Care Home: St Edith`s Court

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What the care home does well Visiting arrangements in the home ensure that people, who live at St Edith’s Court, get to see their relatives and/or friends at any reasonable time. Visitors to the home stated they are made to feel welcome by staff. There is a formal process in place to ensure that prospective people admitted to the care home are assessed prior to admission. There was evidence to show that the prospective person and/or their representative is provided with a copySt Edith`s CourtDS0000015468.V378599.R01.S.docVersion 5.2of the home`s Service User`s Guide and they have the opportunity to visit the home prior to admission. Complaints are well managed at the home and there is a clear audit trail detailing the specific nature of the complaint, investigation, actions taken and outcome. People who live at the home and other interested parties are confident that they will be listened to and action taken by the management team of the home to deal with any concerns raised. Several members of the staff team have worked at St Edith’s Court for several years, providing continuity and consistency for the people who live there. There is a low turnover of staff. There is a safe system in place to safeguard residents` monies. Staff interaction with people who live at the home is very positive. People spoken with confirmed they are treated with respect at all times. The home environment is well maintained, decorated to a very high standard and enables people to maintain a level of independence, privacy and self worth. The quality of meals provided at the home is good. Positive comments about the quality of food provided were noted and these have been incorporated within the main text of the report. There is an effective programme in place to ensure that people living at the care home have the opportunity to participate in social activities. Staff newly employed are recruited robustly and in line with regulatory requirements so as to ensure peoples safety and wellbeing. What has improved since the last inspection? The recording on Medication Administration Records for individual people has now improved with few discrepancies and/or unexplained gaps. Care planning and risk assessing is greatly improved, ensuring that each person has a plan of care that is reflective of their care needs, healthcare needs and any risks. There are clear guidelines in place for staff so as to deliver good quality care. Staff training records have improved to show training and/or courses undertaken since the last key inspection. A new E Learning system has been introduced so as to provide training to staff in core areas. What the care home could do better: Ensure there are safe systems in place to safeguard people in the home by making sure that medication is not easily accessible to them or others.St Edith`s CourtDS0000015468.V378599.R01.S.doc Version 5.2 Ensure that staff who work at the home receive regular formal supervision in line with National Minimum Standards for Older People recommendations. A system must be put in place to ensure that staff receive training for those conditions associated with the needs of older people. Key inspection report CARE HOMES FOR OLDER PEOPLE St Edith`s Court 18 Hillside Crescent Leigh On Sea Essex SS9 1EN Lead Inspector Michelle Love Key Unannounced Inspection 3rd December 2009 09:55 DS0000015468.V378599.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 homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.2 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 Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Edith`s Court Address 18 Hillside Crescent Leigh On Sea Essex SS9 1EN 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) Category(ies) of registration, with number of places 01702 480688 01702 471894 patricia.welch@anchor.org.uk www.anchor.org.uk Anchor Trust Mrs Patricia Ann Welch Care Home 39 Old age, not falling within any other category (39) St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: 18th December 2008 St.Edith’s Court is part of the Anchor Trust who provides residential care in the region. The home is situated in a quiet residential area of Leigh-on-Sea and is situated close to local amenities. The home provides single accommodation for 39 older people over the age of 65. Residents’ flats are situated on two floors and offer en-suite and kitchen facilities, as well as a range of comfortable communal areas throughout the home. A passenger lift is available to the first floor as well as conventional stairs. Outside of the home is a well-designed garden that is stocked with shrubs and plants. Access to the garden is suitable for wheelchair users and sufficient seating areas exist. There are adequate parking facilities to the side of the home in a designated car park belonging to the home. The weekly fee as detailed within the service user’s guide is £595.00 to £627.00. In addition to this, residents are charged for private telephone calls/telephone bills for those who have their own telephone in their room, chiropody, hairdressing, holistic therapy, transport to healthcare appointments where the NHS trust does not provide transport, staff escort for private events and for some social events/community activities. St Edith`s Court DS0000015468.V378599.