Care Home: St Cecilia`s

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What the care home does well The inspection showed that St Cecilia’s has continued to maintain high standards of care and support for its residents. For example, it has maintained its status as an accredited practice development unit and has enabled two people to move on into another service where they may live more independently. A visitor commented, “It’s a really good place, residents are number 1, they’re not patronised and their abilities are encouraged”. The home is good at offering help, including written information and trial visits, to prospective residents choosing a care home. Residents are provided with a clean, comfortable, homely environment that meets their individual needs. The home makes sure residents` personal and health care needs are met well, and staff members treat residents in a caring and respectful manner. The meals provided are varied and nutritious, and choices of food are made available. Staff members are offered the training they need for their work, which helps to ensure residents benefit from a high quality of care provision. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 The home is well managed, in an open and inclusive way. The home is very good at consulting residents, their representatives and staff members about the quality of services provided and very good at involving them in the running of the home. The manager makes sure she is readily available if people have any matters they wish to discuss. What has improved since the last inspection? The home has addressed the issues we raised at our last inspection and met the requirements we made. Prospective residents are now offered information about the terms and conditions of residency to help them to decide whether the home is suitable for them. Care plans contain full information about the care individual residents need, and risk assessments about personal safety are in place. Medication is no longer secondarily dispensed. The frequency of fire drills has been increased, which helps to ensure residents’ health and safety. St Cecilia’s has continued to develop its service provision, drawing upon feedback from the people using its services. For example, a single seat vehicle was purchased at the request of residents and a driver has been recruited. An evidence-based sensory and relaxation group has been developed. Work has started to involve residents in staff induction and training. Some of the residents have been supported to actively and successfully campaign in the local community. What the care home could do better: They need to always ensure the prompt disposal of any prescribed medication that has passed its safe expiry date. They should also try to find a workable solution to the safe and effective recording of the administration of medications such as external creams and suppositories. They should aim to have a greater proportion of care staff with completed NVQ awards in care. The content of the home’s AQAA and discussions during the inspection visit showed there is very good awareness of improvements the home could make that will offer further benefit to its residents. Key inspection report CARE HOME ADULTS 18-65 St Cecilia`s Cheshire Home - Leonard Cheshire Disability 32 Sundridge Avenue Bromley Kent BR1 2PZ Lead Inspector David Lacey Key Unannounced Inspection 21st December 2009 10:30 St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service St Cecilia`s Cheshire Home - Leonard Cheshire Disability 32 Sundridge Avenue Bromley Kent BR1 2PZ 020 8460 8377 020 8466 8292 karen.harwood@lc-uk.org www.LCDisability.org Leonard Cheshire Disability Address 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) Karen Harwood Care Home 30 Category(ies) of Physical disability (30) registration, with number of places St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 30 7th March 2007 Date of last inspection Brief Description of the Service: This care home, which is now called St Cecilia’s, provides nursing care for up to 30 physically disabled people. The home is in a quiet residential area, on a bus route and near to Bromley town centre. The home provides single en-suite rooms for all residents and a variety of communal areas. There are mature gardens at the rear and parking at the front of the house. The home provides 24 hour care through a staff team consisting of nurses, care staff, ancillary and administrative staff. The team is led by a manager who is also a registered nurse. The fees for St Cecilia’s are all based on an assessment of the individual person. As at December 2009, the fees ranged from £1100-£1700 per week. There are additional charges for hairdressing, chiropody, toiletries, transport, magazines and newspapers, and aromatherapy. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is three stars, which means that people using the service receive an excellent service. This key inspection included an unannounced visit to the care home. The inspector spoke with some of the residents and met with the registered manager and some of the members of staff on duty. The inspector toured the premises and observed some practices. Documentation was sampled for inspection, such as care plans, medication records, staff recruitment files, and policies and procedures. Information from the homes Annual Quality Assurance Assessment (AQAA) has been used to inform the inspection process. St Cecilia’s provided detailed information in its AQAA, which focused on showing how outcomes are being met for people living in the home. At the time of writing this report, the inspector was waiting to receive written responses to our survey of residents, staff members and visiting professionals. What the service does well: The inspection showed that St Cecilia’s has continued to maintain high standards of care and support for its residents. For example, it has