Care Home: St Josephs Home

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What the care home does well The AQAA states that the "service provides a responsive, value for money service, which is resident focussed and delivered in a homely, clean and appropriate environment. Our philosophy is that whenever possible the home is a home for life". People that use the service made the following comments about the home "We are well cared for", " there is nothing not to like here" and "staff are lovely." Regarding the quality of the service delivery people said that the staff knew how to meet their needs, they knew how to make complaints and the food is good. " I am very happy living here" and " I am well looked after" were the most common statements made through the surveys by individuals living at the home. Through the "Have your say" surveys from relatives the following comments about what the service does well were made. "Exceptional care, very clean environment and cheerful staff", " provides a home environment, safety and security and individuals spiritual needs are catered for", "Caring and sensitive staff and " personal approach". "Standards of hygiene are excellent and a good homely feel " and " Looks after the wellbeing of all the service users" were the comments through the surveys made by the district nurses that visit the home. What has improved since the last inspection? The home continues to make adaptations and improvements to the environment. This ensures the property is safe and benefits the changing needs of the people. Incorporating working in the units into the roles and responsibilities of the induction trainer will ensure that training needs are identified promptly. What the care home could do better: There are five requirements arising from this inspection and focus on reviewing information, further developing the care planning system and staffing. The Statement of Purpose must be reviewed to give a clear account of the facilities, services, provisions and delivery of care. This will ensure that people wishing to live at the home can make decisions about moving into the home. The care planning system must be further developed by including individual`s likes, dislikes and preferred routines into their action plans. This will provide amore person centred approach that increases consistency of care to the people living at the home. The way individuals with communication difficulties make decisions must be added to the care plan this will ensure they make decisions over their own lives whenever possible, and are included in such decisions at all times. Medication systems must be improved by ensuring the balances of homely remedies are accurate and medication profiles must be developed for people that take prescribed medications. Profiles must include the purpose of the medication, their compatibility with homely remedies, with protocols for `when required` medications. Members of staff must be clear about their expectation to report poor practice witnessed. The presence of a senior Sister on the second floor will ensure that best practice is promoted. A review of the needs of people with dementia will to guide the home to provide appropriate training for staff. This will ensure that staff have insight and skills to meet the needs of people with dementia. CARE HOMES FOR OLDER PEOPLE St Josephs Home 66 Cotham Hill Cotham Bristol BS6 6JT Lead Inspector Sandra Jones Unannounced Inspection 09:30 23 & 25th April 2008 rd 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 Home DS0000020363.V359555.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 Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Josephs Home Address 66 Cotham Hill Cotham Bristol BS6 6JT 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) 0117 9733815 0117 9466786 The Little Sisters of the Poor Sister Catherine Mckinlay Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (41) of places St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 7 persons receiving nursing care. May accommodate up to 34 persons aged 65 years and over, requiring personal care. Manager must be a RN on Parts 1 or 12 of the NMC register Date of last inspection 5th June 2007 Brief Description of the Service: St Joseph’s Home is operated by the Little Sisters of the Poor and provides accommodation and personal care for up to 40 people aged 65 years and over. Within this they can provide support for up to seven people who also require nursing care. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Whilst there is an ethos of Catholicism within the home, it is nondenominational and all religious beliefs are respected. The aim of the home is to ensure that holistic, quality care is delivered in a supportive and effective manner to all residents. The home is governed by a care manager who is assisted by a Deputy and supported by a community of Sisters. The manager directs the day-to-day operations of the home though designated supervisors. The home’s information states that staff are trained to understand and respect rights and choices. St Joseph’s is situated in a busy residential area of the city and close to local amenities and bus routes. The home is modern, well decorated, with facilities over three floors, which are accessible via a lift. There are numerous aids and adaptations for people with physical disabilities. There is a convent located on the top floor of the premises where the nuns live. The cost per week to reside at the home is determined by a persons needs and St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 5 ranges from £348.00 to £550.00. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was conducted unannounced in April 2008 over two days and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the Annual Quality Assurance Assessment (AQAA). This information was used to plan the inspection visit. “Have your say” surveys were sent to people who use the service, their relatives, staff and health care professionals. There was a good response from the surveys sent to the home. Surveys were received at the Commission from eighteen people living at the home, fourteen relatives, thirteen staff and two health care professionals. Thirty-six individuals were living at the home at the time of the inspection and six people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the people living at the home, Sister in charge, qualified nurses, H.R. and care assistants were gathered through face-to-face discussions. What the service does well: St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 7 The AQAA states that the “service provides a responsive, value for money service, which is resident focussed and delivered in a homely, clean and appropriate environment. Our philosophy is that whenever possible the home is a home for life”. People that use the service made the following comments about the home “We are well cared for”, “ there is nothing not to like here” and “staff are lovely.” Regarding the quality of the service delivery people said that the staff knew how to meet their needs, they knew how to make complaints and the food is good. “ I am very happy living here” and “ I am well looked after” were the most common statements made through the surveys by individuals living at the home. Through the “Have your say” surveys from relatives the following comments about what the service does well were made. “Exceptional care, very clean environment and cheerful staff”, “ provides a home environment, safety and security and individuals spiritual needs are catered for”, “Caring and sensitive staff and “ personal approach”. “Standards of hygiene are excellent and a good homely feel ” and “ Looks after the wellbeing of all the service users” were the comments through the surveys made by the district nurses that visit the home. What has improved since the last inspection? What they could do better: There are five requirements arising from this inspection and focus on reviewing information, further developing the care planning system and staffing. The Statement of Purpose must be reviewed to give a clear account of the facilities, services, provisions and delivery of care. This will ensure that people wishing to live at the home can make decisions about moving into the home. The care planning system must be further developed by including individual’s likes, dislikes and preferred routines into their action plans. This will provide a St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 8 more person centred approach that increases consistency of care to the people living at the home. The way individuals with communication difficulties make decisions must be added to the care plan this will ensure they make decisions over their own lives whenever possible, and are included in such decisions at all times. Medication systems must be improved by ensuring the balances of homely remedies are accurate and medication profiles must be developed for people that take prescribed medications. Profiles must include the purpose of the medication, their compatibility with homely remedies, with protocols for ‘when required’ medications. Members of staff must be clear about their expectation to report poor practice witnessed. The presence of a senior Sister on the second floor will ensure that best practice is promoted. A review of the needs of people with dementia will to guide the home to provide appropriate training for staff. This will ensure that staff have insight and skills to meet the needs of people with dementia. 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 Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 9 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 Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 10 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) & (6) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There is an effective admissions process that ensures people wishing to live at the home have all relevant information to make a decision about the nature of the home. They can be reassured that the home will have the skills and resources to meet their assessed needs. EVIDENCE: The Annual Quality Assurance Assessment completed by the manager states that before admission prospective service users are invited to visit the home with their families or friends and the terms and conditions of the home are explained to them. Before admission a pre assessment form is filled in to St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 11 make sure that the Home can adequately meet the needs of the prospective resident. A trial period can also be offered. They can also come for a meal. Seventeen people that responded through “Have your Say” surveys stated that they received enough information to make decisions about moving into the home. Thirteen of their relatives confirmed through the surveys that enough information was received before decisions about the home were made. The Statement of Purpose outlines the facilities and provision of the home. While it is acknowledged that the organisation has its own policies and procedures, the Statement of Purpose must specify the approach to be followed at the home. The Statement of Purpose must be reviewed to give a clear account of the facilities, provision and delivery of care at the home. It is stated within the Statement of Purpose that full assessments of needs cover all areas of care including physical, health, emotional and social care. Individuals are also informed through the Statement of Purpose that trial periods are offered to further ensure that the placement is suitable. The case files of the two most recent admissions to the home were examined and confirm that pre-assessments of needs are conducted before any admission takes place. The pre-admission assessment uses a scoring system to assess the individual’s abilities and needs with physical care, which includes mobility, communication, psychological and behavioural. It endeavours to determine the individual’s level of dependency and summarises their social arrangements and other information. Contracts are signed and copies are held within the person’s files. Terms and Conditions of residency state the room number and information about the rules and fees of the home. