Care Home: St Ives House

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What the care home does well The home clearly provides an environment which is homely and friendly with staff who make every effort to provide the care and support to people that live in the home. One individuals said that she felt "very lucky to be living here" and what she liked about the home was the "friendliness, kindliness and informality of staff" another said they were "very happy living here" and another said "this is my home". A comment received by the home said "I think I am extremely lucky and blessed to be living in your excellent home" and "The overall care has been of a very high standard, always treated with respect and kindness". It is noted that there is a consistent staff group in the home which helps in providing continuity of care. Staff we spoke with and observed on our visit all showed a real understanding of the needs of those that live in the home and commitment to providing quality care. Individuals we spoke with were all very positive about the approach of staff and how they "really help us in every way they can" "you couldn`t ask for better staff". The home provides an environment which offers a range of activities and makes a good effort to encourage individuals to take part in what is made available whilst at the same time enabling individuals to make their choice. There was a sense that individuals are able to really choose how they spend their time, that staff are flexible in their approach. This was illustrated by comments we received "its really up to me what I do" "staff respect my privacy". What has improved since the last inspection? A number of recommendation were made at the last inspection in 2007 these related to a number of areas including record keeping (care plans, medication administering) and medication procedures. We looked at these during this inspection and found that practice in these areas had been improved and the home had positively responded to our good practice recommendations. What the care home could do better: This inspection has identified two specific areas in which the home must improve its practice both relate to information which forms part of individuals care plan. Firstly there must be more robust system in place to make sure that care plans and the information contained in them about the care needs of the individual is kept under regular review. This will ensure that staff are provided with up to date written information about the individuals and changes are noted in the health and well being of the individual. Secondly whilst the home has a risk assessment procedure in place it was not always evident that as a result of risk assessment and where there was potential risk to an individuals health and welfare that staff are provided with clear recorded guidance about how to respond to the risk. This will help in reducing the level of risk to individuals and inform staff of their responsibilities in responding to identified risk areas. We have also made a recommendation regarding the meal arrangements in the home. This was partly in response to a concern we had received about the quality of meals provided in the home. There was no direct evidence or comments received from individuals who live in the home or staff that led us to believe that the quality of meals is not at the nutritional standard required. However some individuals were unhappy about the type of food being provided describing it as "not of our generation" "suitable for older people". There were also some comments from staff who said the food was at times not acceptable. The menus we were shown and the conversation we had with the chef has led us to the conclusion that whilst the variety and quality of meals is good there is the need to be conscious that for some individuals the meals offered are not to their taste or liking. It is for this reason that we have recommended that the current alternative (jacket potatoes or salad) be changed so that for those who prefer something different to the main choice are given a more acceptable alternative which the current choice in our view is not. This was discussed with the manager who was agreeable to looking at our recommendation. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Ives House Horton Road St Ives Ringwood Dorset BH24 2ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Clarke     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: St Ives House Horton Road St Ives Ringwood Dorset BH24 2ED 01425473822 01425489003 accounts@stiveshouse.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Trustees of TH Russell Charitable Trust care home 23 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home St Ives House is a large detached property, which stands in ample secluded grounds and is situated approximately one mile from Ringwood. The home was formerly owned by T H Russell and on his death was placed in trust as a home for older people. (T H Russell Charitable Trust). A group of trustees hold responsibility for the business management matters related to the home, while the registered manager Mrs McDermott attends to the day to day running of the home. Accommodation is offered on both the ground and first floors of the home, with all bedrooms being single and offering en-suite facilities. A passenger lift is available to the first floor. There is a comfortable main lounge on the ground floor, with a separate dining room that leads Care Homes for Older People Page 4 of 25 Over 65 23 0 Brief description of the care home into a large conservatory/sun-lounge. There are communal bathrooms and a newly installed wetfloor shower, with assisted baths, on both floors. There is also a large, attractive conservatory leading off the main lounge and this provides another useful area for service users. In addition, the home offers six flats, which are self-contained and situated in a connected ground floor wing of the house. The service users accommodated in these flats can use the facilities of the main house, and receive varying amounts of care and support as necessary. The home is registered to provide accommodation for a maximum of 23 service users in the category OP (older people). Fees are 3015 pounds per calendar month. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of our inspection to look at the quality of care provided in the home. We looked at a number of records relating to care including pre-admission assessments, care plans, recruitment and training records of staff. We also spoke with people who live and work in the home. We received from the home their Annual Quality Assurance Assessment this sets out what the home considers they do well, how they have improved since the last inspection and what improvements are planned. We used this information to help us in making a judgment about the quality of care provided at St Ives House. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: This inspection has identified two specific areas in which the home must improve its practice both relate to information which forms part of individuals care plan. Firstly there must be more robust system in place to make sure that care plans and the information contained in them about the care needs of the individual is kept under regular review. This will ensure that staff are provided with up to date written information about the individuals and changes are noted in the health and well being of the individual. Secondly whilst the home has a risk assessment procedure in place it was not always evident that as a result of risk assessment and where there was potential risk to an individuals health and welfare that staff are provided with clear recorded guidance about how to respond to the risk. This will help in reducing the level of risk to individuals and inform staff of their responsibilities in responding to identified risk areas. We have also made a recommendation regarding the meal arrangements in the home. This was partly in response to a concern we had received about the quality of meals Care Homes for Older People Page 7 of 25 provided in the home. There was no direct evidence or comments received from individuals who live in the home or staff that led us to believe that the quality of meals is not at the nutritional standard required. However some individuals were unhappy about the type of food being provided describing it as not of our generation suitable for older people. There were also some comments from staff who said the food was at times not acceptable. The menus we were shown and the conversation we had with the chef has led us to the conclusion that whilst the variety and quality of meals is good there is the need to be conscious that for some individuals the meals offered are not to their taste or liking. It is for this reason that we have recommended that the current alternative (jacket potatoes or salad) be changed so that for those who prefer something different to the main choice are given a more acceptable alternative which the current choice in our view is not. This was discussed with the manager who was agreeable to looking at our recommendation. 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 set out 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. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 home undertakes pre-admission assessment so that they can make an informed judgment about the capacity of the home to meet the identified health and social care needs of the individual. Evidence: We looked at two pre-admission assessment they provided good information about the health and social care needs of the individuals. Included was physical health. There was little information about the daily routines, personal circumstances, spiritual needs of the individuals. Where individuals are known to social services copies of their assessments are obtained by the home. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Plans provided the necessary information so that staff can provide the care needed by the individual however the reviewing of care plan information needs to be more robust so that there is clear evidence that care plans fully reflect the current needs of the individual. The homes needs to make sure risk assessments are completed and actions identified to respond and alleviate risk as part of care planning. Individuals who live in the home receive the health care they need to make sure their health needs are protected and safeguarded. The medication arrangements in the home are good in protecting the health and welfare of individuals who live in the home. Individuals who live in the home are treated with respect and their privacy protected. Evidence: We looked at care plans for three individuals. Detailed information as to specific care tasks around personal care. Moving and handling assessments completed. Fall risk Care Homes for Older People Page 11 of 25 Evidence: assessment completed. For one individual mental capacity assessment had been completed. Waterlow and Nutritional assessments. In one instance this indicated cause for concern no record of action taken in response to this concern other then comment likes most food , not milk pudding. Weight recorded monthly. Updates and reviews of care plans for one individual Feb 07, for same individual pressure area and nutritional assessment not reviewed since 07. A Life Story had been completed for one individual. We spoke with staff about the care provided to the individuals whose care plans we had examined there was no evidence that they were not providing the necessary care and were aware of the