Care Home: St Josephs

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What the care home does well People were able to visit the home before admission to assess the facilities. Comments received included: `I came in for the day and decided I like it and have been here ever since.` `I came to look around to see what I thought about the place.` The care plans and risk assessments for the people living in the home were well detailed ensuring people received person centred care and that any risks were minimised. The system in place for administering medication was well managed ensuring people received their medication as prescribed. Comments received from the people living in the home indicating that they are satisfied that their health care needs are met included: `If I need a doctor I can always get one.` `All my care is taken care of, regarding medication.` `The care is very good.` There were activities available for the people living in the home if they wished to take part. Comments received included: `There are (activities) but I do not like activities. I prefer to sit quietly.` `I do not take part in activities but I like to watch the others and I am quite happy.` `I play lots of games, but would like to go out more.` `I do not usually like to take part in activities but we do have them.` Daily records indicated relatives and friends could visit the home when they wished. The people living in the home spoke to us about their family visiting and some stated they went out with them. The people living in the home indicated that they were listened to and able raise concerns. Comments included: `I can always speak to the manager if I have a problem.` `The staff are always very helpful.` `There is always a member of staff around.` `Always` (staff listen and act on what you say.) `I think everyone knows that don`t they.` (How to make a complaint.) There had been little staff turnover at the home which is good for the continuity of care of the people living in the home. Relationships between the staff and the people living in the home were good. Health and safety in the home were well managed and no issues were raised at the time of the inspection. The manager ensured the smooth running of the home in a competent manner and in the best interests of the people living there. What has improved since the last inspection? The contracts being issued to the people living in the home had improved and included more details about the terms and conditions of residence in the home. Staff were signing to say they had read and agreed to follow the care plans and risk assessments for the people living in the home. The menus at the home had been changed since the last inspection and were greatly improved. They offered much more variety and choices were detailed at every meal. At the time of the last inspection the menus were not really being followed. This had been addressed and the food records reflected what was on the menu. The issues raised at the last inspection around meal times had been addressed, meals being served on very small plates had stopped and people were asked if they wanted any more food. More staff had received training in adult protection issues ensuring the people living in the home were safeguarded. There had been further improvements to the environment enhancing the comfort and facilities available for the people living in the home. These included changes to the layout of the communal space in the home, a lot of redecoration, several areas had had new flooring and additional handrails had been installed. There had been an improvement in the numbers of staff qualified to NVQ level. Nine of the fifteen care staff employed at the home had undertaken NVQ level 2 giving the home over the required 50%. The issue raised at the last inspection about the hairdresser signing the financial records of the people living in the home and these being confidential had been addressed. The hairdresser was now issuing receipts. What the care home could do better: The manager needed to ensure that the working files that care staff use on a daily basis were updated when there were changes to the needs of the people living in the home. This will ensure staff have all the current information about the people living in the home. Daily records needed to include details of how the people living in the home were spending their time to evidence their social needs are being met. To ensure good food hygiene in the home the chopping boards in the kitchen should be replaced. The manager should collate all the information gathered from the quality monitoring systems in the home and draw up an improvement plan for the home that details how the service in the home will be improved. CARE HOMES FOR OLDER PEOPLE St Josephs 46 Silverbirch Road Erdington Birmingham West Midlands B24 0AS Lead Inspector Brenda O’Neill Unannounced Inspection 15th July 2008 09:20 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 Josephs DS0000064278.V368023.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 Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Josephs Address 46 Silverbirch Road Erdington Birmingham West Midlands B24 0AS 0121 373 0043 0121 240 9123 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) Care First Class (UK) Ltd Miss Jacqueline Dowling Care Home 15 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (15) of places St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care without nursing to service users of both sexes whose primary needs on admission to the home are within the following categories: - old age not falling within any other category (OP 15) - service users with dementia who are over 65 years of age (DE(E) 2) The maximum number of service users to be accommodated is 15. 