Care Home: St Edmund`s CCSC

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What the care home does well Since the last inspection carried out in February 2008 this service has undergone a huge amount of change. At the time of this inspection part of the unit was still closed following the development of a rehabilitation unit for people with mental health problems. This is due to open in the weeks following this inspection. People staying at St Edmunds receive a full and thorough assessment of their needs, particularly in relation to re-ablement. They are given an extensive programme of support to maximise their abilities and return home with arrangements made to ensure they have all the equipment they need to make them as independent as possible. People staying at the unit or who completed questionnaires said that it was “Like a five star hotel” and “St Edmunds is excellent. The staff are wonderful“. The accommodation provided is clean, bright and in single en-suite rooms that are comfortable and accessible. All the services and professionals needed are under one roof and this means that assessments and support needed can be provided with the minimum of delays. Staff who completed questionnaires were complimentary about the home’s management and opportunities available to them. One wrote “Training is excellent” and “All professions seem to communicate very effectively….…I feel very lucky to be a part of this team”. The unit is successful. Statistics produced show that by far the majority of people admitted return to their own homes. What has improved since the last inspection? As previously stated the service has undergone significant change. A new Mental Health rehabilitation unit has been provided which is due to open shortly. A medication pathway has been introduced for the self administration of medication. This gives a stepped approach to people taking control of their own medication. This is to ensure that both the staff at the home and the person concerned are confident that self-medication is (and remains) a safe option. The home`s menus are being displayed communally so that people know what meal they will be having and can then make an informed choice as to whether or not they want the main meal or would prefer a different choice. The home’s complaints policy is being displayed in an easily accessible place. This is to ensure that people know how to make a complaint, should they need to, and how they can expect it to be dealt with. The complaint’s policy includes contact details of the Commission. The ventilation of the staffs’ internal office area, sited on the first floor, has been reviewed and an air conditioning unit installed. This has made for a more comfortable working environment.Weekly checks of the home’s hot water supply is being undertaken. This is to ensure that any risk, of unregulated hot water being delivered, is minimised and therefore lessens the risk of any person inadvertently scalding themselves. It is understood the "fire compartmentation” of the building has been implemented to the required standards of fire prevention legislation. The security of the building has been reviewed in light of a security infiltration, and additional precautions taken as a result. This is to ensure that the people remain protected at all times. Staff are receiving regular supervision. This helps to ensure that they are working to their full potential and in a consistent way, as well as feeling supported by their management. The manager is now registered with the Commission for Social Care Inspection. New care planning systems have been introduced which are still evolving. These help to ensure that everyone is clear about peoples care needs and how they are to be delivered. What the care home could do better: Full assessments must be completed before the person is admitted to the service to ensure it is the right place for them, and that the home can meet their needs. The home must ensure that home is operated in accordance with their registration, or amend this accordingly. An up to date Service User Guide and Statement of Purpose should be compiled and made available to the people who use the service. This is so that people are clear about what St Edmunds is providing. The home should ensure that along with the older person’s standards their statement of purpose and service user guide should reflect the National Minimum Standards for younger adults. This is because the home is registered to take people from the age of 40. The home is advised to consider increasing the amount of social and person centred care information in the assessments and care plan files. People’s involvement in the drawing up and agreement with the care plans should be recognised. This is so that the home can take a holistic view of the person and make sure their wishes regarding their care are fundamental to the care planning process. Adult protection (Safeguarding) training and Mental Capacity Act training should be given to all staff. This is to ensure that they are aware of people’s rights and what to do if abuse is suspected.The low banister rails should be risk assessed and any required action taken to prevent people falling from the rail. A full quality assurance/quality management system should be implemented. This should ensure people who have stayed at the home have a way of influencing how it operates. It should also help management to identify what is working well and what could be improved. Fire drills, practices and instruction should be carried out in accordance with the home’s risk assessment and schedule in the fire log book. CARE HOMES FOR OLDER PEOPLE St Edmund`s CCSC Victoria Park Road Torquay Devon TQ1 3QH Lead Inspector Michelle Finniear Unannounced Inspection 09:20 5 & 9th February 2009 th 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 Edmund`s CCSC DS0000037052.V373519.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 Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Edmund`s CCSC Address Victoria Park Road Torquay Devon TQ1 3QH 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) 01803 324595 01803 314839 sally.pritchard2@nhs.net Torbay Council Social Services Mrs Sally-Anne Pritchard Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24), Old age, of places not falling within any other category (24), Physical disability (24) St Edmund`s CCSC DS0000037052.V373519.