maintained its status as an accredited practice development unit and has enabled two people to move on into another service where they may live more independently. A visitor commented, “It’s a really good place, residents are number 1, they’re not patronised and their abilities are encouraged”. The home is good at offering help, including written information and trial visits, to prospective residents choosing a care home. Residents are provided with a clean, comfortable, homely environment that meets their individual needs. The home makes sure residents personal and health care needs are met well, and staff members treat residents in a caring and respectful manner. The meals provided are varied and nutritious, and choices of food are made available. Staff members are offered the training they need for their work, which helps to ensure residents benefit from a high quality of care provision. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 6 The home is well managed, in an open and inclusive way. The home is very good at consulting residents, their representatives and staff members about the quality of services provided and very good at involving them in the running of the home. The manager makes sure she is readily available if people have any matters they wish to discuss. 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 St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 7 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 8 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 Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of the service are offered enough information so they can make a choice about whether to move into the home. People are always assessed before admission to ensure the home can meet their needs. EVIDENCE: The home follows its admission procedures, which include providing information and assessment of prospective residents’ needs. The homes statement of purpose and its service user guide meet standards and provide detailed information to help people decide whether to move into the home. Our previous requirement about the terms and conditions of residency had been met. A change was needed to update the commission’s contact details in the service user guide, and this was drawn to the manager’s attention. It was evident from discussions and from relevant documentation that the home is able to meet people’s different needs, with support from health professionals and specialists. Prospective residents’ needs are assessed fully so they may be assured these can be met if they decide to move into St Cecilia’s. Pre-admission assessments sampled for inspection were comprehensive and St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 10 included information from different sources, such as the resident, their relatives, and professionals involved in their care. Assessments included people’s cultural and religious needs. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home’s ability to support them to remain as independent as possible, by maintaining an appropriate balance between taking risks and being safe. The home gives priority to encouraging and supporting residents to make decisions about their lives. Staff have detailed written guidance for providing the care and support to meet residents’ needs. Information about residents is handled appropriately. EVIDENCE: The care and support of three residents was looked at in detail during the site visit. It was evident their preferences for care delivery had been sought and recorded, such as gender care statements and who they share information with about their care. Our previous requirement about care planning had been addressed. The home has introduced person centred care planning and St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 12 managers are working to develop staff members’ confidence in supporting residents with person centred plans. Residents spoken to confirmed they are invited to be involved in the planning and reviewing of their care. Multiprofessional meetings are held with all staff involved in the individual resident’s care. Residents’ rights to take risks are respected and documented. The home had met our previous requirement about risk assessments, and people were being supported to achieve a balance between taking risks as part of an independent lifestyle and being safe. Two people had been supported to move out of St Cecilia’s to live more independently in another service offered by the provider. The AQAA stated St Cecilia’s operates policies and procedures that emphasise residents’ choice and respect for their decisions. There was evidence during the inspection visit to support this. Residents’ involvement is valued and actively promoted in all aspects of running the home. Residents are able to influence changes and are also involved in aspects of the service such as staff recruitment. Residents spoken to confirmed they make decisions about their lives and lifestyles. A relative who visits regularly commented that the home “is never regimented, people can do their own thing”. It was evident the home follows the provider’s policies and procedures relating to confidentiality. Electronic and paper-based records and information is stored securely. Information is shared with the individual resident and those they want to share it with. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 13 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): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that residents’ preferred lifestyles are respected. Residents are offered opportunities to take part in activities both within and outside the home. Residents are provided with a varied and nutritious diet. EVIDENCE: Peoples preferred lifestyles are respected. For example, residents can choose how they spend their time and can get up or retire to bed at whatever time they wish. Residents can bring in their own personal possessions to make their bedrooms more personal and homely. Residents’ visitors are made welcome, which helps residents to maintain relationships with families and friends. The AQAA confirmed residents are supported to express their sexual needs in privacy and with sensitivity. