Care Home: St Peter`s

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What the care home does well This is best described from comments about the service that we received before the visit. Comments were received from people living at the home, GP, healthcare professionals and staff. Comments were as follows: From the GP: `I think the staff give exemplary care. The home is well organised and homely. I have a real sense that the staff know the residents well and make every effort to accommodate their needs and wishes. I visit regularly along with the community matron and am kept informed of any medical concerns. I would be happy for a relative of mine to stay at St Peter`s, From a district nurse: `St Peter`s is a happy residential home. A `family feel` is evident when we enter the building. Clients are listened to and their wishes respected. Families feel they can visit and take their relative out comfortably. Their health needs are met by the primary healthcare team working closely with care staff`. From a community matron: `Staff are very caring and all respond appropriately when things are advised`, From people living at the home: `we`re looked after very well` and: From staff: `Tries to create a homely atmosphere where people integrate and communicate well together`. What has improved since the last inspection? The six requirements made at the last visit had all been met. These included: - The Statement of Purpose had been amended and now includes a statement on meeting the needs of people from different groups in society. This makes sure the home is right for people and they know what to expect when they move in, - Risk assessments are in place for individual needs, that makes sure people are kept safe from harm, - Medication is given out safely and kept secure at all times. This includes signing of medication sheets that show people get the medicines they need, - Activities had been looked at and everyone has the opportunity to take part if they wish. Trips out have been given a greater focus and happen regularly, - All staff have either had safeguarding adults from abuse training or have been booked on to courses. This makes sure people are protected from risk of abuse happening and: - Dementia care training has been happening for all staff including the management team and has been well received. This makes sure people with dementia are cared for by staff that understand their particular needs. What the care home could do better: Two new requirements and four good practice recommendations were made at this visit: Medication practice needs further attention particularly to do with short life medication such as eye-drops. These must be labelled when opened and discarded when the date is reached so that people are kept safe. Where creams and gels are prescribed, staff must sign the Medication Administration Sheets to make sure they are applied regularly. Further, people that look after their own medication should sign the record sheet when they receive a new supply that the home gets for them. This will make sure they get the right medication they need in good time. Staffing levels aren`t consistent over the whole week with fewer on some days including weekends. People commented about staff shortages but the manager said all the agreed hours are covered. These should be checked and the findings sent to the Commission, so that we can be sure peoples` needs are met by regular staffing at all times. The issue of homely remedies or `over the counter` medications not being given continues. The home hadn`t taken enough action to make sure everyone has the opportunity to have things like pain relief if they need it but aren`t written up for it. The provider has been contacted and has been asked to take action so that the home is clear about its responsibilities to people living at the home. We found that complaints weren`t being consistently recorded and there was an unresolved issue about peoples` voting rights. Two recommendations have been made to make sure peoples` concerns are properly recorded and they`re asked about their voting wishes. People commented in the home`s own quality assurance survey about laundry issues. We found that peoples` clothing may not be marked quickly enoughbefore washing that leads to things going missing. A better system should be put in place to make sure this doesn`t happen. CARE HOMES FOR OLDER PEOPLE St Peter`s Bishopthorpe Road Westbury on Trym Bristol BS10 5AB Lead Inspector Sandra Garrett Unannounced Inspection 09:00 21 & 22 August 2008 st nd 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 Peter`s DS0000035285.V367544.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 Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Peter`s Address Bishopthorpe Road Westbury on Trym Bristol BS10 5AB 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 3532227 0117 9031032 brssljk@bristol-city.gov.uk Bristol City Council Lorraine Knight Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 30 23rd August 2007 Date of last inspection Brief Description of the Service: St Peters is run by Bristol City Council Adult Community Care and registered with the Commission for Social Care Inspection (the Commission). The home is in the residential area of Westbury-On-Trym, known as Manor Farm, that is close to Southmead Hospital. St Peters gives personal care to older people over the age of 65. It houses thirty residents with two short stay/respite care places. The home is close to a small rank of shops and there is a pub at the end of the road. There is a large garden at the back of the home and a small car park with lawned area at the front. The home is accessible to disabled people and is laid out over two floors with lift access. The full fee for living at the home is currently £471.24 per week. People funded through the Local Authority have a financial assessment done in accordance with Fair Access to Care Services procedures. Local Authority fees payable are worked out according to individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk. A copy of the last inspection report was displayed in the home at this visit. The certificate of registration was displayed and was correct. