Care Home: St Clare

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What the care home does well St Clare is a well-established care home, which is continuing to provide people with a good level of care. The home employs a staff team that are caring, friendly and supportive and both residents and relatives provided very positive comments about how well the home was managed. Several of the staff team hold National Vocation Qualifications (NVQ) in Care and the deputy manager has completed NVQ Level 4 and the Registered Managers Award (RMA). Staff also receive a good level of training and support. Residents also stated that they enjoyed the activities and the meals that the home provided and overall they felt well cared for. There is a good sense of teamwork and this gives the home a friendly and relaxed atmosphere. What has improved since the last inspection? No requirements or recommendations were made during the last inspection. In January 2008 the deputy manager became the registered manager for the home. She has worked at the home for over ten years and she holds both the NVQ Level 4 and the Registered Managers Award (RMA). The senior carer has now moved into the position of deputy manager and she holds the same qualifications as the manager. Other improvements made to the home during the last year have included providing a wider range of activities, more summer outings, updated call bell system, a new large flat screen television for the lounge and several bedrooms and the dining room have been redecorated. The home has also commenced providing quarterly newsletter for residents. What the care home could do better: Two recommendations were made during this visit. The first recommendation is that the home include more personal background history into people`s care plans, as this provides staff with a broader knowledge of each individual person. A recommendation was also made for a `hot surface` warning notice to be provided for the plate warming cabinet in the kitchen, as it was found to be very hot to the touch. CARE HOMES FOR OLDER PEOPLE St Clare 14 Park Lane Southwick West Sussex BN42 4DL Lead Inspector Merle Blakeley Unannounced Inspection 21st April 2008 10:30 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 Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Clare Address 14 Park Lane Southwick West Sussex BN42 4DL 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) 01273 591695 01273 381703 Mr Christopher George Thrower Mrs Juana Dolores Thrower Miss Victoria Phillips Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 18 (eighteen) 8th September 2006 Date of last inspection Brief Description of the Service: St Clare is a privately owned care home registered to accommodate up to eighteen residents in the category of older persons, over the age of sixty-five. The home is situated within the village of Southwick, West Sussex and is close to local shops and amenities. Accommodation is provided within fourteen single rooms and two double rooms generally used for single occupancy. The rooms are arranged over three floors with a vertical lift providing access to all floors. The home has several communal areas and a small well maintained easily accessible garden. The current fees range from £420.00 to £490.00 per week. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 Star. This means the people who use this service experience Good quality outcomes. This unannounced key inspection was carried out on April 21st 2008. As well as this site visit information was also gained from a returned Annual Quality Assurance Assessment (AQAA) and feedback surveys from five residents, four relatives and four staff. During the visit we were able to talk to six residents, three staff and the registered manager. We looked at four care plans and all supporting documentation such as risk assessments, daily records and healthcare information and a check was carried out on how medications are being stored and administered within the home. Records of how complaints and safeguarding issues would be dealt with were discussed. We also viewed staff records, which included recruitment procedures, qualifications and the types of training courses that are offered to staff. The homes quality assurance system, how people’s finances are managed and health and safety procedures were also viewed and discussed. There are currently fifteen people living at St Clare. What the service does well: What has improved since the last inspection? No requirements or recommendations were made during the last inspection. In January 2008 the deputy manager became the registered manager for the home. She has worked at the home for over ten years and she holds both the NVQ Level 4 and the Registered Managers Award (RMA). The senior carer has St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 6 now moved into the position of deputy manager and she holds the same qualifications as the manager. Other improvements made to the home during the last year have included providing a wider range of activities, more summer outings, updated call bell system, a new large flat screen television for the lounge and several bedrooms and the dining room have been redecorated. The home has also commenced providing quarterly newsletter for residents. What they could do better: 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 Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 7 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 Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 8 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): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A new statement of purpose has been produced. People have their needs assessed prior to moving into the home. EVIDENCE: As there have been changes to the management of the home, a new statement of purpose/service users guide has been produced to reflect these changes. We saw four pre-admission records, which showed that a comprehensive assessment had been carried out with the involvement of residents, family members and other care professionals. There was also evidence to show that people were able to make visits to the home prior to moving in. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 9 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. Care plans are reviewed monthly and people’s healthcare needs are being met. Medication is being appropriately administered. We saw people being treated with respect and dignity. EVIDENCE: Four care plans were viewed and they were found to be relevant and up to date. There was evidence to show that resident’s and their relatives and friends are involved in care plans and reviews. Each time changes are made to a persons care plan they sign a form to say that they have agreed and acknowledged the changes. Reviews of care plans are normally carried out monthly. It would be recommended that the home also include a ‘pen picture history’ of each resident, so that staff have a better understanding of a person’s past history. Risk assessments are carried out and these are reviewed on a weekly basis. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 10 People’s healthcare needs were discussed and records show that residents have had regular access to visiting dentist, opticians and chiropodists, hearing tests have been organised and everyone is registered with their own GP. Some people also have regular contact with psychiatrists and CPN’s. Residents are weighed monthly. The manager stated that currently all residents are in reasonably good health. The home has produced medication guidelines and procedures and medication charts were viewed. The home has just started using a new blister pack dosage system and staff were just getting used to this new system. All staff receive training prior to administering medicines and refresher training is provided annually to ensure staff remain up to date with their skills. One resident was self administering her own medicines but after a risk assessment was carried out it was agreed with the resident that she was no longer managing her medicines in a safe manner and staff now administer them for her. During the day some residents were asked as to whether they felt staff treated them with dignity and respect. People said that the staff treated them very well and some also stated that they were treated with warmth and kindness. Staff were seen to knock on doors before entering and calling people by their preferred names. It was noted that the home has a very friendly and relaxed atmosphere. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 11 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 home has increased the level of activities provided. People are offered choices and they are able to see family and friends at any time. A wellbalanced and nutritional diet is offered. EVIDENCE: On the day of this visit the vast majority of residents were involved in an exercise class that was being held in the lounge during the morning. This class is held fortnightly and appears popular with residents, as it promotes their mobility. The manager stated that some additional activities have recently been included such as a beauty therapist who visits fortnightly, art and craft classes, music for health and entertainers. The number of summer outings is also being increased this year and several of the residents have already enjoyed a day trip out to Wistons for a Cream Tea. When we spoke to some of the residents about the level of activities that were offered they were very happy and several were very impressed by the new large screen television in the lounge. Each month an activities list is drawn up and this is distributed to St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 12 all the residents. The manager stated that on each person’s birthday a special birthday cake is made and a small party is held for them. Visitors are allowed at most times of the day and the manager said that all they ask is if a visitor is coming to the home during the late evening that they phone staff to let them know when they are arriving. The visitor’s book revealed that people were coming in and out of the home regularly. On this particular day two visitors were in the home. Several family members and friends were sent survey forms to write their comments about the home. We received five relative surveys which were very positive and relatives spoke very highly of the home with such comments as “I think that St Clare is almost perfect as a care home”, “St Clare is extremely homely and caring”, “a homely and supportive environment is created in which service users are closely monitored to ensure their continued well being” and “the home is like a home from home, so all the staff are like family and everyone feels they belong”. During the day we observed residents being served lunch. The meal was freshly cooked and looked appetising. People who were spoken to said they enjoyed the food and there were always choices available if you did not fancy the main meal. The manager stated that the home had a good food budget and they sourced local fresh produce wherever possible. A cook is employed from 7am to 1pm Monday to Friday. During the weekends the manager and deputy manager cook the meals. In the afternoon residents were offered tea and cakes. Residents receive breakfast in their rooms. As regards to people being able to make their own choices, we were told that residents decided that they wanted to have their lunch at 12 noon and tea at 5pm and the home has changed the times according to their wishes. Residents were also asked if they wanted to choose a new colour for the dining room and asked how they would like their room decorated. People have choices of when they get up, if they want to join in with activities, who they see and what they wear. The manager stated that is was important for people to retain their ability to make their own choices about things that mattered to them. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 13 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has produced a complaints procedure. A safeguarding adults policy and procedure is in place and staff have attended suitable training. EVIDENCE: The home has produced a complaints policy and procedure, which is displayed in the hallway. Of the five service user surveys that were returned, four people said they knew how to make a complaint. All four relative surveys stated that they knew who to go to if they had any complaints or concerns. The home has not received any complaints. A policy and procedure is in place, which safeguards older people from any forms of abuse. The three staff that were spoken to on the day stated that they knew what to do if they had any safeguarding issues or concerns. They also said they had received training in safeguarding adults and refresher courses were offered regularly. The manager also said that following training in the Mental Capacity Act, she was looking at the need for an advocacy service for any resident who may need it. Training and recruitment records revealed that all staff have attended training in safeguarding adults and each staff member had undertaken a CRB check before commencing employment. No safeguarding referrals have been made. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 14 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, clean and tidy environment. EVIDENCE: We carried out a tour of the premises and we found the home to be clean and hygienic. A cleaner is employed for five hours a day from Monday to Friday. Resident’s bedrooms appeared comfortable and homely and contained many of their personal possessions. Several rooms have recently been redecorated and residents were consulted as to which colour scheme they would prefer. There is currently only one bedroom, which has en suite facilities and residents share the two communal bathrooms. There is a shower room and one assisted bathroom. Each bedroom is installed with a call system, which was updated in 2007. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 15 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs a caring and stable staff team and appropriate recruitment procedures are carried out. A good level of staff training is offered. EVIDENCE: The home employs a relatively stable staff team and there are currently nine care staff employed. Two staff have left the home since the last inspection. One was a staff member who retired after working at St Clare for nearly twenty years. She continues to come into the home one afternoon a week to organise the bingo session with residents. Four new staff joined the team during the latter part of 2007. There are normally three staff and the manager on duty in the morning and two staff and the manager on duty in the afternoon. A part-time cook and a cleaner work Monday to Friday. A part-time maintenance person is also employed. The home has never had the need to employ agency staff. Four of the care staff hold NVQ qualifications in Care and one person is hoping to complete NVQ Level 2 in July this year. The deputy manager has completed NVQ Levels 2, 3 and 4 and the Registered Managers Award (RMA), which is very commendable. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 16 We looked at three staff recruitment files to ensure that they contained all the required information. CRB checks, proof of ID, references and recent photos were all included in each persons file. The home produces an annual staff training programme and for 2008 staff will attend Safeguarding Adults and the Mental Capacity Act, Fire training Part 1, food hygiene, infection control, moving and handling update, risk assessment, pressure and skin care, first aid refresher, fire training part 2, bereavement & loss and challenging behaviour. Staff also stated that if they wished to attend a specific training course the proprietor was very happy to organise this. Staff who were spoken to on the day said that they felt they received a very good level of training and that the proprietor was very supportive in regards to any training issues. During this visit we observed staff interacting with residents and staff were seen to be caring and friendly. In all nine surveys that were returned people commented on how caring and helpful the staff team were. We spoke to three staff members on the day and they all stated that they were happy working at St Clare and felt it was a really nice place to work. They felt the home had a nice atmosphere and they all got on well together as a team and supported one another. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 17 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In 2008 the deputy manager became the registered manager for the home. The quality assurance needs to be expanded. The health and safety of residents and staff is being promoted. EVIDENCE: In January 2008 the deputy manager became the registered manager for the home. She has worked at St Clare since 1997 and has obtained the NVQ Level 4 in Care and the Registered Managers Award (RMA). The senior carer has now become the deputy manager and as stated previously, she also holds NVQ Level 4 and the RMA. The registered manager and the deputy manager work well together as a team and they provide good leadership and support to the staff team. Staff who were spoken to on the day confirmed this and said they St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 18 felt supported in their work and they could always go to either the manager or deputy if they had any concerns or issues. The proprietor who was previously the registered manager continues to be very much involved in the service and is in the home most days. He also provides on-call cover during the night. Staff, residents and relatives said they felt the proprietor was an extremely kind and caring person who was helpful and supportive. The proprietor was not present during this visit. The home has produced a basic quality assurance system and the manager stated that she was aware that more work was required in this area. Topical questionnaires are sent out to residents and address such things as food and décor. During this year the home will send out questionnaires to relatives and relevant stakeholders. The proprietor will also commence carrying out Regulation 26 visits to ensure that the quality of the service is continuing to be maintained. Residents meetings are held occasionally and the home has now started producing a resident’s quarterly newsletter; the first one was sent out this month. It keeps people informed of what is happening in the home regarding staffing, new residents and activities. At present the home does not look after any resident’s finances, as relatives, friends or a power of attorney currently carry out this role. Each person has a safe in their room, where they can store valuables etc. We checked records in regards to health and safety issues within the home. A Fire Safety Officer came to inspect the home in November 2007 and the home was required to carry out some additional fire protection work. This work had been completed. Staff receive fire safety training and a fire risk assessment of the home has been carried out. Fire alarms and emergency lighting are checked monthly. A Food Hygiene Officer visited the home in December 2007 and there were no concerns. A Health & Safety Officer also made a visit in April 2008 and again there were no concerns. The lift is inspected annually and checked every two months. There is a large heated cabinet on the wall in the kitchen which is used only at lunchtimes to keep plates warm, however it did feel very hot to the touch and it will be recommended that a ‘hot surface’ sign is attached to it for safety purposes. St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Clare DS0000014730.V362291.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP38 Good Practice Recommendations To produce a ‘historical pen picture’ for each person’s care plan, which will provide more information for staff. To provide a safety notice for the heated cabinet in the kitchen. 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