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 was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 8.5 hours, with all key standards inspected. Additionally the manager’s progress against previous requirements and recommendations from the last key (December 2008) and random inspection (June 2009) were also inspected. Prior to this inspection, the registered manager had completed and submitted an Annual Quality Assurance Assessment (AQAA). This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into the main text of the report where appropriate. As part of the process a number of records relating to people who live in the home, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents, relatives and members of staff were spoken with and their comments are used throughout the main text of the report. Surveys for people who live at the home, staff and healthcare professionals were left at the home on the day of inspection for distribution. At the time of writing this report we had received 3 completed relative’s surveys. Where comments have been recorded these have been incorporated within the main text of the report. The manager, care manager and other members of the staff team assisted us. Feedback on the inspection findings, were given as a summary to the manager, care manager and Area Manager and the opportunity for discussion and/or clarification was given. A random inspection to the home was conducted on 18th June 2009. This was a focussed inspection to assess progress following the key inspection to St Edith’s Court in December 2008 relating to medication practices and procedures and care planning processes. Some gaps were identified in relation to medication records which had been highlighted previously and shortfalls were again identified in relation to inadequate care planning documentation and risk assessments. As a result of the latter a Serious Concern Letter was issued, detailing a summary of the areas of concern and the regulations breached. What the service does well: Visiting arrangements in the home ensure that people, who live at St Edith’s Court, get to see their relatives and/or friends at any reasonable time. Visitors to the home stated they are made to feel welcome by staff. There is a formal process in place to ensure that prospective people admitted to the care home are assessed prior to admission. There was evidence to show that the prospective person and/or their representative is provided with a copy St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.2 Page 6 of the homes Service Users Guide and they have the opportunity to visit the home prior to admission. Complaints are well managed at the home and there is a clear audit trail detailing the specific nature of the complaint, investigation, actions taken and outcome. People who live at the home and other interested parties are confident that they will be listened to and action taken by the management team of the home to deal with any concerns raised. Several members of the staff team have worked at St Edith’s Court for several years, providing continuity and consistency for the people who live there. There is a low turnover of staff. There is a safe system in place to safeguard residents monies. Staff interaction with people who live at the home is very positive. People spoken with confirmed they are treated with respect at all times. The home environment is well maintained, decorated to a very high standard and enables people to maintain a level of independence, privacy and self worth. The quality of meals provided at the home is good. Positive comments about the quality of food provided were noted and these have been incorporated within the main text of the report. There is an effective programme in place to ensure that people living at the care home have the opportunity to participate in social activities. Staff newly employed are recruited robustly and in line with regulatory requirements so as to ensure peoples safety and wellbeing. What has improved since the last inspection? What they could do better: Ensure there are safe systems in place to safeguard people in the home by making sure that medication is not easily accessible to them or others. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.2 Page 7 Ensure that staff who work at the home receive regular formal supervision in line with National Minimum Standards for Older People recommendations. A system must be put in place to ensure that staff receive training for those conditions associated with the needs of older people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 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. People who come to live at the care home can be confident that they will be assessed prior to admission and that their needs will be identified and met. EVIDENCE: A copy of the home’s Statement of Purpose and Service User’s Guide is provided to prospective people and their representatives and displayed in the main foyer of the home. Both documents provide details of the services and facilities provided at the home. In addition it sets out the home’s aims objectives and philosophy of care. Admissions are not made to the home until a full needs assessment has been undertaken and they are confident that the needs of the individual can be met. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Where appropriate supplementary information, is provided by the persons Placing Authority or Primary Care Trust. On inspection of the care files for the two newest people admitted to St Edith’s Court, records showed that a pre admission assessment had been completed for each person by the care manager and prior to their admission to the home. There was evidence to show that the information recorded was informative and detailed and included a rationale for the admission to the home. Both people spoken with confirmed that they and their representative had visited the home prior to admission so St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 10 as to have a look around, to meet existing people who live at the home and to meet staff. In addition people confirmed that the admission process had been smooth and the staff team very welcoming. The home does not provide intermediate care. