Care Home: St Davids

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What the care home does well This is a well-managed home run for the benefits of residents. People wishing to move into the home are provided with sufficient information and encouraged to visit the home, so they are able to make an informed decision about moving into the home. People living in the home have access to a range of Health and Social Care Professionals ensuring their health care needs are met effectively. They are encouraged to maintain their mobility and other strengths, so that their independence is maintained. People are cared for in a respectful manner by staff and this ensures their selfesteem and dignity are maintained. People are involved in making decisions and are able to exercise control over their daily lives. This promotes their independence and individuality. Arrangements are made for people living in the home to practice their chosen religion, so their religious needs are met. Visiting is flexible and they are made to feel welcome, so that people are able to maintain relationships that are important to them. A good rapport had built up between people using the service, staff and their visitors. One visitor stated, "The staff always ask if we would like a drink". There is a choice of wholesome meals, which meets any dietary needs for reasons of health, taste, culture or religion. All people spoken to stated they enjoyed the meals. People living in the home had no complaints, but stated if they had any concerns they would speak to the manager and they felt confident that they would be addressed appropriately. This provides confidence to people that they will be listened to and taken seriously.People are able to exercise control over their daily lives promoting their individuality. There is a wide variety of activities on offer for people living in the home should they choose, so they are able to lead a meaningful life. There is a rolling programme of decoration and refurbishment. The home is well maintained, decorated and furnished to a high standard, so that people have a pleasant, safe and homely environment to live. There are always a satisfactory number of staff on duty who are well trained ensuring people receive a good standard of care. Staff turnover is low and this ensures continuity of care for people living in the home. Recruitment procedures are robust ensuring people`s well-being is promoted and protected. Staff were friendly and enthusiastic about working at the home and the care they provided. There is a good range of staff training, which is updated regularly ensuring staff are well training and are able to meet people`s individual needs and they have been successful in retaining the "Investors in People" award. There are two registered managers plus a deputy manager and this provides good leadership in the home. Regular meetings are held with people living in the home and staff and suggestions are welcome and acted upon. This ensures everyone has ownership and are involved in the running of the home. There is a system for the safe keeping of small amounts of people`s money ensuring their money is safe. There are regular maintenance checks and servicing of equipment used at the home ensuring safety at all times. What has improved since the last inspection? Staff are now confirming the findings of people`s assessments in writing before they are admitted to the home, which gives them confidence their needs will be met on moving into the home. Record keeping in relation to medication management has improved ensuring clear audits of medication. As part of the admission process staff are assessing people`s capacity to make decisions, so that appropriate assistance can be sought if required. The range of activities has improved; a new wider screen television, a karaoke machine and Wii have also been purchased to improve the range of activities in the home. People who live in the home have also been registered with Ring and Ride in order to develop the activities outside the home.There has been re-decoration and re carpeting of six bedrooms, one bathroom and the kitchen has been redecorated. Chairs with slide bars were purchased to enable people easier access to dining tables and new footstools provided. A record of routine maintenance work is maintained and extra hours have been allocated for staff to oversee general house keeping duties. This ensures the home is well maintained and provides a pleasant place to live. The services of "Peninsular Business Services Ltd" have been secured to advise on all aspects of health and safety and all relevant policy procedures. What the care home could do better: The recording of care plans and daily records needs to be developed to ensure more detailed information is provided about the actions required to meet people`s individual needs. Staff training and competencies need to be completed in respect of blood glucose testing to demonstrate practice is in line with current guidelines. Also training in respect of health care topics will enhance staff knowledge and benefit people living in the home. All staff should complete training in respect of the Mental Capacity Act to ensure they are aware of their responsibilities in the event of a person lacking capacity. Copies of visa/work permits should be retained on staff files for any member of staff who originates from overseas to demonstrate they can legally work in the country. A staff training matrix should be developed so that information about staff training is easier to retrieve. Information from audits and surveys etc should be collated and presented with developments as part of the quality assurance process. The home has also stated they plan to develop end of life planning to ensure staff are able to meet peoples needs in such an event. CARE HOMES FOR OLDER PEOPLE St Davids 36 Somerville Road Boldmere Sutton Coldfield West Midlands B73 6HH Lead Inspector Ann Farrell Unannounced Inspection 11th March 2009 08:00 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 Davids DS0000016782.V374496.