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was the first since August 2007. We had gathered information about the home before the visit took place, and drew up an inspection record in preparation for it. This record is used to focus on and plan all our visits so that we concentrate on checking the most important areas. During the visit we spoke to a number of people living at the home and staff both individually and in groups. We looked at a range of records that included: Care plans and associated records, complaints, health and safety and staff records such as training and supervision. What the service does well: What has improved since the last inspection? The six requirements made at the last visit had all been met. These included: - The Statement of Purpose had been amended and now includes a statement on meeting the needs of people from different groups in society. This makes St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 6 sure the home is right for people and they know what to expect when they move in, - Risk assessments are in place for individual needs, that makes sure people are kept safe from harm, - Medication is given out safely and kept secure at all times. This includes signing of medication sheets that show people get the medicines they need, - Activities had been looked at and everyone has the opportunity to take part if they wish. Trips out have been given a greater focus and happen regularly, - All staff have either had safeguarding adults from abuse training or have been booked on to courses. This makes sure people are protected from risk of abuse happening and: - Dementia care training has been happening for all staff including the management team and has been well received. This makes sure people with dementia are cared for by staff that understand their particular needs. What they could do better: Two new requirements and four good practice recommendations were made at this visit: Medication practice needs further attention particularly to do with short life medication such as eye-drops. These must be labelled when opened and discarded when the date is reached so that people are kept safe. Where creams and gels are prescribed, staff must sign the Medication Administration Sheets to make sure they are applied regularly. Further, people that look after their own medication should sign the record sheet when they receive a new supply that the home gets for them. This will make sure they get the right medication they need in good time. Staffing levels aren’t consistent over the whole week with fewer on some days including weekends. People commented about staff shortages but the manager said all the agreed hours are covered. These should be checked and the findings sent to the Commission, so that we can be sure peoples needs are met by regular staffing at all times. The issue of homely remedies or ‘over the counter’ medications not being given continues. The home hadn’t taken enough action to make sure everyone has the opportunity to have things like pain relief if they need it but aren’t written up for it. The provider has been contacted and has been asked to take action so that the home is clear about its responsibilities to people living at the home. We found that complaints weren’t being consistently recorded and there was an unresolved issue about peoples voting rights. Two recommendations have been made to make sure peoples concerns are properly recorded and they’re asked about their voting wishes. People commented in the home’s own quality assurance survey about laundry issues. We found that peoples clothing may not be marked quickly enough St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 7 before washing that leads to things going missing. A better system should be put in place to make sure this doesn’t happen. 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 Peter`s DS0000035285.V367544.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 Peter`s DS0000035285.V367544.