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 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 care needs of people in the home are clearly recorded within a plan of care so as to ensure positive outcomes for their health and welfare. EVIDENCE: There remains a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to nutrition, pressure area care, manual handling and falls. As stated previously, details recorded from the initial pre admission assessment form the basis of the initial care plan and ‘baseline assessment’. At the random inspection to the service in June 2009 a Serious Concern Letter was forwarded to the registered provider as a result of continued identified shortfalls pertaining to some aspects of care planning and risk assessing processes. A prompt response by the registered provider in June and August 2009 was forwarded to us detailing the actions to be taken/had been taken to address the deficits. Correspondence provided showed that visits to the home were undertaken by the organisation’s Area Manager and National Care Specialist, which included an audit of care plans and to check that the actions outlined within their letters had been and were being carried out so as to ensure that care plans contained all necessary information relating to a person’s care needs. Evidence at this inspection showed that much effort had been taken by the management team of the home and staff team to improve the home’s care planning documentation and associated records, so St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 12 as to ensure they were fully reflective of the person’s care needs. Records also showed that staff who work at the care home now have the necessary information they need in order to meet peoples health, personal and social care needs and ensuring that the delivery of care is appropriate. The AQAA detailed “We feel as a management team that we have a much clearer understanding of the care planning process”. As part of this site visit 5 care files (2 in full and 3 partially examined in relation to specific healthcare needs) were looked at. Records showed that each person had a plan of care and information recorded was more detailed, comprehensive and person centred than noted on previous occasions. The care files were well organised and all necessary information was easily accessible. Records also showed that wherever possible information from people who live at the home and/or their representative had been sought and included within their care plan. There was evidence to show that each care file examined had been reviewed and updated to reflect their current care needs in most cases. For example the care file for one person relating to their personal care needs recorded their strengths, abilities and areas where they require support from staff. This was seen to be informative and person centred and providing sufficient information so as to provide good care that meets their needs. The care file for another person recorded them as displaying challenging behaviour towards others on occasions. The care plan clearly recorded how this manifests and the actions to be taken by staff so as to ensure their’s and others safety and wellbeing. The care plan had been updated each month to reflect evidence of proactive action being taken by the management team of the home, including the involvement of a healthcare professional. Another care file made reference to the person having a sustained period of weight loss over several months. Although there was evidence to show that some of the weight loss had been sustained whilst in hospital, there was no evidence to show that their continued weight loss had been picked up. Daily care records showed that their appetite could be variable most days. Daily care records were observed to be completed each day, providing a good source of information as to how people spend their day. In addition healthcare records showed that people have access to a range of healthcare professionals and services e.g. Chiropodist, GP, Dentist, Optician, District Nurse Services as and when required and the outcomes from any visits and/or interventions provided. In general terms risk assessments were completed for the majority of risk areas identified, so as to ensure positive outcomes for people in the home. However some gaps were noted and care must be taken so as to ensure that these are clearly identified, including information as to how these are to be minimised for people. For example the care plan for one person made reference to them on occasions displaying challenging behaviour. No risk assessment was completed to evidence the actions to be taken if their behaviours escalated. From discussions with both senior and care staff, people demonstrated a good understanding and awareness of individual people’s care needs. Staff interactions and rapport with people who live at the home was seen to be positive and not solely based around tasks and/or routines. We spoke with 4 people who live at the home and they confirmed that care provided by staff was undertaken respectfully, sensitively and in a dignified manner at all times. People were very complimentary about staff and comments included “the girls are lovely”, “the care and support provided here is wonderful” and “I have no complaints”. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 13 We looked at the practices and procedures for the safe handling and recording of people’s medication. Medicines are stored securely for the protection of people in the home and the temperature of the room where medication is stored is monitored and recorded each day so as to ensure medication is of a suitable quality and remains effective for people’s use. Where medication requires cold storage, the temperature of the fridge was also recorded and records showed that these were within recommended guidelines. We looked at medication and medication records for 20 people in the home. Records examined showed these were in good order with few discrepancies noted. Improvements in the records were noted where people require a variable dose of medication, no disparity was observed in the records and actual quantity of medication in stock and the controlled drug records and actual medication available tallied. People who live at the home continue to be supported to manage their own medication where appropriate. A random sample of 2 care files examined showed evidence of a care plan and risk assessment relating to those people who self medicate. During a tour of the premises in the morning we observed the small medication trolley to be left unattended on the first floor. The trolley was locked however medication was left on the lower shelf of the trolley and was easily accessible to other people. In addition we observed medication left unattended and easily accessible to other people in one person’s room. On inspection of their care plan and their Medication Administration Record (MAR) these showed that some of their medications are “made available” by staff for them to take. Our observation showed that staff did not check to see if the person had actually