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 Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Davids Address 36 Somerville Road Boldmere Sutton Coldfield West Midlands B73 6HH 0121 354 4183 0121 354 7526 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) Mrs Jane Whalley Mr Keith Whalley Mrs Jane Whalley Mrs Hazel Rawlings Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code 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) 16 The maximum number of service users who can be accommodated is: 16 23rd February 2007 Date of last inspection Brief Description of the Service: St David’s is located on a quiet residential road in Sutton Coldfield. It is well situated to access community facilities such as shops, places of worship, Good Hope hospital and Sutton Park. The property has been extended to provide accommodation for 16 elderly people. There is a ramped access to the rear garden that has seating available for people when the weather permits. To the front of the home is a well-tended garden and some space for off road parking. The home is a detached three-storey property and the top floor is used for office and staff sleep-in accommodation. All bedrooms are single occupancy and are located on the ground and first floor; all vary in size and have private facilities, which consist of toilet and wash hand basin. There is a passenger lift that provides access to both floors. The bedrooms are well decorated and furnished to a high standard and some of the people living in the home have their own telephone installed. There are two assisted bathrooms, which enables bathing for people with mobility problems and toilets are located throughout the large building. In addition, there are handrails etc. enabling people to maintain their independence. All communal rooms are located on the ground floor and consist of a dining room, large lounge and a conservatory that overlooks a well-maintained garden. All communal rooms offer a high standard of furnishings. St Davids DS0000016782.V374496.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 three stars. This means the people who use this service experience excellent quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home or other agencies and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, staff, people who live there, any developments since the last inspection and their plans for the future. In addition, random surveys were sent to people who live in the home, visit the home and staff before the inspection in order to gain their views about the service. We received ten surveys from visitors; six from people who live in the home and ten from staff who work in the home. All feedback was positive and comments included; “In my view they do everything well. The care is wonderful and the residents are treated with the utmost of respect. Visitors are made to feel very welcome and staff are very approachable”. “I feel that St David’s provides a safe and comfortable environment for my mother. It is clean and homely and the staff are always friendly and very helpful and my mother seems happy here”. The inspector undertook this fieldwork visit over one day. Both registered managers and the deputy manager were available for the inspection. The home did not know that we were visiting on that day. At the time of inspection sixteen people were living in the home and information was gathered from speaking to and observing people who lived at the home. Three people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing aspects of care, looking at medication, care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. At the time of inspection four people who live in the home, four visitors and three St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 6 members of staff were spoken to in order to gain comments. The feedback was very positive and comments included; “I would recommend it to anyone” “You get treated like a person”. “The staff are all very nice”. “I can honestly say I have not left a thing on my plate since I have been here”. “Really and truthfully I have never regretted coming here”. “I don’t think you would get this attention anywhere else”. “Nothing is too much trouble”. What the service does well: This is a well-managed home run for the benefits of residents. People wishing to move into the home are provided with sufficient information and encouraged to visit the home, so they are able to make an informed decision about moving into the home. People living in the home have access to a range of Health and Social Care Professionals ensuring their health care needs are met effectively. They are encouraged to maintain their mobility and other strengths, so that their independence is maintained. People are cared for in a respectful manner by staff and this ensures their selfesteem and dignity are maintained. People are involved in making decisions and are able to exercise control over their daily lives. This promotes their independence and individuality. Arrangements are made for people living in the home to practice their chosen religion, so their religious needs are met. Visiting is flexible and they are made to feel welcome, so that people are able to maintain relationships that are important to them. A good rapport had built up between people using the service, staff and their visitors. One visitor stated, “The staff always ask if we would like a drink”. There is a choice of wholesome meals, which meets any dietary needs for reasons of health, taste, culture or religion. All people spoken to stated they enjoyed the meals. People living in the home had no complaints, but stated if they had any concerns they would speak to the manager and they felt confident that they would be addressed appropriately. This provides confidence to people that they will be listened to and taken seriously. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 7 People are able to exercise control over their daily lives promoting their individuality. There is a wide variety of activities on offer for people living in the home should they choose, so they are able to lead a meaningful life. There is a rolling programme of decoration and refurbishment. The home is well maintained, decorated and furnished to a high standard, so that people have a pleasant, safe and homely environment to live. There are always a satisfactory number of staff on duty who are well trained ensuring people receive a good standard of care. Staff turnover is low and this ensures continuity of care for people living in the home. Recruitment procedures are robust ensuring people’s well-being is promoted and protected. Staff were friendly and enthusiastic about working at the home and the care they provided. There is a good range of staff training, which is updated regularly ensuring staff are well training and are able to meet people’s individual needs and they have been successful in retaining the Investors in People award. There are two registered managers plus a deputy manager and this provides good leadership in the home. Regular meetings are held with people living in the home and staff and suggestions are welcome and acted upon. This ensures everyone has ownership and are involved in the running of the home. There is a system for the safe keeping of small amounts of people’s money ensuring their money is safe. There are regular maintenance checks and servicing of equipment used at the home ensuring safety at all times. What has improved since the last inspection? Staff are now confirming the findings of people’s assessments in writing before they are admitted to the home, which gives them confidence their needs will be met on moving into the home. Record keeping in relation to medication management has improved ensuring clear audits of medication. As part of the admission process staff are assessing people’s capacity to make decisions, so that appropriate assistance can be sought if required. The range of activities has improved; a new wider screen television, a karaoke machine and Wii have also been purchased to improve the range of activities in the home. People who live in the home have also been registered with Ring and Ride in order to develop the activities outside the home. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 8 There has been re-decoration and re carpeting of six bedrooms, one bathroom and the kitchen has been redecorated. Chairs with slide bars were purchased to enable people easier access to dining tables and new footstools provided. A record of routine maintenance work is maintained and extra hours have been allocated for staff to oversee general house keeping duties. This ensures the home is well maintained and provides a pleasant place to live. The services of Peninsular Business Services Ltd have been secured to advise on all aspects of health and safety and all relevant policy procedures. 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 Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 9 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 Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 10 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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for people so that they can make an informed decision about moving into the home. People’s needs are assessed before they move in, so they can be confident their needs will be met upon moving into the home. EVIDENCE: The home has a brochure and service user guide, which provide information about the services and facilities in the home and the manager stated that it was available in alternative formats if required. Copies of the documents are given to people when moving into the home and this was confirmed on discussion with the relative of a person who had recently moved into the home. The information enables people to make an informed choice about moving into the home. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 11 The home provides care for people who require long term or respite care with low dependency needs. People are encouraged to visit the home before moving in so they can have lunch, view the facilities, meet staff and other people who live there in order to sample what it would be like to live there. People can choose their bedroom if more than one bedroom is available and this ensures that they can exercise control over their future living arrangements. This visit also enables staff to undertake an assessment of the persons needs to determine if they are able to meet them appropriately. On inspection of the records for two people who had moved into the home recently it was found that staff had completed a satisfactory assessment and had written to them confirming that they were able to meet their needs. This gives the person confidence when moving into a care home that their needs will be met. On discussion with people living in the home they stated they had visited before moving in. Also a relative stated the whole admission process was very professional and they had been very impressed. They stated the bedroom had been re-decorated before their mother moved in and new carpets, bedding, towels and matching accessories had been purchased. They also stated that they had been involved in the process of drawing up the care plan. This process ensures the person is happy to move into the home and the staff are able to meet their needs. Following admission to the home there is a trial period of one month and a review is held at the end of the month. This provides further opportunity to discuss whether the person would like to continue living there and if their care needs were being met or any changes are required. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 12 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. There are good systems in place to ensure people’s health and personal care needs are met in a way that ensures people’s dignity is maintained. EVIDENCE: Each person living in the home had a care plan. This is a document that is developed by staff following an assessment of individuals needs. It outlines what they can do independently, the activities people require assistance with and the actions staff need to provide in order to support them. Three peoples care files were looked at in detail. There was evidence that risk assessments had been completed in respect of manual handling for all people living in the home. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life; risks are reduced and well being promoted. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 13 The care plans were found to be adequate, but need some further detail in some areas e.g. in the case of the management of diabetes the care plan did not clearly indicate the arrangements for diet, insulin injections and the long term monitoring arrangements in place. On discussion with staff they were able to provide good information about the arrangements in place. The instructions should be more specific so that anyone looking at the care plan is aware of the arrangements for meeting the person’s needs. Daily records for people living in the home were recorded by staff indicating assistance, interventions etc. Again some of these records were vague with comments such as “seems fine”. It is recommended that these records be more specific with statements that are based on facts. Everyone living in the home was registered with a local General Practitioner (GP). They have the option of retaining their own GP. on admission to the Home (if the GP was in agreement). People had access to other health and Social Care professionals as required including district nurses, social workers, dentist, chiropodist and optician. On discussion with people living in the home they confirmed the GP was called if they required a visit and they saw other health professionals regularly. This ensures peoples health care needs are being met. The manager had received written feedback from some of the GP’s who visit the home and they included comments such as “People are extremely well looked after here, confidentiality is maintained, consultations are done in private and patients welfare is paramount to the staff who appear very caring”. “I have been very impressed by the high standard of care that they received. In addition members of staff also exhibit commendable levels of professionalism”. Staff encourage people who live in the home to maintain their independence and mobility, so they maintain their abilities and promote well being. Wheelchairs, grab rails, bath hoists etc. were provided to assist with mobility. A number of people were independent with their personal hygiene needs; others were well supported by the home’s staff. People were well presented and were able to choose clothing, jewellery and make up appropriate for their age, gender, tastes and culture. Feedback from people living in the home was very positive about the care being provided. Staff were observed to have good communication skills with empathy and understanding of how changing situations can impact on the needs of all people, especially those people with cognitive impairment. Comments from people living in the home include; “I would give it top marks”. “I don’t think you would get this attention anywhere else”. “I would recommend it to anyone”. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 14 The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. Medication is stored correctly and adequate stocks maintained, which ensures a robust system for ordering medication. On inspection of the medication for the current month it was found that audits were correct. Staff were supervising one person administering their own insulin, so they maintained their independence. The manager also had details of the medication on the MAR sheets for staff information plus protocols for as required medication (PRN). They were in the process of obtaining written permission from GP’s for the use of a small range of homely remedies for people living in the home, which can be given for common ailments without a prescription from the GP for a short period of time. One of the managers stated that staff were undertaking blood glucose monitoring for people who had diabetes, so that the condition could be monitored and action taken if necessary. However, there was no record of staff training or competencies to demonstrate they were competent to perform the procedure. It was recommended the diabetic nurse be contacted for further advice about training for staff to ensure they undertake the procedures safely. The home has a telephone in an alcove off the main entrance area for people to use and some people have had one installed in their bedrooms to enable them to communicate with friends and relatives in private when it suits them. People are offered facilities to store valuables/medication in their own bedrooms if they wish and this is recorded in the records. During the inspection staff were noted to be caring, attentive and respectful to people living in the home ensuring their dignity and self-esteem was maintained. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 15 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. People are helped to exercise choice and control over all aspects of their lives. There is a choice of healthy meals that meet all dietary requirements. EVIDENCE: There was no evidence of any rigid rules or routines in the home and people who live there can go outside on their own or with friends and family as they choose, depending on their abilities. Visiting was flexible enabling people to visit at a time that suited them, so people living in the home could maintain contact with friends and family. There was noted to be good interaction between staff and visitors making them feel welcome. This was confirmed on discussion with people who were visiting the home. They stated the home was always clean and warm and staff were lovely; delightful. Other comments included; “There is no regimentation and I can visit at any time that suits me”. “You always get offered a drink when you visit”. “Everywhere is very well maintained”. “The home has always been held up as an exception”. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 16 “They always have the residents interests at heart and do their utmost to make them feel at home”. “I feel the care home provides a happy and friendly environment for carers, residents and visitors”. People living in the home confirmed they could choose the times they get up/go to bed and they can go back to their rooms at anytime during the day. People are able to bring personal items of small furniture, pictures, ornaments etc. into the home providing a home from home atmosphere reflecting their personality. The home provides the opportunity for people to follow their own religion ensuring their religious needs are met. The vicar visits every six to seven weeks and Holy Communion is available at the home. There was a variety of activities on offer for people living in the home should they wish to participate. These included dominoes, cards, reading, colouring books, sing along, quiz, bingo, arts/crafts, exercise sessions, yoga class, hand massage etc. They have recently provided a wider screened television in the lounge and purchased a karaoke machine and Nintendo Wii. Everyone has been registered with the ring and ride service recently and there have been visits to the garden centre in the past. One person visits a luncheon club and takes an annual holiday. The hairdresser visits on a regular basis enabling people to have their hair tended to professionally, which enhances self-esteem. People’s bedrooms were individualized with their own possessions. The management team sit down with each individual on a regular basis to obtain their opinion about the service that it provided but also to ensure that the service is being tailored to their individual needs. The management team have adopted the policy of one to one meetings as they felt individual needs were not always being expressed in larger group meetings. There is a rotating menu, which demonstrated a variety of nutritious meals and people living in the home confirmed that they are offered a choice each day. Special diets can be arranged for reasons of health, taste and cultural/religious preferences however these were not required at the current time. One visitor stated the staff had explored the use of specialised cutlery with their mother also. The dining tables at breakfast and lunchtime were nicely laid with a linen tablecloth and condiments and meals were nicely presented. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 17 Comments to the inspector in relation to meals and drinks were positive and included; “No complaints about the food”. “Food – I can honestly say I have not left a thing on my plate since I have been here”. “On Sunday we have a sherry”. “If not to my liking an alternative is available”. “The food is vary varied, plentiful and tasty. There is a choice and I have requested and been given things that I fancied, which weren’t on offer that day”. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 18 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. There are systems in place so that people are protected from harm. People living in the home are confident their views are listened to and acting upon where appropriate. EVIDENCE: A comprehensive complaints procedure was on display in each person’s bedroom advising them of the procedure if they wished to raise any concerns, which included the current details of the Commission. The proprietor was aware of the pending changes and was pro active in making arrangements to update documents with the contact details of the new Commission. The proprietor and managers were seen to interact with people living in the home enabling them to approach them at any time if they wish. Information from six surveys returned indicated that everyone knew how to make a complaint and one stated; “If there was anything wrong I would tell them”. Responses from ten relatives indicated they were aware of the complaints procedure and if there were any concerns they were followed up appropriately. Comments included: “Any queries are dealt with in a very amicable manner, discussed at length, if necessary, and then acted upon”. “I have never had reason to complain”. “Staff have bent over backwards to help although I have never had any concerns, just small requests at the whim of an elderly mother” St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 19 There is a complaints book where staff would record any complaints or concerns and there had been none recorded since the last inspection. On discussion with people living in the home they stated they had no complaints, but if they did they would go straight to the manager and they felt confidant that it would be sorted out. We have not received any complaints about the home. Records indicated that staff had undertaken training in respect of safeguarding and on discussion with a member of staff they had a satisfactory knowledge of the procedure and confirmed they had received training. Staff had commenced undertaking assessment of people’s mental capacity on admission to the home and some staff had received some training in this area. This will need to be provided to all staff, so that they are aware of the procedures for supporting people who lack capacity to make decisions. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 20 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 homely, comfortable and well maintained environment where they feel safe and secure and their privacy is maintained. EVIDENCE: The home is a detached three-storey building with limited off road parking for visitors. The exterior is very well maintained and attractive with a range of shrubs to the front and a large well maintained garden to the rear that is fully accessible to people living at the home. The Home was warm, welcoming and cleaned to a high standard and since the last inspection extra staff hours have been allocated to oversee general house keeping duties to ensure standards are maintained. Decoration, floor coverings and furnishings were of a good quality and there was a rolling programme of redecoration and refurbishment in place. A number of areas St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 21 had been re-decorated since the last inspection ensuring the home was maintained to a high standard and a record is kept of all routine maintenance work completed. It was stated that people are consulted about aspects of décor when it needs renewing, which ensures they have a say in their home. The main kitchen was clean, well located and well equipped for its purpose. There was one lounge/dinning room plus a conservatory, which were comfortable and decorated in a homely style in keeping with the age of the building, providing a choice of areas to sit. Since the last inspection new dining chairs had been purchased, so people have easier access to dining tables and footstools had been provided enabling people to have their legs elevated where necessary. There were two assisted bathing facilities, one having recently been redecorated and carpeted. All bedrooms were for single occupancy with en-suite facilities, with the exception of one which benefits from private toilet facilities opposite the bedroom. A number of bedrooms had lovely views of the garden areas and all were personalised to reflect the tastes and interests of individuals providing a home from home environment. A call bell facility was available in each bedroom to call for assistance if required. Bedroom doors were lockable from the inside, which staff can access in an emergency, but these locks do not allow for people living in the home to lock their room when they are not in them. Lockable facilities are available for the storage of valuables etc. if people want one. On discussion with one person living in the home at the time of inspection they stated; “ The home is always clean, the bedrooms are very nice; I was offered a security box when I moved into the home”. Feedback from surveys confirmed the home was always fresh and clean and comments included; “The home has a high standard of cleanliness”. “Cleaned often – someone’s in my room everyday dusting, vacuuming or tidying, but they always ask if it’s convenient”. “My bed linen is changed every other day. All areas are kept spotlessly clean”. A passenger lift is available to people to access the first floor, where the majority of bedrooms are situated and the second floor is for office use only. Handrails were provided in corridors and near to toilets and raised toilet seats were provided to assist people who experienced problems with mobility. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 22 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. People are supported by staff who are trained and have the knowledge and skills to meet their needs effectively. There is a robust recruitment system for employing new staff for the protection of the people who live there. EVIDENCE: At the time of inspection there were satisfactory numbers of staff on duty to meet peoples needs. The duty rota indicated there were at least two care staff on duty at all times throughout the day with one wake member of staff and one sleep in member of staff overnight and this was confirmed on discussion with staff. The management responsibilities are shared between the two registered managers and the deputy manager who work various shifts and are on call when there is no manager on duty in the home, so staff are able to contact them at any time in the event of any concerns. In addition, to the care staff there are domestic, catering and maintenance staff. People living in the home stated; “You get a fair deal here and I would recommend it to anybody”. “You get treated like a person”. “The staff are all very nice and there’s always enough staff around it you need them”. “Really and truthfully I have never regretted coming here”. “If I had the choice I would come here again”. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 23 “Staff have always got time for a chat”. “It’s not like a home; its like home- mum says thank you so much for finding it. I think the care has extended her life”. Feedback from surveys were also very positive with information indicating that staff have the right skills and experience to look after people properly, they give the support expected, are able to meet the different needs of people and there are sufficient staff available. Comments included; “My aunts continuing pleasure in being a resident at St David’s is as far as I am concerned, the best recommendation one can give to the excellent standards of care in every aspect of life at St David’s”. There is a stable staff group with a low staff turnover, which provides continuity of care to people living in the home. Recruitment records sampled showed that appropriate checks had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Criminal Record Bureau checks had been made and written references received before the employee began work, so that people were protected from the risk of having unsuitable staff work in the home with them. It was also stated that any potential recruits are introduced to people living in the home and feedback sought from them as part of the recruitment process, although it is not recorded. This enables people living in the home to have a say about potential staff who may be commence work in their home. It was noted that there was no evidence of a visa/work permit for a member of staff who originates from overseas and the manager was asked to follow this up and ensure evidence is retained in the home for future