2. Date of last inspection 25th July 2007 Brief Description of the Service: St. Josephs is a large, extended detached property situated in a quiet, residential road between Wylde Green and Erdington and provides residential care for up to 15 older people. The home is conveniently located for public transport, shops and local facilities. There is off road parking to the front of the home for a limited amount of cars. Accommodation for the people living in the home is over the ground and first floors with the second floor being used as office and storage space only. There are nine single and three double bedrooms throughout, one of the double bedrooms has en-suite facilities. There is a shaft lift for ease of access to the first floor. There are adequate numbers of toilets and bathrooms throughout the home however not all are equipped with the necessary aids and adaptations for frail older people or those with any mobility difficulties. Communal space consists of a lounge/dining area and a further lounge at the rear of the home that looks out onto the well-maintained garden, which has a patio, lawn, mature shrubs and a pond. The kitchen, a small laundry and staff facilities are also located on the ground floor. The range of fees charged at the home were not detailed in the service user guide. St Josephs DS0000064278.V368023.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 that the people who use this service experience good outcomes. One inspector carried out this inspection over one day in July 2008. During the course of the inspection a tour of the home was undertaken, we spoke to the manager, two staff and five of the people living in the home. We looked at the care being received by two of the people living in the home and the recruitment files for two staff members. Other documents looked at were in relation to health and safety, staff training and complaints. Prior to the inspection the manager had completed and returned to us the Annual Quality Assurance Assessment (AQAA) which provided us with additional information about the home. Satisfaction surveys were sent out to nine of the people living in the home. Seven of these were returned and without exception all the comments about the home were very positive. There had been no adult protection issues or complaints raised with the Commission about the home. No complaints had been logged at the home since the last inspection. What the service does well: People were able to visit the home before admission to assess the facilities. Comments received included: ‘I came in for the day and decided I like it and have been here ever since.’ ‘I came to look around to see what I thought about the place.’ The care plans and risk assessments for the people living in the home were well detailed ensuring people received person centred care and that any risks were minimised. The system in place for administering medication was well managed ensuring people received their medication as prescribed. Comments received from the people living in the home indicating that they are satisfied that their health care needs are met included: ‘If I need a doctor I can always get one.’ ‘All my care is taken care of, regarding medication.’ ‘The care is very good.’ There were activities available for the people living in the home if they wished to take part. Comments received included: St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 6 ‘There are (activities) but I do not like activities. I prefer to sit quietly.’ ‘I do not take part in activities but I like to watch the others and I am quite happy.’ ‘I play lots of games, but would like to go out more.’ ‘I do not usually like to take part in activities but we do have them.’ Daily records indicated relatives and friends could visit the home when they wished. The people living in the home spoke to us about their family visiting and some stated they went out with them. The people living in the home indicated that they were listened to and able raise concerns. Comments included: ‘I can always speak to the manager if I have a problem.’ ‘The staff are always very helpful.’ ‘There is always a member of staff around.’ ‘Always’ (staff listen and act on what you say.) ‘I think everyone knows that don’t they.’ (How to make a complaint.) There had been little staff turnover at the home which is good for the continuity of care of the people living in the home. Relationships between the staff and the people living in the home were good. Health and safety in the home were well managed and no issues were raised at the time of the inspection. The manager ensured the smooth running of the home in a competent manner and in the best interests of the people living there. What has improved since the last inspection? The contracts being issued to the people living in the home had improved and included more details about the terms and conditions of residence in the home. Staff were signing to say they had read and agreed to follow the care plans and risk assessments for the people living in the home. The menus at the home had been changed since the last inspection and were greatly improved. They offered much more variety and choices were detailed at every meal. At the time of the last inspection the menus were not really being followed. This had been addressed and the food records reflected what was on the menu. The issues raised at the last inspection around meal times had been addressed, meals being served on very small plates had stopped and people were asked if they wanted any more food. More staff had received training in adult protection issues ensuring the people living in the home were safeguarded. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 7 There had been further improvements to the environment enhancing the comfort and facilities available for the people living in the home. These included changes to the layout of the communal space in the home, a lot of redecoration, several areas had had new flooring and additional handrails had been installed. There had been an improvement in the numbers of staff qualified to NVQ level. Nine of the fifteen care staff employed at the home had undertaken NVQ level 2 giving the home over the required 50 . The issue raised at the last inspection about the hairdresser signing the financial records of the people living in the home and these being confidential had been addressed. The hairdresser was now issuing receipts. 