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 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being given clear information about the home when they come into it. Satisfactory use of contracts that give clear information about room numbers and fees makes sure people using the service are aware of their rights and responsibilities. Satisfactory arrangements for people coming into the home make sure their needs can be met. People are looked after well in respect of their specialist needs by staff that are suitably trained and experienced. EVIDENCE: St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 10 To the question in our ‘Have Your Say’ survey people filled in with us comments were made about information given to them and whether they had signed their contracts. Comments included (about contracts): ‘I’ve signed a couple of things’, ‘Yes I signed one of those’ (about information given to them), ‘I had everything, yes’ and: ‘My daughter found (the home), made an appointment then came and fetched me and I’ve been here ever since’. A requirement made at the last visit about the Statement of Purpose had been met. The newly amended Statement of Purpose that all the local authority homes use was seen. This includes details of the kinds of needs the home can deal with and also has a statement on Equalities and Diversity. This means respecting peoples needs in relation to race, culture, religion, sexuality, disability and age and not discriminating against them in the meeting of those needs. Two people from ethnic backgrounds had been living at the home but were no longer there. No black or minority ethnic people were living there at this visit. Contracts are of a standard type used in all local authority homes and are different depending on whether someone moves in permanently or for short stays. Contracts seen included room numbers, fees and were all signed. Social work assessments are done for each person moving into the home even if just for a short stay. Copies were seen in individual files. One person had stayed at the home on a couple of occasions before moving in permanently and the assessment gave information about this. Assessed needs picked up as part of the social work care plan are then transferred and expanded in the home’s own care plan, done during the four-week trial period. Where people have spent time in hospital, a member of the management team visits to reassess them to make sure the home can go on meeting their needs when they come back to the home. The assistant manager and the manager gave information about doing such visits. Sometimes they find that someone needs more care than the home can give them. In this case people are discharged to nursing homes. Specialist needs such as dementia, cognitive impairment (this means an undiagnosed condition that could affect their memory and reasoning skills), sight and hearing difficulties are part of each person’s care plan and staff are given information about how to help manage them. We case tracked (this means looking at all records associated with the person and tracking their care by talking with both them and staff caring for them), three people with specialist needs. These were to do with extreme age (one person is well over a 100 years of age), behaviour that challenges staff, sight difficulties and issues following a serious fall that meant the person needs a lot of extra care. Records we saw were clear about these peoples specialist needs. St Peter`s DS0000035285.V367544.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 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in looking at care plans and recording peoples weight regularly, makes sure peoples changing needs are picked up and met. People living at the home are looked after well in respect of their healthcare needs. Failure to keep short life medication properly doesn’t keep people living at the home safe from harm. Further, failure to properly record all medicines given doesn’t keep them protected. Being treated with dignity and respect benefits people living at the home. However, staff use of language to describe their work with people could show disrespect of peoples needs. EVIDENCE: St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 12 To the question in our survey ‘Do you receive the care and support you need?’ people commented: ‘I’m very independent but they do what I need’, ‘they look after me very well’ and ‘yes I’m looked after very well’. To the question: ‘Do the staff listen and act on what you say?’ comments weren’t so positive: ‘Depends on who you’re asking and what you’re asking for. Some are very good and some not so’ and: ‘sometimes you can ask for something and it isn’t done but then sometimes you can ask and it is done, so I’m a bit in-between on that one’. A requirement about risk assessments (this means picking up and making sure that actions are in place to try and reduce the particular risks) made at the last visit was met. Clear assessments were in place including for self-medication and falls. Care plans gave good information about meeting each person’s particular needs. For the person over 100 years of age the care plan showed exactly what needed to happen for the person and how to treat her/him so that s/he doesn’t become anxious about change. Care plans showed the names people like to be called and were detailed. They included information about dental and foot care, activities and emotional needs as well as personal care, mobility, washing and bathing etc. Another person’s plan showed how staff were to manage behaviour and effects of poor mobility. Staff talked to us about this and were knowledgeable about how the person wanted to be cared for and how to manage what could be seen as challenging behaviour. At the front of care plan records there was a guide to person-centred care (this means care that looks at a person’s whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks). The manager had done this together with another sheet on how to write in a person-centred way and what not to include. This is good practice. One staff member commented: ‘we’re given a daily report regarding each resident’s needs and welfare. All information will be recorded/updated on each individual’s care plan. This enables staff to be sure each