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 14 Residents have a range of activities to choose from. For example, the home has a therapy room and a computer room with broadband internet access. Some residents have their own computers and many have their own televisions and DVD players. Some residents undertake activities outside of the home. For example, a resident was supported to attend a party political conference and residents have been supported to appear on a television programme. A resident has given a conference presentation about accessibility at a local rail station, and was enthusiastic in her description to the inspector of the campaign to improve access to the platforms at this station. Another resident said she uses the physiotherapy room and that “sometimes carers take me out”. Equally, residents are not under any pressure to take part in activities if they do not wish to do so. A resident said there are always things to do if she chooses but sometimes she prefers to stay in her room. There is a well-established volunteer group supporting the home in its delivery of person-centred services to residents. The home provides support to volunteers by involving and training them in this. The inspector met with a volunteer who was working with a resident in the computer room, helping him to access various internet news pages. The volunteer said she also sings with a visiting music group and helps out on reception. She said she had a CRB check before she started and an induction when, for example, she was trained to move wheelchairs around the home. Residents who spoke with the inspector made positive comments about the meals served at the home and discussions showed they are satisfied with the quality of food provided. A resident said, “The food is generally good and alternatives are always available if I want something else”. Food served is well presented and residents are able to choose what they eat. Carers offer sensitive assistance with feeding as required. Residents’ special dietary needs are catered for, such as diabetic diets. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living in the home has a care plan, which offers detailed guidance to staff on how to meet their assessed needs in ways that person prefers. People are treated with respect and their dignity and privacy are maintained. The personal and health care needs of people using the service are met well. Medicines administration is generally managed well. EVIDENCE: The home is able to show how its residents receive effective support with their personal and health care, based upon rights of dignity, equality, fairness, autonomy and respect. For example, care plans selected for inspection had been drawn up based on the assessment of the individual residents needs. They were detailed and showed how residents preferred to receive support. The plans had supporting risk assessments, for example, for mobility, falls, nutrition and pressure areas. Plans had been regularly reviewed and updated with the involvement of the individual resident wherever possible. The home St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 16 has been improving care plan documentation so it is more person-centred. The inspector sat in on the handover between staff on the morning and afternoon shifts, at which nurses and carers were present. Staff who had been working the morning shift gave feedback about their work with individual residents, reporting positive signs and also raising any concerns. Each of the residents was discussed in turn so that the staff members coming on duty for the afternoon and evening shift were fully briefed about the support each person was likely to need. Residents were groomed well and were wearing suitable clothing for the time of year. People’s health care needs were being met and it was evident that whenever possible residents are responsible for managing their own health care with the support of the staff. Physiotherapists are available on site and explained how they provide support and treatment. Two residents were spoken with while using the physiotherapy facilities. One was having passive limb exercises and the other was using the exercise cycle, telling the inspector “I’ve cycled to Brighton this morning!” Staff members have training in various aspects of healthcare and the use of equipment, and they work closely with visiting professionals to the benefit of residents. All residents are registered with a GP and the home’s visiting GP was seeing residents on the day of the inspection. This was the GP’s regular, weekly visit to the home but visits are made at other times as needed. Residents said they can see a doctor when they need to do so. There were records of visits from other health and social care professionals. This included the local nursing homes liaison team, a member of which was visiting the home on the day of inspection. The home offers care and support to residents with physical disabilities and therefore the way in which they are moved and supported is integral to their care. Two residents spoken with separately said carers are gentle when giving personal care or helping them to mobilise, and always explain what they are going to do. One of the residents said there are always two carers to help him use the ceiling hoist and “they always look after me well”. The home has detailed guidance for staff that covers all areas where residents may require assistance and support, including the use of moving and handling equipment. A resident was seen being helped to mobilise by two carers with the use of a hoist. Carers used appropriate moving and