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 12 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) & (10) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There are effective care planning systems in place and for individuals to benefit from receiving an individualised and consistent service further improvements are needed. Care plans must be improved to fully empower people with communication needs to make decisions about all aspects of their care. People living in the home can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect People at the home can expect sensitive and prompt support for their personal and health care needs from a skilled staff team. Medication systems are safe. EVIDENCE: St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 13 The Annual Quality Assurance Assessment (AQAA) completed by the manager states that “there are Care Plans for all our service users. The doctor comes regularly to the home usually once a week. But will also come at any other time when called. All staff are trained to treat the service users with respect so that their privacy and dignity are maintained. All care staff involved in medication administration are appropriately trained”. Fifteen people living at the home stated through the survey that they always receive the medical support they need. Ten of their relatives said that they are kept informed of important issues. Two surveys were received from district nurses that visit and one sated that individual’s health care needs are always met and another said this is usual. A pre-admission assessment based on all areas of care need is conducted before admissions occur. From the assessment a care plan is then formulated which is monitored monthly and reviewed six monthly. Reviews identify changes in the care plan and the format followed specifies the sources used to assess the suitability of the existing care plan. Care plans list the need, expected outcome and list the steps to be taken by the staff to meet the identified need. It is evident from the action plans that a person centred approach to meeting needs is being developed. Further steps must be taken in terms of incorporating likes, dislikes and preferred routines into the action plans. Action plans must be more specific to consistently meet the identified need. For example, the steps to be taken when individuals are abusive or agitated. For individuals with communication needs care plans must be clear about the way individuals make decisions. Individuals personal care needs form part of the care plan and action plans guide the staff on the steps to be taken to meet the identified need. However, the individuals preferred routines are not specified within the action plans. There is little recorded evidence on the individual’s participation and input into their care plan. Three members of staff were consulted about their responsibilities towards care planning. Members of staff said that the Sisters develop care plans and care assistants act as keyworkers, which entails having specific responsibilities for a group of people living at the home. The role of a keyworker includes spending 1:1 time with the people in their group, ensuring they have toiletries, and clothing. Staff make entries in the individuals daily reports on tasks undertaken, activities, outcome of visits, observations of the person and their wellbeing. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 14 Separate records are kept regarding health care visits from outside professionals and members of staff record the date of contact with GP’s, district nurses, dentist, optician and chiropodist. Other documentation from health care professionals show that people at the home have input from specialists and access local NHS facilities. Risk assessments are conducted for mobility, nutrition and pressure areas and through the scoring system the level of risk is determined. Further detailed risk assessments are completed where there are medium and high levels of risk. For individuals with pressure areas, assessments for monitoring pain and reports on wound dressings are kept. Prescribed medications are administered through a monitored dosage system and the qualified nurse on duty said that currently qualified nurses administer medications. Three staff were consulted about medication practices at the home one member of staff said that they had done part of the training and the other two said they had not attended medication training. The records of administration show safe recording practices because there were no gaps in the recording and appropriate use of codes for medications not administered. Homely remedies are administered from a stock supply and separate records of administration are kept. However, there were discrepancies between the records and the balances held. For people to benefit from safe handling of medication safe practices must exist. Individual medication profiles that include the purpose of the medications, their side effects and compatibility with homely remedies with protocols for prescribed, “ When required” medications are not currently in place. Individuals profiles for prescribed medications with protocols must be devised for “ when required” medicines so that members of staff know when to administer this medication. The home has made arrangements for the removal of medications no longer required at the home and a record of their disposal is maintained. There is a Respect, Privacy and Dignity policy and reference to this policy is made in the Statement of Purpose. The procedure is clear about the ways privacy and dignity is respected and confirms that members of staff attend appropriate training to ensure individual’s rights are respected. Individuals living at the home were consulted about the way staff respect their rights particularly privacy and dignity. People giving feedback made the following comments about the way their rights to privacy and dignity is St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 15 respected. It was stated that staff knock on bedroom doors before entering, GP’s visits are in private and staff addresses them correctly. Members of staff said that confidentiality of information; discreet personal care, explaining the tasks to be conducted and empowering people to make choices are ways that they respected individual’s rights. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 16 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) & (15) Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. There are good support systems in place for individuals to lead active and interesting lifestyles. Staff respect people’s choices, preferred daily routines and preferences. People living in the home receive a varied and wholesome diet that they are able to influence. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that “we endeavour to give a ‘homely’ feeling to our home with as few restrictions as possible. Visitors are free to visit at any time and meals can be given to the Resident’s family when booked in advance. We provide varied social activities outings and holidays that meet the expectations of the residents and promote them in maintaining a quality of life style. Individuals are enabled to exercise choices and staff actively encourage and promote individuality and independence”. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 17 Social assessments form part of the care planning process and information about social network, hobbies, interests and cultural needs is sought. Care plans to meet the individual’s interests, hobbies and cultural needs are then developed from the information gathered through the assessment. An activities coordinator is employed, bingo, Keep-fit and outings are organised at the home. The activities organiser said that there is monthly News and Reviews meeting and individuals make suggestions about activities through this forum. Weekly activities and events are posted in the home’s notice board and in the morning people generally attend Mass followed by twice daily activities and rosary in the evenings. Arts and Crafts are also organised and take place twice weekly, which are attended by people that are more independent. Sixteen people said through the surveys that activities are always arranged and six said this was usual. The home has a well-stocked shop and books, videos and puzzles can be borrowed from the library. There is a home’s minibus for outings, which are organised weekly during periods of good weather. People living at the home were consulted about activities and were able to describe the group activities organised at the home. One person said the library is very good, another said that reading and watching television are their preferred activities. One person that is not a Catholic said that religion is not imposed. Fourteen relatives stated that their relative’s diversity and dignity needs are met and two said this is usual. The organisation recognises the importance of supporting people to maintain contact with family and friends. The Visitors policy confirms that there is open visiting which can take place in bedrooms for additional privacy. Ten relatives said through the “Have your say” surveys that their family member is assisted by the home to keep in touch and three said this was usual. Individuals giving feedback about the home said that their visitors are welcome and that visits can take place in bedrooms. The arrangements for personal possessions, safekeeping of cash and fees are specified within the contract. Individuals are encouraged to have personal possessions in their bedrooms, fees must be paid by standing order and facilities for the safekeeping of cash exist at the home. There is a four-week menu that the Sisters devise and, each day members of staff seek the individual’s meal choice. The home has a very large kitchen that is well stocked with fresh, frozen and tinned foods. Seventeen people said through the surveys that they always like the meals, four said it was usual and one said this was sometimes. Individuals giving feedback said that the food St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 18 was good, there is a choice of mealtimes and if necessary alternatives were provided. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 19 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) & (18) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Individuals can expect their concerns to be listened to and to be protected from abuse a more consistent approach to Whistleblowing must be developed. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager says that “training protects people from the risk of abuse. We are always at the disposition of the residents and their families to listen to them2. The home has a Complaints procedure, which specifies the steps to be followed when complaints/concerns are received at the home. It is recognised through the procedure that individuals have the right to make complaints and to resolve complaints the staff will inform the complainant of the actions to be taken and will seek their level of satisfaction. The Sisters said that on arrival the complaint procedure is explained and to ensure people can make complaints anonymously there is a suggestion box in the library. The Sister on duty said that there were no complaints received at the home since the last inspection. The people at the home said that they can approach the Sisters or staff with complaints and felt confident that their concerns would be taken seriously and acted upon. Sixteen people said through the “Have