taken their medication as prescribed and this was seen to be in conflict with the person’s risk assessment which stated “staff to go back and check medication has been taken” and “observe for any medication that has not been taken or that may be found on the floor or left lying around”. As a result of the above we left an Immediate Requirement Notice. A response was emailed to us by the registered manager of the home detailing the actions taken as a result of the above findings during the site visit. At lunchtime the team leader on shift was observed to administer medication to people. This was seen to be administered safely and with regards to people’s dignity and personal choice. On inspection of the staff training matrix this showed that for one person their medication training was completed in 2006, for four people this was undertaken in 2007 and for three people this was done in 2008. The AQAA details that staff training was conducted at foundation and advanced levels. A random sample of 2 team leader’s medication competency assessments, were requested and these were seen to have been undertaken in June 2009. The care manager confirmed that these are commenced every 6 months. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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. People who live at the care home can expect to have their social care and dietary needs met. EVIDENCE: An activities co-ordinator is employed at the home for 25 hours per week Monday to Friday, with their hours having been increased since the last key inspection. A copy of the activities programme is available and displayed on a notice board adjacent to the dining room on the ground floor. In addition there was a list of forthcoming events for the festive season. The AQAA details that all staff are to be actively encouraged and enabled to initiate activities for people in the home and this is not seen as the sole responsibility of the activities co-ordinator. Several people on the day of the site visit were observed to attend a knitting group during the morning, while others were seen to undertake their own personal interests and hobbies in the comfort of their room, to access the local community independently or to go out with friends and/or family members. One person spoken with showed us their art work, which is displayed in their room and Christmas cards that they had recently designed and were addressing and posting to friends and family. The activity programme showed that in addition to the knitting group people are able to participate in a sewing group, gentle exercises, arts and crafts projects, flower arranging, card games, religious observance, film afternoons and coffee mornings. We spoke with 5 people during the day and they confirmed that they were happy with the range of activities provided and St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 15 felt this met their social care needs. The AQAA details people at the home receive a regular newsletter regarding issues in the home and forthcoming events. There remains an open visiting policy at the home, whereby visitors to the home can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at St Edith’s Court are actively encouraged and supported to maintain friendships and relationships. Several people spoken with confirmed they can see their member of family and/or friend at any time and they are always made to feel welcome. There is a rolling 4 week menu in place at the home. This is displayed adjacent to the dining room and several people were observed to look at this during the morning. We spoke with 6 people on the day of the site visit and all were aware of the meal choices available. The menu’s continue to offer people a varied diet, including a range of alternatives e.g. sandwiches, soup, jacket potatoes, salads or omelette. The lunchtime meal was observed within the main dining room. Staff, were also seen to take plated meals to people in their room. Dining tables were attractively laid, with placemats, serviettes, cutlery, choice of drinks including alcohol, condiments and vase of flowers. As stated previously at inspections to the home, in order to enable people at the home to maintain independence and a sense of self worth, serving dishes of vegetables are placed on individual tables at lunchtime so that they can help themselves and have second helpings if they so choose. Each resident who was in the dining room was reminded of the meal options available by staff. Where people require assistance from staff to eat their meal, this was undertaken with care and sensitivity and the dining experience for people was seen to be positive. Comments from people in the home pertaining to the quality of meals provided was positive and included, “the meals are very good”, “Oh the food is good” and “I have no issues about the food here”. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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. People who live at the home can expect to have their concerns taken seriously and to be listened to so as to ensure their wellbeing. EVIDENCE: The home has a complaints procedure that explains to people how to raise issues and the timescales by which they can expect a response. This was clearly displayed in the entrance to the home and also contained within the Service User’s Guide. The AQAA details this is to be reviewed in the next 12 months. Several people who live at the home and visitors spoken with confirmed their knowledge of the home’s complaints procedure and stated that they were confident and issues raised would be dealt with effectively by the management team of the home. One comment recorded was “I have always felt able to discuss any problems”. The opposite of this as detailed from the home’s quality assurance surveys conducted in June/July 2009 recorded “I am not exactly comfortable but I would do my best to do it” and “Not always as I feel the communication is not always as good as it could be”. The manager advised that no formal complaints had been received over the past 12 months however a number of more informal complaints were received and recorded. There were a number of complaints relating to care practice issues, difficulty contacting the office