handling practice, and throughout the process they provided the resident with verbal reassurance, encouragement and explanations about what they were doing. The residents’ dignity was maintained. Please see standard 23 for comment about actions taken by the home to ensure residents’ health and welfare when it became apparent on one occasion that staff had fallen short of the expected standards of moving and handling practice. Ordering, receipt and disposal of medicines were being carried out well. Storage of medicines was generally satisfactory, although a resident’s eyedrops being stored in the drugs fridge had passed its safe expiry date but was still being used. It was apparent this was an isolated case and no other expired St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 17 medications were seen to be in use. Immediate action was taken by staff in this instance but a requirement has been made to ensure safe practice in the future (see requirements). Staff were making sure the temperatures of the fridge and of the medicines room were being kept within safe levels for the effective storage of medication. Medication being stored and recorded as a controlled drug (CD) was being stored properly and recorded in the home’s CD register. The sample of medicine administration records seen showed these had been completed accurately, with the exception of recording the administration of prescribed medications such as external creams and suppositories. It was understood that nurses ask carers if they have administered a cream but inspection of a sample of medication charts showed that such administration is not recorded. This was raised with the manager and a recommendation has been made to support the home’s effort to find a workable solution to this matter (see recommendations). Our previous requirement about secondary dispensing had been met. This practice was not seen and a qualified nurse who takes the lead on medication administration within the home confirmed that medicines are no longer subject to secondary dispensing. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives are offered the information they need to be able to make a complaint. They may be assured that the home takes any concerns or complaints seriously, and follows its procedures when investigating and responding to them. Residents’ concerns are acted upon to enable any necessary improvements to be made. Effective training is provided for staff so they know about safeguarding the people in their care, including following the relevant procedures. EVIDENCE: St Cecilia’s follows its procedures and responds to any concerns or complaints promptly. The manager explained that the provider’s system for reporting concerns, complaints or allegations was to change from January 2010 but the home was using the current procedures until then. The AQAA stated the home has had five complaints in the last twelve months, one of which was still pending an outcome, and that managers are open to complaints and look to improve practice as a result. Records had been kept of the actions taken in respect of those complaints. Staff members spoken with were aware of the need to refer any issues or concerns to the management team. There is an appropriate complaints procedure, and residents have copies of a leaflet entitled “Have Your Say”, which has also been recorded as an audio version by St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 19 a service user. The complaints process is openly discussed at residents’ multidepartment meetings to remind them of how they may wish to raise concerns. During the inspection visit, residents said they would speak to their relatives, a staff member or the manager if they were not happy about something. The commission has not received any complaints about this care home over the past year. The inspector saw examples throughout the day of positive, relaxed interactions between residents and staff. A copy of the local councils safeguarding guidance was available, as well as the providers safeguarding and whistle blowing policies and procedures. Staff confirmed they receive relevant training, including how to recognise and respond to any allegations of abuse. The AQAA stated that one safeguarding alert had been made to social services in the last twelve months. The alert followed an incident where a resident had sustained bruising to both legs from being transferred by care assistants using a manual hoist. The CQC had been made aware of the matter by formal notification from the home and had also been informed of it by the relevant local authority. Discussion with the manager during the inspection visit confirmed the prompt actions taken to ensure residents’ health and welfare, and that the safeguarding investigation was continuing. Whilst many residents manage their personal finances, the home also operates a system to ensure that appropriate records are in place when it is involved in helping to manage residents’ monies. The inspector examined with the home’s administrator a sample of records showing how three residents money is managed. Monies are safely stored and each transaction had been clearly identified and signed. In each case, the amount of money held matched the recorded amount. Receipts had been retained, and receipts for deposits of money given to the resident or their representative as appropriate. Residents are invoiced for additional charges, such as hairdressing, toiletries or newspapers. The home operates robust staff recruitment procedures, which support and protect residents. Staff recruitment is referred to in this report under standard 34. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a homely environment, which is clean, comfortable and safe. Staff members know about basic infection control practices, and are trained to use the procedures and facilities that are in place to prevent infection. EVIDENCE: The home was clean, tidy, and no offensive odours were evident. The weather on the day of inspection was very cold but the home was being kept at a comfortable temperature. The home appeared well decorated and furnished. All residents benefit from private rooms with en-suite facilities. Bedrooms seen had been personalised with the residents’ possessions and mementoes. Residents spoken with were happy with their bedrooms and confirmed they are involved in choosing how their rooms are decorated. The communal areas St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 21 include a room where residents are able to spend time on their own or with their visitors. Residents are able to enjoy the garden, which has raised beds and surfaces suitable for people using wheelchairs. On the day of inspection, the manager was interviewing candidates for the post of maintenance person to whom the staff can report any items needing repair or replacement. The home has a passenger lift to access all floors and equipment to assist residents to mobilise is provided. Where necessary for the occupant, bedrooms had the equipment needed to maintain as much independence as possible. Grab rails are fitted in all corridors and toilets, and corridors are large enough for wheelchairs. Staff and volunteers are provided with training in how to use a wheelchair and how to inspect it before its use. Pressure-relieving mattresses and cushions were available for those residents assessed as needing them. The emergency call system is readily accessible to residents and operates throughout the home. The hot water outlets tested during the inspection visit were at a satisfactory temperature, within safe limits. There are sufficient sluices and disinfectors in the home, and this equipment was in good order. Infection control procedures are in place and staff members spoken with confirmed they had completed relevant training. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes sure there are enough staff on duty to meet residents needs, though needs to rely on temporary staff to cover vacant shifts. The training offered to staff is relevant to their work in the home, though more care staff should attain NVQ awards as this will benefit residents. People living in the home benefit from the robust staff recruitment procedures, in which their involvement is encouraged. EVIDENCE: On the day of this unannounced inspection visit, the home was full. The number of staff working in the home was appropriate to meet the needs of the people in residence. Staffing rotas seen showed that staffing levels had been maintained, including staffing for cleaning, laundry and catering. Discussions with some of the residents and relatives showed they believe that the staff team always aims to provide good care and support. For example, a resident said that carers are normally quick to respond when called although she sometimes has to wait if they are busy with another resident. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 23 Rotas also showed the home was using agency staff to cover a number of care shifts. For example, on the day of inspection, three of the eleven carers on the morning shift were agency staff, and there were two agency carers on the afternoon shift. The AQAA showed that over 400 shifts had been covered by temporary staff in the previous three months. A resident said that agency carers do not know the residents and it was also said that some staff are not known to residents. Although the home tries to use agency staff that have worked at St Cecilia’s before, the manager was well aware of the potential impact on the continuity of care being delivered. The manager said the home uses a good and reliable agency and has a core of bank staff, which is also a source of recruitment to permanent posts at the home. The AQAA showed a significant level of staff turnover, which was discussed during the inspection visit. The manager confirmed recruitment was underway to fill vacancies and provided information on the reasons for staff leaving. These included maternity leave and the expiration of student visas rather than any dissatisfaction with their employer. It was understood that recruitment to nursing posts is difficult at the present time, in part due to competition from local NHS employers. Staff recruitment files selected for examination showed that sound recruitment procedures were in operation and that all required information was obtained about applicants before they started work in the home. Staff members who spoke with the inspector confirmed they had applied and been interviewed for their posts. They had been required to provide references and have a Criminal Records Bureau (CRB) disclosure through the provider. A volunteer said she had obtained a CRB disclosure before starting work in the home. Training records showed that staff members have regular updates of mandatory training after completing induction. Feedback during the inspection visit from staff members about the work they did and the on going support they received was positive. The inspector asked staff about specific areas, including residents care, health and safety, and training and support. The staff possessed a range of knowledge and skills, and had undertaken various types of post-induction training, which aimed to help them meet residents needs. They work as part of a team, with senior staff monitoring and supporting to ensure they provide good quality care. The provider has held Investor in People status for many years, which is a positive indicator that training and development for staff is good. The AQAA stated that 16 of the 41 permanent care staff had achieved NVQ awards in care at level 2 or above, indicating a need for a greater proportion of care staff to complete this award (see recommendations). St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 24 St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be