Care Home: St Elizabeths

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well The staff in the home are skilled, provide a good service and are focussed on meeting the needs of people living in the home. There is a consistency of staffing with a low turnover. The home is well managed and the Manager balancing her time effectively between ensuring paperwork is completed, supporting staff and ensuring she has time to spend with people living in the home and their relatives. Systems in the home are regularly updated to ensure they are suitable for the people living in the home and the home is kept clean and in good repair. The home ensures that the healthcare needs of people living there are regularly monitored and that people have access to relevant healthcare services as and when necessary. What has improved since the last inspection? Since the previous inspection the home had addressed all the concerns raised at that time. This included improving individual risk assessments for service users, providing and recording fire training for staff and ensuring the hot water outlets provided water at a safe temperature. The home has also begun work on a planned extension providing three extra en-suite rooms, an additional lounge area and a re-landscaped garden. Newer activities have been introduced in the home, particular activities aimed at including less able people. What the care home could do better: The home has the basis of a good quality assurance programme based on seeking the views of people living in the home and others with an interest in the home. The Manager understands how this programme needs to be improved and fully implemented so that it becomes an annual process of evaluation and planning for the service in response to the views of people receiving the service. CARE HOMES FOR OLDER PEOPLE St Elizabeths 115 Swift Road Woolston Southampton Hampshire SO19 9ER Lead Inspector Nick Morrison Unannounced Inspection 8th May 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Elizabeths DS0000011646.V363278.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 Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Elizabeths Address 115 Swift Road Woolston Southampton Hampshire SO19 9ER 023 8042 1212 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) stelizrch@aol.com Mr Andrew Watt Mrs Barbara Watt Mrs Barbara Watt Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2007 Brief Description of the Service: St. Elizabeth’s is a family run business and is owned by Barbara and Andrew Watt. The home is registered to provide care and accommodation to 15 residents over the age of 65 years and those who have a diagnosis of dementia. St. Elizabeth’s is a large detached property with gardens accessible to all service users living at the home. The home is located close to the centre of Woolston and a short car or bus ride to Southampton city centre. Fees at the home range from £327 to £425 per week and service users are responsible for paying for their own toiletries, hairdressing, chiropody and items of a personal or luxury nature. St Elizabeths DS0000011646.V363278.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 stars. This means the people who use this service experience good quality outcomes. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 8th May 2008 and lasted five hours. During this time we went into each room, looked at service users’ files and met with people living in the home. We also met with the Manager and spoke with two members of staff. All records and relevant documentation referred to in the report were seen on the day of inspection. We sent out surveys and received back nine surveys from relatives, ten from service users, five from staff and one from a Care Manager. We have also referred to the Provider’s Annual Quality Assurance Assessment (AQAA). What the service does well: What has improved since the last inspection? Since the previous inspection the home had addressed all the concerns raised at that time. This included improving individual risk assessments for service users, providing and recording fire training for staff and ensuring the hot water outlets provided water at a safe temperature. The home has also begun work on a planned extension providing three extra en-suite rooms, an additional lounge area and a re-landscaped garden. Newer activities have been introduced in the home, particular activities aimed at including less able people. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home. EVIDENCE: Examination of service users files showed that each person living in the home had had an assessment of their needs prior to admission. Assessments were comprehensive and contained input from service users, their families and relevant health professionals. Families of service users and service users confirmed that they had been consulted during the assessment process. Families also confirmed that the home provided useful information prior to their relative moving into the home. Information about the home, including the Statement of Purpose, Service User Guide, Inspection Report and Complaints Procedure, was kept in the entrance to the home. The home does not provide intermediate care. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs identified in a care plan and from having their healthcare needs met. They are protected by the home’s medication policies and procedures and are treated with dignity and respect. EVIDENCE: There had been a requirement from the previous inspection that the people who use the service must be safeguarded from potential risk of harm by the process of individual recorded risk assessments. Examination of service users’ files and discussion with the Manager demonstrated that this requirement has now been met. There were risk assessments on file where risks had been identified and these were dated, signed and kept under regular review. Examination of files showed that there were care plans in place for each service user. The plans had clearly been written in response to those needs identified in the pre-admission assessment, as well as to those needs identified St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 10 as staff in the home got to know service users better. Staff spoken with said that the plans were accessible at all times and that they understood the care plans for each person living in the home. The plans were all reviewed on a monthly basis and changes made where necessary. Changes were also made to the plans in-between the monthly reviews if it was clear that needs had changed. All staff said they understood the care plans and that they were easily accessible within the