiently thorough that it is possible to readily see that these have been made. St Anne`s (Holsworthy) DS0000009221.V365338.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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