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 Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment procedures in the home ensured the needs of the people being admitted to the home were known and could be met by staff. People moving into the home were able to visit prior to admission if they wished and were being issued with a contract that detailed the terms and conditions of their stay. EVIDENCE: There was a service user guide for the home that included the vast majority of information that people would need to make an informed decision as to whether the home could meet their needs. Some minor amendments were needed, for example, fees for private payers should be included. The files for two people admitted to the home since the last inspection were sampled. These showed that the manager undertook the pre admission assessments. All the relevant areas were covered during the assessments and St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 10 they included a summary of need at the end. The files also included a copy of the social workers assessment ensuring the staff at the home had as much information as possible prior to admission. People were able to visit the home before admission to assess the facilities. Comments received included: ‘I came in for the day and decided I like it and have been here ever since.’ ‘I came to look around to see what I thought about the place.’ Both files included copies of the contracts issued to people when they moved into the home these had been improved since the last inspection and included more detail about the terms and conditions of residence in the home. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. The systems in place for care planning and risk assessments were good and ensured the needs of the people living in the home were met and any identified risks were minimised. The health care needs of the people living in the home were met. The medication system was well managed and safeguarded the people living in the home. Staff were mindful of the privacy and dignity of the people living in the home. EVIDENCE: The care for two people of the people living in the home was followed. The files for both of the individuals included care plans which were entitled Individual Service Statements (ISS). Both of the ISSs detailed all the needs of the two individuals and how they were to be met by staff. There had been several changes to the needs of one person and the ISS had been updated accordingly. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 12 ISSs covered numerous aspects of the lives of the people living in the home including, personal care, mobility, communication, religious and social needs and eating and drinking. Personal care needs were broken down into specific areas such as bathing and dressing. There was some very good detail of what people were able to for themselves and what staff needed to help with. For example, ‘able to make suitable choice of clothing. Able to do up buttons and zips needs assistance to put on tights. Able to brush own hair.’ Where there were issues with continence the ISS detailed what aids were to be used and if people asked to go to the toilet or had to be taken. Where there had been changes to the needs of the individuals these were clearly documented. For example one person was independently mobile but due to a fall now needed assistance and supervision due to being unsteady. One of the people whose care was being tracked was clearly quite independent but the ISS did detail such issues as wants medication given on a spoon as she is worried she will drop the tablets. Dietary needs and preferences were also well detailed. The files also included a breakdown of the individuals’ daily routines which included what time they liked to go to bed and get up, their preferred drinks on waking, where they liked to sit and how they liked to spend their time. These documents were cross referenced to the ISSs so that staff knew where to look for further information. Both files included several risk assessments for manual handling, nutrition, pressure issues and other personal risks. The manual handling assessments included good details of what staff should do if people fell and detailed what equipment was to be used if the person was uninjured. One of the nutritional assessments highlighted there was cause for concern and comments were added that detailed how staff were to monitor this. Personal risk assessments included areas such as the risks of individuals leaving the building, challenging behaviours and anxiety. All the risk assessments had accompanying management plans that detailed how staff were to try and reduce the risks. These had also been updated as changes occurred. It was noted that although all the documents relating to the individuals’ care had been amended as changes occurred the changes were not always made on the working file that care staff used. The manager was advised to ensure the working files are kept up to date. It was evident from talking to staff and observing practice that they were aware of the changes, for example, they were aware of the changes in one individual’s behaviour and nutritional needs and how they were to manage these. It was recommended at the last inspection that the manager placed read and sign sheets with the ISSs and risk assessments that indicated staff had read, understood and agreed to follow them. These were in place at the time of this inspection. Both files included professional visit sheets that detailed all contact, including telephone calls, with health care professionals and social workers. These St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 13 included visits from G.P.s, dentists, opticians, chiropodists, district nurses and community psychiatric nurses. Staff were also recording any delays in people receiving the required input and what they had done about this. The outcomes of medical visits were detailed. Staff were clearly able to identify health care needs and these were then followed up and monitored. Comments received from the people living in the home indicated they are satisfied their health care needs are met these included: ‘If I need a doctor I can always get one.’ ‘All my care is taken care of, regarding medication.’ ‘The care is very good.’ Wherever possible the people living in the home were being weighed regularly and significant weight loss was being followed up. As recommended at the last inspection the provider had ordered a set of sit on scales so that everyone could be weighed and the weights would be more accurate. Medication continued to be administered via a 28 day monitored dosage system. The system was well managed and no requirements were made. There were copies of the most recent prescriptions and a photograph of the people living in the home with the individual MAR (medication administration records) charts. Medication was acknowledged when received into the home and signed for when administered. All the medication audited at the time of the inspection was correct. There were some controlled drugs in the home these were being appropriately stored, administered and recorded. The manager was undertaking weekly audits on all the medication to ensure the balances in the home were correct. It was recommended that a larger medication trolley was obtained as the one in use was very overcrowded. No issues were raised by the people living in the home about their privacy or dignity. Staff spoke to the people living in the home appropriately and friendly relationships were evident. Personal care was offered discreetly. There was a cordless telephone available for the use of individuals so that they could make or receive calls in private. All bedroom doors were lockable with keys available for the people living in the home. Double bedrooms had screening available for privacy. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. There were activities available for the people living in the home if they wished to take part. People were enabled to make choices and decisions in their every day lives. The people living in the home were satisfied with the meals being served to them. EVIDENCE: The inspection started at a busy time of day when some of the people living in the home were getting up, others were having breakfast and others had finished. Despite this the home was calm and relaxed and staff still found time to laugh and joke with the people living in the home. The activity records in the home indicted there was some activity for the people living in the home to take part in virtually every day. Activities were generally facilitated by staff and included such things as, darts, reminiscing, films, sing a longs, quizzes and a variety of games. There was some variation for some of the people living in the home who did not wish to take part in organised activities, for example, one person was recorded as doing word searches and jigsaws. Staff were also recording when they had just sat St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 15 chatting to someone and when people had declined to join in with the activity. Records also indicated that outside entertainers went into the home on occasions. The completed surveys returned to us before the inspection also indicated there were activities available in the home. Comments received included: ‘There are (activities) but I do not like activities. I prefer to sit quietly.’ ‘I do not take part in activities but I like to watch the others and I am quite happy.’ ‘I play lots of games, but would like to go out more.’ ‘I do not usually like to take part in activities but we do have them.’ The manager acknowledged on the AQAA that activities could be improved by having more activities and people going out more. One of the plans for the next year is to have a regular driver so people can be taken out more. The range of activities on offer was an ongoing topic of discussion with the people living in the home at meetings with them. Social care needs and preferences were detailed on the ISSs, for example, for one person it stated ‘very quiet does not take part in activities, likes skittles and listening to the radio.’ When speaking to this individual she confirmed she was very quiet and did not usually join in with activities but liked to go to bed early to listen to her radio. Although staff were recording the organised activities there was little in the daily records about how the people living in the home spent the rest of their time. Daily records indicated relatives and friends could visit the home when they wished. The people living in the home spoke to us about their family visiting and some stated they went out with them. The people living in the home appeared to be encouraged to exercise choice and control over their lives in such things as choosing what they did during the day, what to wear, when to get up and go to bed and what to eat. ISSs included details as to what extent they could self care and could direct their own personal care and of their preferred waking and retiring times, preferred daily routines, likes and dislikes in relation to food and so on. People had clearly been consulted about how they wanted their care delivered. The people living in the home had been encouraged to personalise their rooms to their choosing and personal effects were seen in all the bedrooms. The menus at the home had been changed since the last inspection and were greatly improved. They offered much more variety and choices were detailed at every meal. At the time of the last inspection the menus were not really being followed. This had been addressed and the food records reflected what was on the menu. Staff were seen to ask people what they wanted from the menu for lunch. We had lunch with the people living in the home and the meal St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 16 was well cooked and presented. Staff were available to offer assistance where needed and people had appropriate cutlery and tableware, for example, plate guards to encourage their independence. It was also noted that if people did not want anything from the menu an alternative was available. One person had egg and chips at her request. The issues raised at the last inspection around meal times had been addressed, meals being served on very small plates had stopped and people were asked if they wanted any more food. Without exception the people living in the home that were spoken with were happy with the meals served to them. The surveys returned to us before the inspection also had some positive comments about the meals including: ‘I like most of them, but I do not like fish and I only like small meals but never go hungry.’ ‘The food is lovely.’ ‘The meals are quite good.’ St Josephs DS0000064278.V368023.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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home were listened to and their views acted on. The policies and procedures on site and the training staff received ensured the people living in the home were safeguarded. EVIDENCE: There were policies and procedures in the home for adult protection and complaints. These were not seen at this inspection as they were found to be acceptable at the last visit we made to the home. The people living in the home indicated that they were listened to and able to raise concerns. Comments included: ‘I can always speak to the manager if I have a problem.’ ‘The staff are always very helpful.’ ‘There is always a member of staff around.’ ‘Always’ (staff listen and act on what you say.) ‘I think everyone knows that don’t they.’ (How to make a complaint.) There were good relationships between the staff and the people living in the home which would give them the confidence to raise issues. The minutes for meetings with the people living in the home also showed that people were listened to. For example there had been discussions about the menu and food items that people had said they were ‘fed up of’ and these had been removed St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 18 from the menu and issues with laundry going missing the possible causes and how this could be resolved. It was recommended to the manager that they log any minor issues that are raised by individuals living in the home and include how these were resolved as further evidence that they listen to people and act on what they say. The staff at the home had received several written compliments about the care they had provided in the home. At the time of the last inspection not all the staff at the home had received the required training in adult protection issues. This had been resolved and only the new staff were still to be trained and this had been arranged for August. St Josephs DS0000064278.V368023.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): 19, 20, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been further improvements to the home which provided the people living there with a comfortable, well maintained and generally safe place in which to live. EVIDENCE: There had been further improvements to the environment enhancing the comfort and facilities available for the people living in the home. There had been some changes to the layout of the communal areas in the home. The large lounge had been changed to a lounge /diner and the former dining room had been changed to another lounge area. Although this meant the dining area was a little small (not everyone was choosing to eat at the dining room tables) it had given the people living in the home an alternative area to sit rather than one large lounge. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 20 Both rooms had been redecorated, had new flooring and some new furnishings had been purchased. Large flat screen televisions had also been purchased with free view giving additional channels for people to watch. Both areas were very pleasant. New carpet had also been fitted in all corridors, hallways and on the stairs and all these areas had been repainted making the environment much brighter. Additional handrails had also been installed in some areas to assist the people living in the home when moving around. As at the last inspection there were adequate numbers of toilets throughout the home and some had had hand or grab rails installed. There were two bathrooms on the first floor of the home, one with a medic bath, which was to be changed to a floor level shower when finances allowed. This will give the people living in the home the choice of either a bath or a shower. The other bathroom had had a bath hoist installed since the last inspection allowing for staff assistance when needed. The emergency call point in this room was not accessible from the bath. This needed to be addressed so that people who wished to bathe alone could call for help when needed. There was one large bathroom on the ground floor that had a bath hoist fitted. The flooring in this room had been renewed making it more hygienic. The bedrooms seen varied in size and were a mix of singles and doubles. Some of the rooms had been redecorated and had new carpet laid. All the bedrooms were being redecorated on a rolling programme. The majority of the required furnishings and fittings were in place. All rooms had a lockable piece of furniture and the people living in the home were able to have keys to their bedroom doors if they wished. Bedrooms were personalised to the occupant’s choosing. Not all the bedrooms had accessible bedside lighting. The kitchen was clean and tidy and appropriate food labelling and temperature recordings were in place. It was noted that the chopping boards were very well worn. The manager was advised to replace these to ensure good food hygiene. The installation of the commode pot washer had been completed since the last inspection. The home was generally clean and hygienic. St Josephs DS0000064278.V368023.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): 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. A stable staff team was maintaining appropriate staffing levels. Staff had undertaken the necessary training to ensure they could care for the people living in the home. The recruitment process was robust and protected the people living in the home. EVIDENCE: There had been little staff turnover at the home since the last inspection. This is good for the continuity of care of the people living in the home. It was clear from the observations made and the comments received that the people living in the home were happy with the care they were receiving and that staff were very friendly towards them. Comments received included: ‘The care is very good.’ ‘The staff are always very helpful.’ ‘I am quite happy.’ There were two care staff on duty throughout the day and night, the manager’s hours were supernumery to the care rota. The home also employed catering, domestic and maintenance staff. Only two staff had been employed since the last inspection. The recruitment files for the two individuals were checked. The files showed that all the St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 22 necessary documentation had been completed and all the required checks had been undertaken before the individuals started work at the home. Files included two written references, POVA first checks and CRBs. Where there had been queries about references the manager had pursued this and made notes on the appropriate file. It was noted that one of the application forms was not dated or signed. The manager was advised she should always check for this. Where necessary files also included evidence that people were eligible to work in this country. Both of the new staff had Skills for care induction booklets on their files. One of these had been completed and signed off the other had not. The manager stated she had got behind with this but she had been going through the training topics with the employee. She was reminded she should have records of all training undertaken by staff. There was a training matrix for the home on the wall in the office and staff also had individual training records. These were sampled and indicated that since the last inspection staff had undertaken training in abuse awareness, first aid, infection control, fire safety and food safety. Some staff were also undertaking a distance learning course on dementia care which would give them much more knowledge of the illness. There was also further training planned for August 2008 in health and safety, manual handling and adult protection. There had been an improvement in the numbers of staff qualified to NVQ level. Nine of the fifteen care staff employed at the home had undertaken NVQ level 2 giving the home over the required 50 . St Josephs DS0000064278.V368023.