home. They understood the importance of good care planning. One member of staff told us “care plans are always detailed and upto-date” another told us that “care plans are an important part of what we do as carers.” Examination of service users’ files showed that healthcare needs were monitored regularly and responded to effectively. Where health needs had been identified the home responded quickly and ensured that people received the healthcare services they needed. Good records were kept of all health appointments and interventions. The home liaised effectively with healthcare professionals in the interests of service users. One service user told us “outside nurses attend if necessary” and a relative told us the home liaised very well between the hospital and the family when their relative was in hospital. Observation throughout the inspection showed that staff were very good at treating service users with respect at all times. The importance of respecting service users was highlighted in the home’s policies and in the training that staff received. The Manager required high standards from her staff. One relative told us the home was good at “combining affection with respect for the dignity of residents.” All service users told us they received their medication as they needed it. The medication in the home was generally well managed and good records were kept of medication administered to service users as well as of all medication coming into and going out of the home. The medication was safely stored and all staff administering medication had received appropriate training. Copies of the medication policy were kept next to the medication cupboard so that staff could refer to them as necessary. There was also good information on each type of medication so that staff could be aware of what signs to look out for if anyone living in the home refused any medication at any time. The home was about to introduce a new medication into the home in the week following our inspection visit and had received advice and training from the Pharmacist in preparation for this. One person in the home had cream prescribed by the doctor. The medication records did not account for the cream and, as a result of discussion, the St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 11 Manager has agreed to ensure that all prescribed medication is recorded as it is administered. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from being able to exercise choice and control and have stimulating activities. They also benefit from good support in maintaining contact with friends and families and a good, balanced diet. EVIDENCE: Staff had received training in communicating with people who have dementia and were skilled in communicating with people living at the home. Service users’ methods of communication were recorded and there was close liaison with families over the needs, choices and wishes of each service user. Families confirmed that all the staff in the home were very good at communicating effectively with their relatives and that they were respectful of the choices they made. Observation of staff on the day of the inspection visit showed that they gave time and consideration to all service users and attempted to respond to their St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 13 wishes at all times. They spent time listening to people and engaging them in conversations. The Manager had spent time over the year introducing newer and different activities to try to get service users involved. Emphasis was placed on activities that helped service users to maintain both mental and physical skills and abilities. Current activities in the home included number and word games, ball therapy, reminiscence and a regular entertainer. One relative and the single Care Manager who responded to our survey said the home could be improved with more activities. The rest of the respondents were positive about the amount and range of activities available in the home. Records showed that the range and amount of activities in the home was good and that the needs and preferences of service users were referred to in identifying suitable activities. Service users were individually supported to enjoy the kind of lifestyle they expected within the home. One relative told us “the home is more like a family home and my father has the freedom to live as he chooses.” The home has a visitors’ policy in place and attach importance to service users maintaining contact with their families and friends. Visitors are encouraged to visit at any time. All relatives we had feedback from were very positive about the visiting arrangements in the home. One relative told us “the staff make relatives feel at home.” Menus showed that the food in the home was varied and nutritious. The Care Manager told us that food in the home was of a good standard and homecooked. Observation of the kitchen area on the day of inspection showed that fresh ingredients were used and that meals were freshly prepared wherever possible. Alternative meals were made available for people who needed specific diets. The mealtime observed on the day of the inspection visit was calm and relaxed. Service users had their food individually plated according to their wishes and preferences and had it served to them by members of staff. Interaction was encouraged over the mealtime and staff were available to offer support to people who might need it. This was done in a very respectful and unobtrusive manner. The lighting in the dining room was adjusted so that people were able to clearly see their food. The home is also involved in some research with the University looking at malnutrition and how nutrition may affect people who have dementia. This was seen as a positive contribution to the knowledge of staff in the home as well as being a direct benefit for people living there. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 14 All service users and relatives were complimentary about the food in the home. One service user described it as “very interesting and tempting” and another told us that staff “always offer more food in case I’m still hungry.” St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a clear and effective complaints procedure and are protected by the home’s adult protection procedures and practices EVIDENCE: The home has a clear and effective complaints policy in place. The policy is made available to service users and their families on admission and a copy is also available in the front entrance of the building. Service users and their families told us they were aware of the complaints policy and how to use it, but said they had never had to make a complaint. The home has a very positive attitude to complaints and actively encourages people to complain. However, there had been no complaints since the previous inspection. Discussion with staff and examination of training records showed that all staff had received training in adult protection issues and were aware of their responsibilities within the adult protection procedures. The manager was clear about the reporting procedures and had used them in the past to highlight concerns. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in clean, safe, well-maintained environment. EVIDENCE: All parts of the building were kept very clean, but the home retained a homely and comfortable appearance. The Provider ensured that items in the building were replaced as and when necessary. There was also a programme of routine maintenance and records were kept to demonstrate that maintenance issues were responded to swiftly. The home employs adequate numbers of domestic staff to ensure the home is kept clean. There were comprehensive cleaning rotas in place, including one for cleaning the kitchen. Infection control procedures were in place and were St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 17 posted in places throughout the building to ensure that staff were able to refer to them throughout their work. Feedback from service users and their families confirmed that they thought the home was always kept clean and tidy. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by adequate numbers of sufficiently trained staff and are protected by the home’s recruitment policies and practices EVIDENCE: Rotas showed that there were sufficient numbers of staff on duty throughout the week. The rotas corresponded to the staffing arrangements seen on the day of the inspection visit. Members of staff told us that that staffing numbers were good; one member of staff said, “Staffing levels are always high, service users never seem to be rushed.” Service users also told us the staffing numbers were good; one said, “the home is well staffed and we get good and prompt attention.” Employment records showed that the home had a very low turnover of staff and a Care Manager told us that providing consistency of care and consistency of staff was something the service does well. Each member of staff had a Learning and Development Plan in place that was linked to their ongoing support and supervision sessions. Training records St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 19 showed that staff receive regular and appropriate training. One member of staff told us “there are always new training courses available and management will always try to accommodate our training needs.” One the day of the inspection visit it was clear that staff were skilled in communicating with the people who live in the home and spent time talking to people and ensuring their needs were met. One relative told us “staff provide reassurance with patience and understanding.” Another said that what the home does well is to provide a “warm friendly atmosphere, helpful staff, nothing is too much trouble.” St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s financial procedures and by the management of health and safety issues. EVIDENCE: The Manager is registered and has the skills, knowledge and experience to manage the service. All the feedback from service users, relatives, staff and the Care Manager about the Manager of the home was very positive. One member of staff told us “the Manager of the home has time for everyone and has high standards.” A relative described the management of the home as a “good balance between efficiency and a relaxed atmosphere.” St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 21 Service users had their own bank account and there was a system in place for accounting for money held on services users’ behalf in the home. The system was thorough with regular checks taking place. Good records were kept of all transactions. There had been a requirement from the previous inspection that the people who use the service must be protected from the potential risk of harm from fire by fully trained staff. This training must be recorded. Records in the home showed that all staff fire training was up-to-date. Staff at the home confirmed this. This requirement has now been met. There had also been a requirement from the previous inspection that the people who use the service must be fully safeguarded against the risk of scolding from hot water outlets. This requirement has also been met. Hot water outlets were fitted with controls to ensure that water was delivered at a safe temperature. Health and safety was well managed in the home. Comprehensive workplace risk assessments were in place and these were monitored and reviewed on a regular basis. The Manager was clear about health and safety legislation and specific regulations were accounted for within the home’s health and safety policies. Procedures for safe working practices were posted around the building and were covered in staff induction training. Staff were clear about the need for ensuring the health and safety of themselves, their colleagues and service users in all the work they undertook. Any incidents or accidents were recorded clearly and these records were regularly reviewed to ensure that practices were changed where necessary. All staff received regular training and updates in health and safety issues. Substances hazardous to health were well managed and stored safely. Staff had received information in controlling these substances. The laundry area was very well equipped and well managed. The home has a quality assurance system in place based on the views of people living in the home as well as their relatives and other stakeholders such as healthcare professionals and Care Managers. The current process for responding to these is that the Manager and the Deputy Manager look at the responses and decide what to do to improve things if necessary. W discussed with the Manager the need to analyse all the feedback the service receives and to then develop an action plan for the coming year based on what people had said about the service and then to share this plan with people who had contributed to the process. The plan then needs to be implemented and monitored over the year. The Manager confirmed that she understood the necessity for this and has undertaken to do his over the next year. St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 22 St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Elizabeths DS0000011646.V363278.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!