particular needs of the individual specifically the individual where there was concern about their nutrition. For one individual who is epileptic no risk assessment completed as to risk of fits and guidance to staff as to their response. Records showed that individuals have access to range of community health services such as chiropody, dental and optician. Community nurse visits the home where this level of care is needed. One individual told us that the staff response well when they ask to see their doctor will ring your doctor if you ask. Medication administer records were looked at and had been completed as required with no gaps. Where changes had been made signature of staff member. Storage of medication was satisfactory and secure. Controlled drugs not recorded in Controlled Drug Register however stored as required. We spoke to individuals about the approach of staff and one individual told us how staff are very friendly and helpful another individual told us that staff respect your privacy if you prefer to stay in your room and they always knock on the door. We observed staff throughout our visit talking with and assisting individuals in a sensitive and supportive manner. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 meals provided in the home offer a good variety meeting the nutritional needs of individuals who live in the home however there should be an improved variety of daily choice available to suit those who do not wish to have the main choice of the day. Activities are varied and offer social opportunity for individuals who live in home. The home provides an environment which is friendly and welcoming so that individuals can maintain their contact with family, relatives and Friends. Individuals who live in the home are able to exercise choice and have control over their daily routines and how they choose to spend their lives. Evidence: We spoke to a number of individuals about the activities provided in the home they were all very positive about the range of activities available theres always something different going on good activities activities are always welcomed and enjoyed The dairy for January showed activities including giant scrabble, caring canines, outside entertainers. Individuals we spoke with said that their visitors always made to feel welcomed and Care Homes for Older People Page 13 of 25 Evidence: individual commented in homes questionnaire Friends and family welcomed when they come. A relative we spoke with said that the home was welcoming describing staff as very helpful and always felt they were informed about how their relative was and had rang when they had any concerns. We spoke to individuals about the food provided in the home whilst there were those who enjoyed the meals and said they were always good with always a choice. One individual commented that the food wasnt what you expect to be given to the elderly and food is fairly good, think sometimes not my age group. The home had undertaken a questionnaire about the meals and food provided in the home. Of the 14 who responded 8 said the choice of meals was good, 4 fair and 2 poor. Menus showed meals such as roast Pork, cottage Pie, lamb hot pot. The choice is always jacket potatoes or salad. Staff also said that at times the meals were not satisfactory. The lunch on the day of our visit was well presented and certainly enjoyed by the individuals we spoke with. It was noted that sweets had been prepared specifically for diabetics though staff were not aware of this at the time and therefore individuals who were diabetic were not offered this choice of sweet.We spoke with the chef who was clearly very interested in making sure meals were appetising and of a good quality. Individuals we spoke with all said how they felt they could choose what I do I can get up when I like and go to bed. We asked one individual who needed assistance in getting up what would happen if they didnt feel like getting up what would the reaction of staff be they would just say they will come back later its not a problem even though they are busy. Records showed that individuals are given choice and staff assist in individuals having control over their daily lives and routines. One individual told us that they spend alot of time in their room and this wasnt a problem another said how they could go to my room whenever I want and staff will help me if I need it. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has a complaints procedure which enables individuals who live in the home to formally complain. The home provides an environment where individuals are able to express their any dissatisfaction and be listened too and action taken to resolve the dissatisfaction. Evidence: The homes complaint procedure is included in the Service Users Guide and given to individuals when they move to the home. We spoke to one individual who told us they knew how to make a complaint. Another told us that if they were unhappy I would speak to the manager another told us I would always tell the staff they would do something about it if I was unhappy about anything. One individual told us staff listen to me they listen to you and respond to it. The home had received one complaint this had been responded too in a professional way and had been upheld. We received a complaint from an individual about the food provided in the home and this was looked at as part of this inspection. We found no cause for concern about the quality of meals provided in the home other then the lack of choice and have made a recommendation about this. We discussed the nature of the complaint with the manager at the time of our visit who agreed that this was an area that could be improved. The home has Safeguarding Adults policies and procedures in place. Staff have received training in Adult Protection and Abuse. We spoke to staff about what they Care Homes for Older People Page 15 of 25 Evidence: considered abuse in a care home and they were able to give some good examples of where practice by staff could be considered as abusive i.e. ignoring people, not giving choice and telling rather then asking, leaving individuals in soiled or dirty clothes. They were very clear that they would report any concerns to the manager or deputy. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 home provides a homely and well maintained environment with a good standard of cleanliness and hygeine. Evidence: Walking around the home it was evident that there is a good standard of decoration and maintenance of the home. Rooms are regularly refurbished and in the past year a wet floor shower has been installed. Individuals we spoke with all said how clean the home was one saying that it is always kept very clean and another individual said in the home questionaire how the home was beutifully clean and homely. A number of individuals said how much they enjoyed the extensive gardens and a woodland walk has been created to make the area more accessible. The home has infection control procedures in place with hand washing facilities for staff who are also provided with protective clothing where this is necessary. the majority of staff (24) have undertaken infection control training. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are good so that the needs of individuals who live in the home can be met in a safe and efficient manner with care being provided by skilled and competent staff. The recruitment and selection practices of the home help to make sure that the health and welfare of individuals who live in the home are protected. Evidence: We examined the worked staffing rota for the month of January and it evidenced that generally there are 5 staff on duty am (8-8 & 8-2) 4 pm until 8pm and two waking night. Individuals we spoke with said that staff respond very quickly to requests for help and always available. One individual said that they felt they received all the help I need. We looked at the recruitment records for three members of staff. All had completed full and detailed application forms, Criminal Record Bureau check and POVA had been obtained and two references. Training records for 4 members of staff showed they had completed the mandatory areas of training: moving and handling, infection control, health and safety (Fire) and Adult Protection. Other training completed by staff included Continence Management, Care Homes for Older People Page 18 of 25 Evidence: Diet and Nutrition, First Aid, Dementia. Over 50 have NVQ professional qualification. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for the people that live in the home to express their views about the quality of the service they receive. The health and safety practices of the home help to protect the welfare of those that live and work in the home. Evidence: Mrs McDermott has managed St Ives House for a number of years and has extensive experience of working in a care setting. She has completed the NVQ4 Registered Managers Award and undertaken training as required. Individuals we spoke with described her someone we can talk too and staff said that they found management approachable and if we have any problems we can talk to them about it. The homes quality questionnaire asked if individuals found management approachable and willing to listen 7 respondents said they strongly agreed and 4 agreed. The home undertakes quality assurance questionnaire and results for 2009 (11 respondents) were very good with positive results around the quality of care provided in the home. Comments included: Care Homes for Older People Page 20 of 25 Evidence: staff always most helpful and cheerful I feel well cared for staff very caring The home does not manage the financial affairs of any individual and where they are unable to do so a representative normally family members takes this responsibility on behalf of the individual. Where the home purchases items receipts are obtained and these were seen. Fire records were seen and confirmed that day and night staff regularly undertake fire drills. An inspection of the fire safety equipment was last undertaken in September 08. A Fire Risk assessment has been completed. Weekly fire alarm tests take place as do monthly emergency lighting tests. Hoists and other equipment is serviced annually and the lift was last serviced in January 09. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The manager to make sure that care plans are kept under review. This refers to the need to make sure that information provided in care plans is kept under review and reflects the up to date needs of the individual. 31/03/2009 2 7 13 The manager to make sure 31/03/2009 that unnecessary risks to the health and welfare of individuals are identified and so far as possible eliminated. This refers to the need to undertake risk assessments and importantly document actions and guidence to staff in response to identified risk i.e. around nutrition needs, where individual has risk of epleptic fits. Care Homes for Older People Page 23 of 25 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 As part of pre-admission assessments include information about the personal circumstances/history of the individual, spiritual and daily routines so that the care plans are more person centered rather then purely focusing on the health and associated care needs. The recording of administering of controlled drugs to be entered in Controlled Drug Register. Provide greater range of choice to the main meal of the day to improve the variety offered to individuals. 2 3 9 15 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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