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 providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 24. Service users may be accommodated from 40 years of age. 2. 3. Date of last inspection 6th February 2008 Brief Description of the Service: St Edmunds is currently classed as an intermediate care facility for up to twenty-four service users who have been identified as having the capacity to return home following rehabilitation input. The home provides intensive rehabilitation with personal care for a period of up to six weeks. There is no charge to the individual as Torbay Care Trust funds places at the home. At the time of the Inspection a part of the building had been closed off for remodelling to provide a separate Mental Health Intermediate care Facility, which will be opening in several weeks time. Therefore only 11 intermediate care beds were available. A multi-disciplinary assessment is carried out following admission, and people benefit from the attention of physiotherapists, and occupational therapists who are based in the home. Visits to people’s homes are carried out before discharge for assessment of on-going needs for adaptations or support. All bedrooms are currently used for single occupancy, and all have a spacious en suite toilet and shower. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 5 The home is well equipped for people with reduced mobility, having a shaft passenger lift, assisted baths and disabled toilets. There is also a well-equipped gymnasium for use with the therapists, and a kitchen to help with assessments. There is level access on each floor and out to the gardens from the ground floor where there is a day care centre. This is not inspected by the Commission for Social Care Inspection. There is some car parking available on the site, or on local streets. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report reflects a summary of a cycle of Inspection activity at St Edmunds since the last Key inspection visit to the home in January 2008. To help CSCI make decisions about the home the manager gave us information in writing about how the home is run; information received since the last inspection was seen along with the records of what was found at that time; Questionnaires were sent to people staying at the home about what it was like to stay at St Edmunds; two site visits were carried out with no prior notice being given to the home as to the specific date and timing of the first visit; discussions were held with the business manager, a visitor and the staff on duty; various records were sampled, such as care plans and assessments; a tour was made of the home; and time was spent individually with some of the people who were staying at the home. This approach hopes to gather as much information about what the experience of being at St Edmunds is really like, and make sure that people’s experiences of the home form the basis of this report. This inspection has been carried out using the older person’s National minimum standards as the majority of the people at the home were older people. However the home is also registered to take people from the age of 40, so due regard should be taken by the home of the Younger adults standards when developing and monitoring the service provision. This should also be reflected in the statement of purpose and service user guide. What the service does well: Since the last inspection carried out in February 2008 this service has undergone a huge amount of change. At the time of this inspection part of the unit was still closed following the development of a rehabilitation unit for people with mental health problems. This is due to open in the weeks following this inspection. People staying at St Edmunds receive a full and thorough assessment of their needs, particularly in relation to re-ablement. They are given an extensive programme of support to maximise their abilities and return home with St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 7 arrangements made to ensure they have all the equipment they need to make them as independent as possible. People staying at the unit or who completed questionnaires said that it was “Like a five star hotel” and “St Edmunds is excellent. The staff are wonderful“. The accommodation provided is clean, bright and in single en-suite rooms that are comfortable and accessible. All the services and professionals needed are under one roof and this means that assessments and support needed can be provided with the minimum of delays. Staff who completed questionnaires were complimentary about the home’s management and opportunities available to them. One wrote “Training is excellent” and “All professions seem to communicate very effectively….…I feel very lucky to be a part of this team”. The unit is successful. Statistics produced show that by far the majority of people admitted return to their own homes. What has improved since the last inspection? As previously stated the service has undergone significant change. A new Mental Health rehabilitation unit has been provided which is due to open shortly. A medication pathway has been introduced for the self administration of medication. This gives a stepped approach to people taking control of their own medication. This is to ensure that both the staff at the home and the person concerned are confident that self-medication is (and remains) a safe option. The homes menus are being displayed communally so that people know what meal they will be having and can then make an informed choice as to whether or not they want the main meal or would prefer a different choice. The home’s complaints policy is being displayed in an easily accessible place. This is to ensure that people know how to make a complaint, should they need to, and how they can expect it to be dealt with. The complaint’s policy includes contact details of the Commission. The ventilation of the staffs’ internal office area, sited on the first floor, has been reviewed and an air conditioning unit installed. This has made for a more comfortable working environment. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 8 Weekly checks of the home’s hot water supply is being undertaken. This is to ensure that any risk, of unregulated hot water being delivered, is minimised and therefore lessens the risk of any person inadvertently scalding themselves. It is understood the fire compartmentation” of the building has been implemented to the required standards of fire prevention legislation. The security of the building has been reviewed in light of a security infiltration, and additional precautions taken as a result. This is to ensure that the people remain protected at all times. Staff are receiving regular supervision. This helps to ensure that they are working to their full potential and in a consistent way, as well as feeling supported by their management. The manager is now registered with the Commission for Social Care Inspection. New care planning systems have been introduced which are still evolving. These help to ensure that everyone is clear about peoples care needs and how they are to be delivered. What they could do better: Full assessments must be completed before the person is admitted to the service to ensure it is the right place for them, and that the home can meet their needs. The home must ensure that home is operated in accordance with their registration, or amend this accordingly. An up to date Service User Guide and Statement of Purpose should be compiled and made available to the people who use the service. This is so that people are clear about what St Edmunds is providing. The home should ensure that along with the older person’s standards their statement of purpose and service user guide should reflect the National Minimum Standards for younger adults. This is because the home is registered to take people from the age of 40. The home is advised to consider increasing the amount of social and person centred care information in the assessments and care plan files. People’s involvement in the drawing up and agreement with the care plans should be recognised. This is so that the home can take a holistic view of the person and make sure their wishes regarding their care are fundamental to the care planning process. Adult protection (Safeguarding) training and Mental Capacity Act training should be given to all staff. This is to ensure that they are aware of people’s rights and what to do if abuse is suspected. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 9 The low banister rails should be risk assessed and any required action taken to prevent people falling from the rail. A full quality assurance/quality management system should be implemented. This should ensure people who have stayed at the home have a way of influencing how it operates. It should also help management to identify what is working well and what could be improved. Fire drills, practices and instruction should be carried out in accordance with the home’s risk assessment and schedule in the fire log book. 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 Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 10 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 Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The referral system does not operate consistently and sometimes people are admitted who are not suitable for the service. People do not always receive enough information about the service before they are admitted. EVIDENCE: St Edmunds has some information in the form of a brochure which is currently in development. The older information available at the home is considerably out of date, and does not reflect the management or policies of the centre. People spoken to at the home or who completed questionnaires had not received information about St Edmunds in writing and one person felt they were not sure why they had come, but were glad that they did. One person who completed a questionnaire said “”I was told I was going to another hospital and only told I was coming here the evening before I came….. I think I came here too early”. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 12 The statement of purpose contains information about the aims and objectives of the establishment but does not contain all the required information from Schedule 1, such as the name and address of the registered provider and manager, complaints procedure and arrangements for people to be consulted on the way the home is run. People are referred to St Edmunds without staff from the home having met them and made an assessment of their needs and capabilities or their suitability for intermediate care. People are referred and information is supplied by the referrer as to the person’s capabilities and suitability for rehabilitation. Staff at the home then look at this basic referral and accept the referral or not. For people in hospital, the liason nurse may visit and make a decision about whether the person is suitable for St Edmunds or not. Staff at the home and visiting medical staff felt that sometimes the information supplied on the referrals was not always complete or accurate and led to some inappropriate admissions to the unit. As an example on the day of the first site visit a person who had moved to St Edmunds the day before for rehabilitation was returned to the hospital as they were seriously ill and unable to benefit from the services at the home. This had led to significant disruption and two unnecessary moves for this person who was very unwell. Discussion was held on potential changes to the admission process, which will be even more important with the impending opening of the mental health rehabilitation unit. Copies of contracts of residency were seen in people’s files. These outlined information about the level of care provided and what people can expect at St Edmunds. St Edmunds provides Intermediate care. This means it is a specific unit arranged to provide for intensive rehabilitation support with a view to returning people to their own home. The unit does not provide long term care for people, who mainly stay for up to six weeks. Specialist services such as Physiotherapy and occupational therapy are available on site. Intermediate care is funded, so people staying at St Edmunds would not be expected to pay for their care there. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. Some areas were excellent. This judgement has been made using available evidence including a visit to this service. People’s healthcare needs were being met very well; however the way the unit has been configured may have led to conflicts in their registration status. EVIDENCE: Following admission each person receives a full series of assessment from the multi-disciplinary team that works at St Edmunds This includes assessments from the Occupational therapists and Physiotherapists that work there. It also includes a full nursing assessment, medication assessment and review and assessment by a visiting GP attached to the service. The assessments are then used to compile a plan of care with the aim of returning the person to health and their own home as soon as possible. Some files contained information that was not clear, but in the main they were well maintained and comprehensive. People spoken to at the unit could not praise it highly enough. One person said it was “Like a five star hotel” and that “They couldn’t be better”. People were St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 14 clearly grateful for the support and assistance they received and the positive focus of the unit. People’s health care needs were being met well, with good access to local General practitioners and a full multi-disciplinary team on site for much of the time. During the inspection site visit it appeared that the home was employing nurses to carry out nursing care on the premises, without the unit being registered to provide Nursing care. This was discussed on the second site visit and the homes management agreed to speak to the registration department of CSCI to discuss ways of remedying this without delay. The unit is well equipped, with aids and adaptations available as needed. Each person has an en–suite room and there is a well equipped gymnasium and training kitchen to help assess equipment someone may need when they return home. There are wide, level corridors and a lift for transport between floors. Assisted bathing facilities are available on each floor, and specialist beds are available. Medication management systems were seen on the first site visit. The systems for storage and administration were discussed with a senior carer along with the training staff undergo before being able to administer medication. Some people staying at the home deal with their own medication, and this is assessed following a medication pathway. Once assessed as being capable to deal with their medication it is kept in individual lockable cupboards in their rooms. The systems for recording the administration of medication were satisfactory including the administration of controlled medication, which requires extra precautions due to its strength or effects. Information is available to people to check on specific medication if needed. A pharmacist is a part of the multidisciplinary team, so people at the home can have a full medication review as a part of their assessment. This can help to identify problems with medication or side effects that for example might be making someone prone to falling. People who completed questionnaires all said that their healthcare needs were met but some felt that staff did not always listen to them. There was no evidence seen in people’s files on how their contribution to their care plans, wishes or aspirations was included, and they were not signed by them. Evidence was seen of people giving their permission for assessment. Discussion was held on amendments to the care planning system for the Mental health and Dementia care unit soon to be opened. St Edmund`s CCSC DS0000037052.V373519.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at St Edmunds experience busy and active programmes of rehabilitation aimed at returning them to their own homes. EVIDENCE: St Edmunds is not a traditional care home. People stay there for a short period, usually of a maximum of six weeks to enable them to be rehabilitated following a stay in hospital, major surgery or an accident. People may also go there for assessment and to be ‘built up’ following a period of illness. People at St Edmunds all follow activity plans aimed at returning them to strength and assessing their ability to return home. The building has a gymnasium where people staying there can attend with physiotherapy staff and other activities such as exercise groups are undertaken with care staff looking at building flexibility and co-ordination. People spoken to said that their days were busy and purposeful. The focus of activity is however mainly health based in a structured environment. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 16 Visitors are able to attend at any time, and people living at the unit confirmed that they did so. People living at St Edmunds often also go home accompanied by staff as a part of their rehabilitation programme, looking at how well they can manage in their own environment and any adaptations needed to enable them to be safe at home. People spoken to said that the meals were of a good quality and well presented. One person said food was “ very good and appetising”. Another who completed a questionnaire said they would “Like to have flora as I am not allowed butter”. Kitchens also supply the attached day centre. On the day of the first site visit the main meal was Roast lamb, cabbage, swede, peas or a ploughman’s lunch, with a choice of trifle, cheese and biscuits or ice cream for dessert. The evening meal was to be hot dogs, sandwiches, angel whirl and fresh cakes. The home has appointed a ‘nutritional champion’ amongst the senior care staff who has been looking at ways of improving and enhancing the meal provision. Many people come to St Edmunds needing to be ‘built up’ following sickness or poor self care and it is important that the food served is a nutritious as possible. The champion has been looking at developing meals for special needs such as for people with dietary or religious needs that are appetising and provide a high nutritional content. This is commendable. Meals are approved by a dietician and menus are on display. The building also has a rehabilitation kitchen where people can be assessed and supported to make their own snacks and hot drinks. This helps to identify any aids and adaptations that may be helpful when the person return to their own home. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes policies and procedures regarding complaints management and the protection of potentially vulnerable people means that people should be protected from abuse or are able to raise concerns appropriately and be confident of a fair resolution. EVIDENCE: St Edmunds has a complaints procedure which is available in the home’s entrance hall. This explains how and to whom complaints should be made and also what response people can expect. No formal complaints have been received in the last year. The complaints procedure is also available in other areas of the home and in a leaflet from Torbay care trust. This includes information about access to the Patient liason service which can support people in making their concerns known. People spoken to had a fair idea of what they would do if they were unhappy about something at St Edmunds. Discussion was held on the home’s adult protection policies and procedures. Staff have not all yet received training in protection of vulnerable adults but information is available in the home about what to do if abuse or abusive practices are suspected and staff who completed questionnaires were confident that they knew what they would do if they were concerned about someone’s care. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 18 Training is also to be provided in the Mental Capacity Act. This should help to ensure people’s rights to make decisions are protected. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. St Edmunds offers an attractive environment to work and stay in. EVIDENCE: At the time of the site visit St Edmunds was nearing the end of a long period of remodelling and upgrading to provide the second floor with a separate unit for mental health rehabilitation. This unit will provide accommodation for up to 9 people with a mental health problem, which may include Dementia with a separate unit for rehabilitation with a view to returning them to their own home. The First floor comprises a physical rehabilitation unit, with eleven single bedrooms all with en-suite facilities. The ground floor consists of the day care centre, kitchen, laundry, offices and the gym and training kitchen. There is St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 20 some parking to the front, side and rear of the building and on street parking nearby. There had been recent problems with the security of the building but additional measures have been taken and further planned to ensure this is no longer a problem. A tour was made round all areas of the building. Each person has a single room with en-suite facilities and there is a lounge, kitchenette and dining area on each floor. Windows have restricted openings to prevent anyone accidentally falling from them and hot water and hot surfaces have been protected or restricted to ensure people cannot be accidentally scalded or injured. Specialist assisted baths are available to ensure people can be bathed in comfort. Raised toilet seats, grab raised etc are available as needed. The home has an Infection control champion and audit system, which helps to ensure that people are safeguarded from any foreseeable infection risks. There are appropriate systems for the transport of clinical waste and soiled linens throughout the building. All areas seen on this visit were clean, warm, free from odour and comfortable. People spoken to said that the accommodation was “Excellent”, “five star” and “couldn’t be better”. During the tour it was noted that the banisters were low to the main staircase. Health and safety audits were said t be undertaken regularly on the environment. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing practices support people well. EVIDENCE: At the time of the site visit the home was partially closed to allow for alterations to prepare the new unit. Therefore only the first floor was in use for residential accommodation. This meant there was a high staffing compliment to support the up to 11 people that could be accommodated there. The staffing compliment consists of physiotherapists, occupational therapists, nurses, care and senior care staff, rehabilitation co-ordinators and support staff, with ancillary staff such as cooks, domestics and general assistants. Staff spoken to were knowledgeable about the home and the care being delivered. They were competent and confident in the interactions seen between the various disciplines at the home and with visiting professionals. The homes recruitment processes were discussed and sample systems seen that demonstrated that the systems had been followed. This had included the obtaining of references, criminal records bureau checks and the following of a full induction. A thorough recruitment process helps to ensure people are protected from being cared for by people who may be unsuitable to be working with potentially vulnerable people. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 22 St Edmunds has a programme of training for staff, which includes core and service specific training. Some updating is needed for some staff, but the Business manager has a training matrix and as training becomes available people are being booked on courses. On the first visit a member of staff could be seen following an induction programme which also involved working with individuals from the staff team to gain an understanding of how their role fits within the team. Some elements of the Induction programme had been recorded as being completed in advance of them having been undertaken. Staff who completed questionnaires said that they were given good training to fulfil their role and that usually communication systems worked well. One said that the “Training is excellent” and “All professions seem to communicate very effectively….I feel very lucky to be a part of this team”. People using the service were complimentary about the staff. One said “the staff are excellent. They can’t do enough for me”, and another said St Edmunds is excellent. The staff are wonderful” Relationships between staff and their lines of management and accountability were identified in a staffing structure chart in the statement of purpose, and job descriptions were available. People spoken to who were living in the unit were not clear about who all the staff were that had been supporting them. There are regular staff meetings and a weekly multi-disciplinary team meeting. Discussion was held on the position of the employed nursing staff, as previously indicated. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being well managed, however changes may need to be made to ensure the home remains properly registered. EVIDENCE: The manager of the home, Mrs Sally Pritchard is a knowledgeable and experienced nurse. She has managed the home for a year and has commenced many positive strategies for improvement. People who discussed her were full of praise for her management skills, dedication and commitment to the home and the staff. Discussion was held on quality assurance systems at the home. The home currently issues questionnaires to people when they have left the home, to St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 24 enable them to give feedback about the service they have received. These were being anonymised and made available in the home’s lounge. They were not currently being analysed or used to develop a quality assurance or quality management system for the home, which would incorporate other information from internal and external audit. This will help people who have used the service influence the way it operates in future. It will also give the management evidence of what is working well and where things can be improved. Staff are being supervised appropriately, with both line management and professional clinical supervision being available for each profession represented. Supervision systems are complex, where some of the therapist staff are line managed by the registered manager, but have professional clinical supervision outside of the home. Supervision is a process combining professional development and performance management and is being given to staff approximately every 6-8 weeks throughout the year. Staff also receive an annual appraisal. These should all help to ensure staff are working consistently and to their full potential to support people staying at the home. Accounting systems for monies held in trust were seen and sampled at random where they were found to be accurate. The home only holds small amounts of money or belongings for safekeeping. All transactions are witnessed and signed for by all parties. The home also has a fund for donations which is administered by the Trust. Health and safety arrangements seen were satisfactory. Fire tests are being carried out regularly, but fire drills and practices were not being recorded in the logbook on every occasion. Portable electrical appliance testing is undertaken and servicing contracts could be seen for hoists and other equipment. The business manager stated the risk register was regularly reviewed and evidence could be seen of regular tests of Water temperature and maintenance contracts. Health and safety policies and procedures were available on each level. These included arrangements for the safe management of chemicals and cleaning equipment. Risk assessments in relation to individuals staying at the service were available in their files, for example for moving and handling. Risk assessments were also undertaken for safe working practices according to the business manager but these were not seen. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 25 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 1 2 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 x 3 St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP2 Regulation 14 Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do soa) The needs of the person have been assessed by a suitably qualified or suitably trained person; b) The registered person has obtained a copy of the assessment c) There has been appropriate consultation regarding the assessment with the service user or a representative of the service user d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Timescale for action 13/05/09 St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 27 (Full assessments must be completed before the person is admitted to the service to ensure it is the right place for them). 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. OP1 YA1 Refer to Standard Good Practice Recommendations An up to date Service User Guide and Statement of Purpose should be compiled and made available to the people who use the service. This is so that people are clear about what St Edmunds is providing. This was a recommendation at the last Inspection and has not yet been complied with. The home should ensure that along with the older person’s standards their statement of purpose and service user guide should reflect the National Minimum Standards for younger adults. This is because the home is registered to take people from the age of 40. The home is advised to consider increasing the amount of social and person centred care information in the assessments and care plan files. People’s involvement in the drawing up of the care plans should be recognised. Adult protection (Safeguarding) training and Mental Capacity Act training should be given to all staff. This sis to ensure that they are aware of people’s rights and what to do if abuse is suspected. The areas of low banister rails should be risk assessed and action taken as a result to ensure people cannot fall over the rail. A full quality assurance/quality management system should be implemented. This should ensure people who have stayed at the home have a way of influencing how it DS0000037052.V373519.R01.S.doc Version 5.2 Page 28 2.. OP1 YA1 3. OP7 4. OP18 5. 6. OP19 OP33 St Edmund`s CCSC 7. OP38 operates. It should also help management to identify what is working well and what could be improved. Fire drills, practices and instruction should be carried out in accordance with the home’s risk assessment and schedule in the fire log book. St Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Edmund`s CCSC DS0000037052.V373519.R01.S.doc Version 5.2 Page 30 - 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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