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): 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. The manager ensured the smooth running of the home in a competent manner and in the best interests of the people living there. The health and safety of the staff and the people living in the home were well managed. EVIDENCE: There had been no changes in the management of the home since the last inspection. Since the manager of the home had been in post the home had improved. She had completed her Registered Manager’s Award and was very committed to ensuring the people living in the home had the best quality of life possible. She was very knowledgeable about the needs of the people living in the home. They were comfortable in her presence and she had good relationships with the staff team. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 24 The home had a quality assurance system in place. This included one of the directors of the company auditing the home on an annual basis against the National Minimum Standards to identify any shortfalls. There were also regular meetings held with the people living in the home to get their views, ideas and opinions. Staff meetings were also held. Satisfaction surveys were issued to the people living in the home their relatives and staff and there were ongoing in house health and safety audits. The manager needed to collate all the information gathered from the quality monitoring systems in the home and draw up an improvement plan for the home that detailed how the service in the home will be improved. The home continued to manage some of the personal allowances for the people living in the home. The records for this were sampled and found to be appropriate. Any expenditure made on behalf of the people living in the home was receipted and all the balances checked were correct. The issue raised at the last inspection about the hairdresser signing the records and these being confidential had been addressed. The hairdresser was now issuing receipts. Health and safety in the home were well managed and no issues were raised at the time of the inspection. Staff had received training in safe working practices and there were systems in place to ensure this was updated regularly. The equipment being used in the home was serviced regularly. All the in house checks on the fire system were up to date and fire drills were undertaken every six months. The incident and accident recording and reporting in the home were good. St Josephs DS0000064278.V368023.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 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 St Josephs DS0000064278.V368023.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 OP21 Regulation 13(4)(c) Requirement Emergency call points must be accessible from all bathing facilities. This will ensure the people living in the home can summon help when needed. Timescale for action 31/08/08 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. Refer to Standard OP1 Good Practice Recommendations The service user guide for the home should be amended to include the range of fees charged at the home for people paying for their care privately. This will ensure people have all the relevant information to enable them to make an informed decision as to whether the home can meet their needs. It is strongly recommended that the manager ensures that the working files that care staff use on a daily basis are updated when there are changes to the needs of the people living in the home. This will ensure staff have all the current information about the people living in the DS0000064278.V368023.R01.S.doc Version 5.2 Page 27 2. OP7 St Josephs 3. 4. 5. OP9 OP12 OP16 6. OP21 7. 8. 9. OP24 OP26 OP30 10. OP33 11. OP36 home. It is recommended that home obtains a larger trolley for the storage of the medication in the home. Daily records should include details of how the people living in the home are spending their time to evidence their social needs are being met. It is recommended that staff log any minor issues that are raised by individuals living in the home and include how these were resolved as further evidence that they listen to people and act on what they say. The plans to have a floor level shower in the home should be pursued at the earliest opportunity so that the people living in the home have the choice of having either a shower or a bath. Bedrooms should continue to be redecorated as planned to ensure they are kept to an acceptable standard for the people living in the home. To ensure good food hygiene in the home the chopping boards in the kitchen should be replaced. The manager should ensure the induction training records are fully completed when the training takes place as evidence that staff have been given all the necessary training to fulfil their role. The manager should collate all the information gathered from the quality monitoring systems in the home and draw up an improvement plan for the home that details how the service in the home will be improved. All staff should have supervision six times a year to ensure their performance is overseen and discussed with them and training needs are identified. This will ensure the people living in the home receive care from the appropriate people. Not assessed for progress at this inspection. St Josephs DS0000064278.V368023.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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