your say” surveys that they know who St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 20 to speak to if they are unhappy and two said this is usual. Seventeen people also said that they know how to complain. Thirteen relatives said through the survey that they know how to complain and their complaints had been handled appropriately. There are detailed policies and procedures on abuse, which describes the factors of abuse with the actions to be taken for alleged abuse. The Whistleblowing policy further evidences the homes commitment towards safeguarding adults from abuse and is clear about staff’s duty to report poor practice without reprisals from other staff. The Sister on duty said there were no outstanding Safeguarding Adults referrals. Members of staff were consulted about their responsibilities towards safeguarding individuals from abuse. Members of staff confirmed that Safeguarding Adults training was provided by the organisation. Comments regarding the factors of abuse and their duty to report poor practice show a clear awareness of their responsibilities. Through discussion with the staff it transpired that some individuals make racist comments and at times exhibit aggressive and violent behaviours towards staff. The comments of one member of staff gave raise to concerns about the safety of people at the home. These comments included “we are kicked and punched, individuals are cheeky and racist, we correct them straight away and people are pulled up about their rudeness and racism.” When asked about dementia training this member of staff said, “We were provided with dementia training but this was guidance and not useful, we need restraint training”. Another member of staff working in this unit agreed by saying, “ a number of people with dementia are aggressive and at times are racist, usually we speak to the Sisters and sometimes the Sisters speak to the perso”.” However, members of staff have not reported poor practice witnessed. It is evident that there is an inconsistent approach to ‘whistleblowing’ and some staff lack confidence in when and how to use policies and procedures. These concerns were discussed with the Sister on duty and reassurance was given that the situation would be managed while the member of staff was employed at the home. The Sister also said that the home is being restructured and a Sister will be rostered to work on this unit providing strong leadership presence. Equalities and Diversity training must be provided to members of staff and risk assessments that include strategies for dealing with racist, aggressive and violent behaviours must be devised. This will ensure that members of staff are consistent with managing difficult behaviour that challenge. Also assements about the level of training to be provided to meet the needs of people with dementia must be undertaken and the appropriate training must then be provided. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 21 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) & (26) Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. The home is well maintained so residents benefit from living in a comfortable and clean environment. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager stated that individuals are provided with warm, safe, comfortable accommodation, all rooms are en suite with showers except 4 without showers. There are a number of pleasant, special communal rooms and a large well kept garden. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 22 St Josephs is situated within extensive and well-maintained grounds. It is an older building, which has been fully modernised and is secured by high walling and electrically operated gates, providing additional security and privacy for people living in the home. There are accessible pathways for people who use wheelchairs and various seating areas with plenty of sun screening. The modernisation makes the home fully accessible and has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, specialised bathing facilities, grab rails and assisted toilet facilities. Great attention has been given to ensure that all areas are homely. People are supported to personalise their bedrooms with pictures and ornaments and are able to bring items of furniture should they wish. Bedrooms are of generous size and have en suite facilities; rooms are lockable so that people can maintain their privacy and keep their personal possessions secure. Lounge areas are spacious and allow for people to be seated together. People giving feedback said that the accommodation was good and that ensuite facilities ensured their privacy. There are kitchenettes throughout the home, which are well equipped and enable people living in the home, visitors and guests the facilities to make drinks and snacks at any time of day. People living in the home also have access to launderettes on each floor should they wish to do their own laundry. The home was clean and smelled fresh and pleasant throughout. The home employs domestic staff on a daily basis. People confirmed that the home is always fresh and clean and comments included, “There are very high standards of cleaning in all rooms” and “The home is spotless all the time”. Seventeen people said through the survey that the home is clean and free from unpleasant smells. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 23 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) & (30). Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Adequate staffing levels help to ensure that people’s needs are met. Individuals are supported by a competent and skilled staff team who are well supervised. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager states that staffing levels are maintained in sufficient numbers ensuring that residents’ needs are being met. Recruitment practices are robust and protect residents from risk of harm. Staff training ensures that they possess the knowledge and skills to care for all current needs. Twelve individuals said through the survey that staff are always available and six said this was usual. Eleven staff said through the survey that there are enough staff and a number of relatives indicated through the surveys that the home is sometimes short of staff. A member of staff with responsibilities for recruitment said, while the home is recruiting for domestic, laundry and care assistants, staffing levels are maintained with bank and existing staff. There is a rota in place for each unit and the structure is unit Sister, care assistants and domestic staff. The rotas show that there is a unit Sister on St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 24 duty on each floor throughout the day and the Sisters on the second and third floor are also qualified nurses. On the ground floor there are two care assistants and one domestic on duty in the mornings and in the evenings staff levels are reduced to one care assistant. On the first floor there are four care assistants and two domestics in the morning and three in the afternoon. On the third floor there are three care assistants and two domestics in the mornings and two care assistants are rostered in the afternoon. At night there are two care assistants and one qualified pereson awake in the premises. The files of the most recently employed staff were examined during the inspection and completed application forms, two written references, Criminal Records Bureau (CRB) disclosures, POVA First checks and Terms and Conditions of employment are kept in their personnel files. For qualified staff nurses, Nursing and Midwifery Council (NMC) registrations are checked annually and records support that registered nurses are employed at the home. Thirteen staff said that checks that ensured their suitability to work with vulnerable adults were conducted and included written references and CRB’s. Comments made by the staff show a clear understanding of their roles and responsibilities. Individuals consulted about the staff said, “The staff are lovely and there is no problem with the nuns”. Other comments positive comments about the staff ability to meet their changing needs were made. An Induction trainer was recently employed at the home, the trainer said the induction programme is a twelve-week package that follows the Skills for Care induction and six units cover Moving and Handling, Food Hygiene, Fire Safety and Policies and Procedures. The induction trainer said that training is advertised and currently staff are attending Dementia and Continence training. Food Hygiene, Medication and Moving and Handling training will be provided to the staff. Members of staff confirmed that they have access to training. Twelve relatives said that the staff have the right skills to meet the needs of the people at the home. Ten staff said through the surveys that the induction provided enabled them to undertake their role. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 25 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) & (38) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Needs and best interests of people living in the home are central to the management approach in the home. The health and safety of all people who use the service is protected and promoted EVIDENCE: The Annual Quality Assurance Assessment (AQAA) completed by the manager referred to the day-to-day smooth running of the home where staff and the service users are happy and content. The AQAA contains clear, relevant information that is supported by a wide range of evidence. It is the policy of the organisation to move managers’ every six years and the current manager was moved for this reason, the deputy manager was also St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 26 moved within the organisation. The inspection was conducted with the deputy manager during the last few days working at the home. People living at the home and staff were anxious and eager to meet the new Sisters that would be taking responsibilities for the day-to-day management of the home. Fire Risk Assessments that evaluate the potential for fire at the home were developed in 2006 and must be reviewed to ensure that the actions prevent the risk of fire. The home continues to complete health and safety checks and records show gas checks, hoists passenger lifts and portable appliance testing by outside contractors are conducted and evidenced that the home promotes health and safety within the workplace. St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 27 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 3 X X 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 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 3 X 3 X X 3 St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 6 Requirement The Statement of Purpose must be reviewed to give a clear account of the facilities and provisions and delivery of care and must include policies and procedures Care plans must be further developed to include a) clarity about the way individuals with communication needs make decisions, b) individuals likes, dislikes and preferred routines. Medication systems must be improved a) balances of homely remedies must be accurate, b) medication profiles must be devised for individuals with prescribed medications that must include protocols for when required medication. Members of staff must be clear about their responsibilities to report poor practice witnessed. A review of the dementia needs of the people at the home must be conducted to then provide appropriate dementia training to the staff. Timescale for action 30/07/08 2. OP7 12 30/09/08 3. OP9 13 (2) 30/06/08 4. 5. OP18 OP27 13 (6) 18 (c) (i) 30/08/08 30/08/08 St Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 29 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 Josephs Home DS0000020363.V359555.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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