assured the registered manager has the skills and experience needed to run the care home well, and communicates a clear sense of direction. There is an open style of management, with staff and residents encouraged to contribute their views about the running of the home. There are effective quality assurance strategies in place. The provider carries out formal visits to monitor the quality of care provided. The home promotes the health and safety of its residents, staff and visitors. EVIDENCE: St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 26 The registered manager has the skills, qualifications and experience to run the home effectively. She encourages a person-centred approach to care and adopts an open and inclusive approach, welcoming individuals’ views on improving the quality of care. She had documented in the AQAA how residents are involved in every aspect of the running of the service, including recruitment and selection, practice development, planning of events and development of menus. The manager is aiming to increase residents’ involvement in staff induction and training. There were positive comments from staff about the managers approach to running the home. These showed that the manager has good people skills and communicates a clear sense of direction. Staff said they were supported by their manager and were able to meet with her regularly. It was evident staff are involved in the running of the home. For example, during the staff handover observed by the inspector, carers were invited to contribute their ideas about how the differing workloads on the upper and lower floors could be dealt with more effectively. The home’s AQAA set out in detail how the home ensures that race, gender identity, disability, sexual orientation, age, religion and belief are promoted and incorporated into all aspects of its service provision. It was evident during the inspection that there is strong awareness of and commitment to equalities and diversity. The provider’s policies include diversity and equal opportunities and adherence to these is monitored through induction, supervision and training. Examples included that residents’ preferences about their individual support needs, including choices about the gender of staff providing personal care, are sought and documented. Also that residents have access to a multidenominational chapel within the service and may also access a place of worship of their choice should they wish to do so. The home has good systems in place for reviewing and monitoring the quality of care. The statement of purpose that is given to residents included a report of the outcomes from the annual service users’ survey that the provider had carried out in June 2008. The July 2009 report was seen on file in the administrator’s office and it was understood this will also be made readily available to residents and their representatives. There were other quality assurance strategies in place, including specific audits carried out regularly. The home has received accreditation from Leeds University’s School of Healthcare. The University’s accreditation report of July 2009 was very positive, describing the home as “an outstanding Practice Development Unit”. The home sent us their AQAA when we asked for it. It was clear and detailed, giving the information we asked for. There were reports from the provider of monitoring visits to the home, and we have been notified without delay of events regarding residents health and welfare. It was evident the home takes care to promote the health and safety of its residents, staff and visitors. Monthly health and safety meetings are held, St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 27 attended by all department heads, and there is a monthly ‘walk-around’ and checklist completed. There was evidence of regular servicing of the equipment used, and health and safety documentation sampled for inspection was up to date and within the appropriate timeframes. Our previous requirement about fire drills had been addressed. The AQAA confirmed fire training has been improved and that the home’s fire strategy had been tested by carrying out a practice total evacuation of the home. Records showed eight fire drills carried out in 2009, and the manager stated that some are carried out early in the morning so that night staff members are included. St Cecilia’s was awarded an ‘excellent’ rating at the local authority’s most recent food hygiene inspection. The AQAA stated that assessments of people’s mental capacity are carried out or requested as needed, and that deprivation of liberty safeguards are considered as appropriate. The registered manager confirmed there were no residents subject to these safeguards at the time of our inspection visit. St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 28 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000010142.V378521.R01.S.doc 3 4 4 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 X 4 4 3 X X 3 X Version 5.3 Page 29 St Cecilia`s Cheshire Home - Leonard Cheshire Disability No 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 YA20 Regulation 13 Requirement The registered person must ensure the prompt disposal of any prescribed medication that has passed its safe expiry date. Timescale for action 31/01/10 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 Refer to Standard YA20 Good Practice Recommendations The registered person should ensure a workable solution is found to the safe and effective recording of the administration of medications such as external creams and suppositories. The registered person should ensure a greater proportion of care staff complete NVQ awards in care at level 2 or above. 2 YA32 St Cecilia`s Cheshire Home - Leonard Cheshire Disability DS0000010142.V378521.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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