and unable to leave a telephone message, quality of the meat provided at mealtimes on occasions and medication not available for one person on one occasion. Records viewed St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 17 indicated that each had been investigated, responded to where appropriate and actions identified and completed. There was evidence of a monthly audit of the number and types of complaints received as part of quality monitoring procedures. Several records of compliment were available and these included “To Pat and staff, thank you so much for the kindness that you have all shown to myself and the family during the past difficult weeks it has been much appreciated”, “I cannot thank you enough for the wonderful care shown to our relative over the past few years. The staff have been so kind, thoughtful and always smiling. The atmosphere at St Edith’s has always been a happy one. Our relative was so lucky to spend their final years with you all” and “I would just like to express my thanks to you and all the staff at St Edith’s. Our relative was so happy in their flat and appreciated all you did to make their life comfortable. They had so many needs and could be demanding. As a family, we noticed how well they were cared for and how patient and kind the staff were towards them”. The manager advised that no safeguarding referrals have been made at the home since the last key inspection in December 2008. Staff spoken with, were able to demonstrate an awareness of how abuse can occur in everyday practice and a commitment to reporting it to a member of the management team. On inspection of the staff training matrix, this showed that several people have recently received SOVA (Safeguarding of Vulnerable Adults) training however for some people this is due and for others this was last undertaken in 2006. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 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. People live in a safe, well maintained and comfortable environment which encourages independence and self worth. EVIDENCE: A partial tour of the premises was undertaken by us throughout the day of the site visit. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a very high standard and is both homely and comfortable. Each of the 39 rooms are equipped with en-suite facilities and 37 rooms have a small kitchen area adjacent to their main room, which enables them to make drinks and prepare snacks. As stated previously this is seen as positive as this enables people to exert and maintain a level of privacy, independence and helps promote a sense of self worth. A random sample of peoples’ rooms, were inspected and all were seen to be personalised and individualised to reflect their personalities and to suit their individual taste. People are actively encouraged to bring in their own items of furniture and personal possessions. There are 4 large lounge areas, one of which doubles as an activities room, a hairdressing salon and central dining room. There are sufficient bathing and communal toileting facilities available which enable immediate access and these are fitted with appropriate aids and adaptations. The premises were seen to be clean, tidy and odour free. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 19 Since the last key inspection one of the lounges has been refurbished with new furniture and carpets. In addition carpets have been replaced within 8 residents’ rooms and within the corridors on both the ground and first floors. The main kitchen has had major works so as to improve the ventilation system. The AQAA details that further works are planned within the next 12 months and these include upgrading the main kitchen, refurbishment of another lounge area, to replace kitchenettes in peoples’ rooms and to convert an unused bathroom to a ‘walk in’ shower room. There is a patio area off the dining room and seating areas surround the well maintained gardens. The patio and sitting areas are accessible for wheelchair users. As a random sample of safety and maintenance certificates and fire records were inspected at the last key inspection to the service and seen to be in date until their next examination, these have not been looked at on this occasion. No health and safety issues were highlighted at this site visit. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 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. People who live at the home can expect to be supported by staff, who are robustly recruited and who have the skills and training to meet their needs. EVIDENCE: We were advised by the manager that staffing levels at the home are 2 team leaders and 6 care staff between 08.00 a.m. and 15.00 p.m., 2 team leaders and 5 care staff between 15.00 p.m. and 22.00 p.m. and 1 team leader and 2 care staff between 22.00 p.m. and 08.00 a.m. The manager confirmed that the staffing levels are determined by the completion of the Department of Health’s residential forum and this is undertaken annually as part of the organisation’s annual business planning meeting. We were advised that currently the majority of people in the home are categorised as having ‘medium’ dependency care needs with 1 or 2 people falling into the ‘high’ dependency spectrum. The manager confirmed that if the dependency needs of people in the home should increase, this would be discussed with the Area Manager and appropriate staffing levels deployed. The manager’s hours remain supernumerary to the above figures. In addition to the above a number of ancillary staff, are employed and these include catering staff, housekeepers, administrator and a maintenance person. On inspection of 4 weeks staff rosters, records showed that staffing levels as detailed above have been maintained. Staff on duty on the day of the site visit corresponded with the staff roster and the deployment of staff throughout the day was observed to be appropriate for the needs and numbers of people in the home. Staff, were noted to attend to people’s care needs in a timely manner and to answer call alarm facilities within a reasonable time frame. The majority of the staff team have worked at St Edith’s Court for some considerable and there is a low turnover of staff. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 21 We looked at the staff recruitment records for 3 people newly employed at St Edith’s Court. Records showed that robust recruitment procedures are in place so as to ensure people’s safety and wellbeing. A record of induction that complies with Skills for Care Common Induction Standards were in place for each person however there was no evidence of a basic ‘orientation’ induction having been undertaken at the home e.g. shown around the home, shown where the home’s fire exits were, shown where care records for people are located etc. The manager confirmed that newly appointed staff, continue to be supernumerary for the first week of their employment at St Edith’s Court. A copy of the staff training matrix was provided to us. Records showed that in the last 12 months people have received training in core subject areas. These include SOVA, manual handling, food hygiene, fire awareness, first aid, dementia awareness and the mental capacity act. The organisation have introduced since the last inspection E Learning and these cover such topics as COSHH (Control of Substances Hazardous to Health), infection prevention and control, health and safety and basic food hygiene. There was little evidence to show that people have been provided with specific training around the needs of older people e.g. Parkinsons Disease, sensory impairment, continence awareness, pressure area care/tissue viability, deprivation of liberty safeguards etc. The training matrix recorded 10 people as having NVQ Level 2, 4 people working towards NVQ Level 2, 7 people having attained NVQ Level 3 and 3 people working towards NVQ Level 3. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 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. People living in the home can be confident that the home is run in their best interests so as to ensure positive outcomes for people. EVIDENCE: The registered manager has achieved the Registered Manager’s Award, Edexcel NVQ Level 4 in Management, City and Guilds D32/33, Vocational Assessor City and Guilds C25 Coaching Award and is the home’s Fire Safety trainer. They have been the manager at St Edith’s Court since 2001 and have experience working in care, both within the private sector and within social services. Our findings from this inspection evidence that the manager and other members of the management team/staff team have implemented and improved systems and practices at the home which required addressing and these have benefited both people who live at the home and staff. The AQAA details there is an ‘open door’ policy whereby people who live at the home and their representatives are able to discuss any concerns or issues with the management team. Relative’s surveys returned to us recorded “St Edith’s in St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 23 the 10 years of my relatives residence has always given us great support and is outstanding in all areas. I visit regularly and have the time to observe the details. Staff are well chosen and trained and give excellent care” and “Very satisfied with level of care which has made our relative more alert and engineered a feeling of wellbeing. A good atmosphere of ‘life and happiness’staff all appear to enjoy their jobs”. The registered provider has a quality assurance system in place that includes obtaining the views of residents and relatives and this was conducted in June and July 2009. On the whole comments recorded were in general observed to be positive and included, “the management team of the home are very approachable and extremely helpful” and “staff are friendly, courteous, polite, smiling and helpful”. In addition to this, the registered provider monitors the quality of the service through regular monthly visits by a member of the organization and monthly quality indicators are completed by the manager in relation to the turnover of people in the home, deaths, hospital admissions, discharges, incidents and accidents, concerns and complaints, safeguarding, pressure sores and infection control issues. Records also showed there are regular staff and resident meetings and the minutes of these were readily available. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was seen to be informative and detailed, providing an accurate account of the current situation within the service and changes they have made and where they still need to make improvements. People are supported to manage their own money where possible. Where money is held for safekeeping, this is managed well. A copy of the staff supervision matrix was provided to us and this showed that some staff, are receiving regular formal supervision and others are not in line with the frequency as recommended within the National Minimum Standards for Older People. The AQAA provides a list of policies and procedures currently available within the home. Appropriate health and safety policies were seen to be in place. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 24 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 STAFFING Standard No 27 28 29 30 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 N/A 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 4 X X X X X X 3 Score 3 3 3 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 3 36 2 37 X 38 3 St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Ensure that medication is not left unattended or easily accessible to others that it is not prescribed for. So as to ensure peoples safety and wellbeing. Ensure all staff who work at the care home receive regular supervision so that they feel supported and able to undertake their job effectively. Previous timescale of 1/5/08, 30/7/08 and 1/3/09 not met. Timescale for action 03/12/09 2. OP36 18(2) 01/03/10 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. 2. Refer to Standard OP18 OP30 Good Practice Recommendations All staff should receive updated SOVA training. All staff should receive specialist training for those conditions associated with the needs of older people. St Edith`s Court DS0000015468.V378599.R01.S.doc Version 5.3 Page 26 Care Quality Commission Eastern 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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