Care Home: St Cecilia

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What the care home does well Peoples` needs are clearly identified before they move into the home. The health and personal care that people receive is based on their individual needs, the principles of respect, dignity and privacy are put into practice. People who use the service are supported to make choices in their daily lives within their capacity to do so. There is an effective complaints procedure in place. There is a policy and training for staff in safeguarding to ensure that people who use the service should be protected from harm. People in the home are supported by staff who have been properly recruited and trained to ensure their needs are met and they are safe. Management and administration of the home ensures that peoples needs are met and the service continues to develop. What has improved since the last inspection? At the end of the key inspection in January 2009 there were five requirements. Care plans have been developed to be more person centred and contain sufficient detail to ensure people`s needs are fully met. There is a system in place to audit medication. The home has an extensive programme of refurbishment which includes furniture and decor. The risks of cross infection have been reduced by improved practice. Work has been done to minimise risk in the home. What the care home could do better: At the end of this inspection there are no requirements and there is one recommendation. It is important that the audit system for medication is consistently applied by staff to ensure the safety of people who use the service. Key inspection report Care homes for older people Name: Address: St Cecilia 29 Nelson Road Branksome Poole Dorset BH12 1ES     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 1 2 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 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. 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: St Cecilia 29 Nelson Road Branksome Poole Dorset BH12 1ES 01202767383 01202767383 st.cecilia29@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Robert John Eshelby care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: One named person (as known by the CSCI) under the age of 65 may be accommodated to receive care. Only independently mobile residents may be accommodated in the second floor rooms. Date of last inspection Brief description of the care home St Cecilia is registered to provide care for up to fifteen older people over 65 years of age with mental health needs. The home is detached and situated in a quiet tree lined residential street. There is easy access to the shops and amenities of Westbourne. Accommodation comprises of six single rooms on the ground floor four of which have en-suite facilities and a further six rooms on the first floor, one of which is a double room and one of which has an ensuite facility. There is a bathroom and WC on both the ground floor and the first floor. The second floor has recently been refurbished and now provides two single bedrooms and a bathroom. There are secluded gardens to the Care Homes for Older People Page 4 of 25 Over 65 15 15 0 0 Brief description of the care home rear of the property and a tarmac drive at the front of the home with trees, shrubs and a seating area. The current level of fees for personal care and accommodation at St Cecilia is 516 pounds based on the local authority rate of payment for care services. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service without any warning. This was a key inspection, so we were looking for improvements since the last key inspection in early 2009. We spoke to people who use the service, we spoke to staff and we spoke to the registered provider who also manages the home. We looked at care files for people who use the service, we looked at recruitment and training files for staff, we looked at a range of health and safety information and we toured the building. We looked at information sent to us since the last inspection. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Care Homes for Older People Page 7 of 25 order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 who use the service have their needs assessed before a decision is taken to move into the home. Evidence: We looked at the pre admission assessment for two people who use the service. The care files for both people were arranged in a way which enables the reader to follow the progress of the individual from pre admission assessment to current situation. The pre admission section of the care file contained the assessment of needs statement from the funding authority as well as the letter of agreement, financial assessment, pre admission forms by the provider and the letter of acceptance confirming that the home are able to meet their needs. In both the files we looked at there was a detailed pre admission assessment as well as the care management information from the funding authority and we could see the Care Homes for Older People Page 10 of 25 Evidence: care plan was based on this information. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to care planning mean it is clear how peoples needs are being met. Consistency in the medication process will ensure that records are accurate. Evidence: We looked at the care files for two people who use the service, in the personal file under the section titled post admission information we found; a residents admission form as well as information relating to their terms and conditions, contract, property they came in with as well as a person centred care plan, with a section titled This is me this section detailed what is important to me and for me and covered information on family, and statements on things such as I like looking good and wearing make up and jewelery I love activities such as singing and playing the piano We could see that people were being asked about their life and consideration was given to how this could be incorporated into their life in the home, through activities and in conversation when people were upset, it helped staff understand why that might be. The care plan for one person had an action plan in place for what to do if they had Care Homes for Older People Page 12 of 25 Evidence: weight loss and this was detailed and provided clear guidance for staff on action to be taken. Each file also contained a nutrition care plan. In the two files we looked at there was a communication action plan which during observation of staff we could see they were putting the information into action. Risk assessments we looked at were detailed and fully completed. We could see that care plans are reviewed and updated to reflect changing needs. We could also see that people had the equipment they need to remain as independent as possible. We looked at medication and the home has a clear audit trail in place to monitor the medication stored in the home. We looked at medication in the controlled drugs cabinet and found that staff were not consistently making sure the total number of tablets was recorded. We found that the record of the number of tablets used tallied with the number left, but the running total was not always there. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to participate in activities at a level they can cope with. People are offered a varied diet which meets their nutritional needs. Evidence: The provider is using a company which is helping develop a more individual activity programme for people using the service. Each person has an evaluation and are supported with a variety of games music and exercise which is in keeping with their skills and abilities. during our visit we observed people being able to be themselves and participate in activities if they wished. We observed staff supporting people to make decisions about what they wanted to eat or do. One person who was upset was supported by a member of staff in a very gentle way which mirrored the information in the persons plan. One person who was very vocal was enabled to be vocal but also distracted by staff into participating in an activity. People are also encouraged to help in daily activities such as dusting, folding laundry, laying the table. We also observed that people were able to eat their lunch at their own pace and staff were helping in an unobtrusive way. We looked at care plans which detailed the nutritional needs of people and recognised Care Homes for Older People Page 14 of 25 Evidence: their individual likes and dislikes. The home also use the services of an accredited dietitian on menu planning and nutritional content of meals. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints system in place. Safeguarding training is in place for staff so they understand the needs of vulnerable people and how to protect them from harm. Evidence: There is a complaints policy in place, no complaints have been recorded since the last key inspection. All staff have completed safeguarding training and there is a policy in place to support them. The home also has the protocols provided by the local authority. there is also information in the care files we looked at that demonstrate awareness of concerns around mental capacity. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the environment with peoples needs in mind. Evidence: There have been improvements made to the home both inside and outside. Work has been done to the ground making the entrance to the home lighter and brighter by removing foliage from the grounds. The outside of the home has been painted. the garden is well maintained and we were told that the paths are being sprayed with a substance which will get rid of the moss, we were also told that until this is done people who use the service do not walk in the garden alone. Work has been done inside the home replacing furniture, linen for bed and replacing towels. There is now a covered area leading to the laundry room, the fridge and freezer are now in the covered area and not in the laundry room. The are industrial washing machines, the walls and floor have been tiled. The registered provider told us that the boiler will be replaced soon. Work has been done by plumber to replace all iron pipes with copper. The bathroom on the first floor is being refurbished. The kitchen has been updated and the flooring is impermeable, the work surfaces and cabinet doors have been changed. Care Homes for Older People Page 17 of 25 Evidence: All carpets in the home are cleaned by a firm each week. The home was clean and we observed staff following good infection control practice during our visit. Pedal bins with lids are used. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedure is followed and training is in place for all staff to develop their skills and knowledge. Evidence: Each day there are two carers, a cook, a cleaner and the registered provider and his wife on duty. In the afternoon there are three carers and the registered provider on duty. The provider told us they are currently interviewing for a weekend cook. We looked at recruitment files for one person, we found there was an application form, proof of identity including proof of the right to work in this country. the Criminal Records Bureau check was satisfactory and received before the person started working in the home. There were two written references. Three staff have NVQ level 2 and four are working towards it. Two staff have NVQ level 3 and two are working towards it. Five staff have completed training in dementia care. There are fourteen staff working in the home. Ten staff have completed training in person centred dementia care. Two staff have done person centred care planning. The registered provider works with all staff each day in supporting people with dementia. Seven of the fourteen staff have also recently completed further specialised training in supporting people with dementia. Care Homes for Older People Page 19 of 25 Evidence: One member of staff is a dementia champion who is taking a special in depth interest in new ways of working with people with dementia and passing this information on to other staff. Staff are encouraged to think about how they talk to people who use the service and to consider some of the following; dont ask questions you know they cant answer, and learn from the residents. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 home is managed in the interests of the people who live there and consideration is given to how good practice in dementia care can enhance the lives of the people who use the service. There are systems in place to ensure that the health, safety and welfare of people using the service is protected. Evidence: The registered provider is managing the service since the departure of the registered manager and is in day to day control. A newsletter is produced which details changes to the home such as the improvements to the environment, updating of the heating and hot water system and additional of thermostatic values throughout. The newsletter also tells people of the work both management and staff are doing in developing new ways of supporting people with dementia and working with other professionals in a positive way to enhance their experience of living in the home. At the last inspection there was concern expressed that as the office is not in the Care Homes for Older People Page 21 of 25 Evidence: home itself this could cause the manager to be out of touch with the day to day activity in the home. Since the last inspection the registered provider and his wife are in the home every day and ensure one of them is always in the home. The home has a fire risk assessment which is up to date. There is a system in place for analysing accidents and incidents. The provider has purchased a new set of policies and procedures from a company and is in the process of updating these to reflect the practice of the home. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 The registered provider should ensure that staff who are dispensing medication consistently follow good practice in recording the amount of controlled drugs held. Care Homes for Older People Page 24 of 25 Helpline: 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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