reference. Following employment new staff undertake the homes induction training and are supernumerary for a period of time, which gives them the opportunity to develop the knowledge and skills to meet the needs of people living in the home. All new staff undertake the homes induction training and the Skills for Care induction ensuring they have the knowledge to meet peoples need when commencing employment. This process was confirmed on discussion with a new member of staff. There is a rolling programme of basic training that includes fire safety, manual handling, health and safety, food hygiene etc. Records indicated a number of the staff had completed the training or were in the process of undertaking updated training. This training ensures staff have the appropriate skills and knowledge to care for people living in the home. Retrieval of training information was not easy and it was recommended that a training matrix be devised to show all the training completed by all staff at a glance, which will enable managers to see when staff require updated training at any time. It is also recommended that training more specific to people’s needs and conditions such as tissue viability, continence, medical conditions etc. be included in the training programme. This will improve staff knowledge and benefit people living in the home. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 24 Records indicated that over 50 of staff had completed NVQ 2 training or above in care and they hold the Investors in People Award. This training improves staff knowledge and skills and leads to improved outcomes for people living in the home. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of people living there. Systems are in place to ensure the health, safety and protection of people living in the home EVIDENCE: This is a well managed home with a friendly, open and positive environment. The management team consist of the two registered managers and a deputy manager who were able to demonstrate clear leadership and competency to run the home. It was apparent that they were enthusiastic and striving to improve the quality of the lives of people living at the Home. Comments include; “The home provides excellent care for its residents. The managers have maintained a very caring, pleasant, safe and exceptionally well run home”. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 26 “I have been very impressed by the high standard of care that they received. In addition, members of staff also exhibit commendable levels of professionalism. Systems are in place for the safekeeping of people’s money if they wish and they were found to be of a good standard. The quality of the service is monitored via a number of systems within the home, which includes regular one to one meetings with people living in the home by a member of the management team. Regular staff meetings and supervision is held and a survey is sent out to relatives, people who live in the home and professionals who visit the home annually. Feedback from the surveys was available and all comments were positive. Comment from one health professional; “People are extremely well looked after here, confidentiality is maintained, consultations are done in private and patients welfare is paramount to the staff who appear very caring”. It was recommend that feedback from all areas should be collated and the outcomes recorded with any areas where further work is to be undertaken etc. Feedback from staff surveys we received was positive and all confirmed they received the training they required, the manager was always at hand, communication was good and they were always kept up to date with changes. One stated “The home provides a safe, secure environment for residents, promotes individuality, encourages taking part in activities every day”. An external organization has been employed by the proprietor to assist with health and safety plus review of risk assessments, polices and procedures. Maintenance checks were completed on the fire system and equipment, so that people are safe in the event of a fire occurring. Checks were made on hot water outlets to ensure it is maintained at a satisfactory temperature to prevent scalding. The staff spoken to during the inspection were enthusiastic about working in the home, they stated the managers were approachable and they acted on any concerns raised straight away. They felt they worked well together as a team and provided good care to people who lived in the home. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 X 3 St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 28 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 3 Refer to Standard OP7 OP7 OP8 Good Practice Recommendations Care planning should be developed further, so it provides details about the action required to meet people’s needs. The recording in daily records must be based on facts and outline any interventions etc. hat have occurred All staff who undertake blood glucose monitoring must undertake training and be assessed as competent to undertake the procedure to ensure they follow safe practice guidelines. Training should be extended to include topics on clinical conditions to further inform staff knowledge. Evidence of visa/work permit should be available for staff who originate from overseas to demonstrate they are legally entitled to work in this country A training matrix should be developed to provide an overview of all the training staff have completed to enable DS0000016782.V374496.R01.S.doc Version 5.2 Page 29 4 5 6 OP8 OP29 OP30 St Davids 7 OP33 easy retrieval of information. The information from surveys, audits etc. should be collated to provide an overview of the service with any plans for development as part of the quality assurance process. St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Davids DS0000016782.V374496.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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