resident’s needs are met’. The third person’s records we case-tracked showed changes made to the care plan in the light of her/his illness. However from looking at the plan, talking with the person and also with staff it was clear that the whole plan needed to be re-done as the situation for that person had changed completely. Daily records were properly written in person-centred ways and gave information about peoples lives at the home as well as meeting their care needs. A staff member commented: ‘any concerns will be recorded in St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 13 resident’s daily records and reported to the officer in charge’. Records were regularly written although we saw a record about a person with diabetes needing foot care. The person had a swollen, painful toe. However nothing more was written about this and we couldn’t find any record anywhere of what had happened about it. However clear records of GP and district nurse visits to deal with pressure areas on the person’s feet were seen. To the question ‘Do you receive the medical support you need?’ peoples comments were mixed: ‘ I don’t know, I’m not sure to be honest’, ‘I don’t need any. They don’t offer and I don’t ask’, ‘There is a doctor and nurses that come in. I presume you have to ask to see them if you need to’, ‘Yes I have my own doctor, I don’t see the one here’, ‘Yes. The office staff are very good, it doesn’t matter if it’s a bad finger or something more serious’ and: ‘Yes. A nurse comes to see me every day’. Healthcare professionals including a GP, district nurse, community matron, chiropodist and pharmacist had all filled in our ‘Have Your Say surveys that are geared to the visits they make to the home. Comments from these were largely positive and included: ‘The manager phones district nursing team to report any nursing needs or interventions that may be required’, ‘Carers demonstrate a gentle, empathic approach’, ‘They are always open to suggestions and very responsive to the residents’ care needs, ‘They know patients well and respond quickly to their medication needs’ and: ‘In comparison with other homes I deal with they are far better than most’. We did a check of medication and found that a requirement made at the last inspection about medication practice was met. We observed practice and found the assistant manager and manager that gave medications over the two days, used the correct procedures. The assistant manager said that the medication trolley is taken around the home first thing in the morning and at night to give people their medicines. All Medication administration sheets were properly signed after giving for each day with no gaps. Photos of each person were at the front of the sheets. Medications subject to legal requirements were properly stored and recorded with two staff signatures. Quantities of these were checked and found to be correct. However, it was disappointing to note that the situation about ‘homely remedies – non-prescribed medicines hadn’t been resolved. We have written to the responsible individual (a representative of the local authority that keeps in contact with the Commission and makes sure the home is run to the required standard), asking for clear actions to be taken so that people are able to get simple pain relief for e.g. a headache, if they aren’t prescribed such medicine. Staff must also be clear what they can give that isn’t prescribed and in what circumstances. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 14 We found during the check of medication, people that look after their own medicines had blank administration sheets. This made it difficult to see if and when they had been given fresh supplies of them. It wasn’t clear whether people that have prescribed creams, lotions or gels had the application of these recorded on the sheets each time they were used. We also found that short life medicines such as eye drops hadn’t been dated when opened and could have been out of date. Further, a box of medicine opened in May ’08 was also found to be out of date. From the home’s own independent quality assurance survey done in July ’08 comments were made about privacy and dignity: ‘I am given privacy and always treated with dignity’ (2 similar comments) and: ‘Privacy is very good’ (3 similar comments). From our observations, surveys and conversations with people it’s clear that they are treated with dignity and respect. Call bells were answered promptly and staff showed they had good relationships with people – even those that can present them with challenges. We discussed this with the manager who was very clear about the way people are to be treated. However when talking with different staff we did hear them say that people can be ‘demanding’. This isn’t respectful or a person-centred way of talking about them. There may be an underlying need, anxiety or impairment that makes them challenging to staff rather than simply demanding of their time. Further, we heard staff at lunchtime saying loudly in front of people ‘s/he wants’ or ‘s/he likes’ when telling the cook what was requested. The manager agreed the examples given aren’t satisfactory and said she would continue to discuss use of language with staff. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a range of social and leisure activities including outings, that meet their needs. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home are well managed and give people variety, choice, good nutrition and social contact for people. EVIDENCE: We asked people about activities in the home. People said: ‘I used to take part in them before my accident but haven’t been able to over the last few weeks. I hope to be able to do so again soon’, St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 16 ‘There’s everything to do there really is loads. It’s not compulsory but it’s there for anyone if they want’, ‘There’s plenty to do. I like to take part sometimes but I used to go more’, ‘I like to join in with activities but sometimes they forget to tell me. I enjoy going on the outings though’, ‘I know there’s plenty going on in the lounge but I enjoy my reading, going to the shops and going to the smoking lounge. I enjoy the odd game of Scrabble’ and: ‘They have activities every morning in the lounge, they come down and tell me and I decide if I want to go or not’. The manager said she had done a survey of activities with people and gave us a copy. This showed that people mainly chose to have a range of games, bingo sessions, exercise, entertainments (from outside sources), music and trips. Some people didn’t want to do anything and some only wanted to do certain things like attend entertainments. People were asked if they wanted to join in and some had commented that they preferred one to one or depending how they feel at the time. From the AQAA sent in before this visit the manager had stated: ‘We have been given 28 hours extra care staffing per week ,this will help with dependancy and the facilitation of activities’. (However see below in Standards 27 – 30 for more information about this). We looked at activities records and saw a good range on offer. These were mostly different games including Scrabble, draughts and Hoopla, quizzes including ‘memory joggers’, ‘who wants to be a millionaire’ and a musical quiz, bingo and trips out in a local authority minibus driven by one of the staff. The trips had proved to be popular and recent ones were to Clevedon and Portishead, Weston-Super-Mare and the Wye Valley. Only a small number of people are happy to go on trips although the staff try and persuade others. We discussed this with the manager as there may be confidence issues or anxiety about trips for some people. The manager said she would think about shorter trips e.g. just for a ride somewhere close, to see if it would encourage others to go. From minutes of residents meetings held in April, June, July and August ’08, activities and trips were discussed at each. It was clear from looking at them and the activities records that peoples wishes had been met particularly about trips. Activities records gave details of people that joined in and their enjoyment of them. Records were good, person-centred and gave real sense of how people like to spend their time. Key time is offered one to one for each person for an hour a week. We discussed activities and key time with staff. From the residents meeting held in April, people said they were ‘happy with their key time and nobody had anything to complain about’. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 17 A local community group was coming in twice a week to do coffee mornings and a bingo session. However the coffee mornings hadn’t been well attended so had now stopped. People can go out to the local shops if they’re able to and one person was doing that when we visited. Others that need assistance can go out with staff in key time. A Church of England vicar visits once a month to run a service that anyone can join in with. Ministers from other denominations are asked to visit on request. It was clear people have lots of choice in a relaxed atmosphere within the home. From the activities survey we saw that people were also asked if they wanted an early morning cup of tea. Some people have some or all of their meals in their rooms and some have tea-making facilities so that they can be more independent. Restraints aren’t used and people are able to come and go as they wish. They can choose to have key time or not and what they want to do in key time. To the question in our survey about meals at the home comments were mixed: ‘The food is good but I just haven’t got much of an appetite at the moment’, ‘The food is really brilliant and alternatives are always offered’, ‘The food is very good’, ‘The food is absolutely lovely. I have no complaints with it at all. As long as you ask before lunch the cook will make you anything you ask for’, ‘It’s not the same as what you’d eat at home but it’s pretty good’, ‘It’s not what I would cook but I always send back a clean plate’, ‘They cater for me and find me things that I can eat. I don’t have much of an appetite at the best of times. They do offer me a lot of choice though’ and: ‘the food’s all right. There’s good and bad of course’. Meals offer a variety of choices both in main courses and desserts. A good practice recommendation about displaying menus was partly adopted. A laminated menu was displayed in the dining room. However this was the only place and the menu itself was in a size that people with sight difficulties might find hard to read. Staff go around the home telling people what’s on the menu and taking orders for the particular choice of meal. The manager said she had visited another home recently where the four weekly menus were all displayed. She thought this was a good idea and would think about doing the same. We asked staff about cultural diet needs. One person visits for respite and has a need for a cultural diet. Staff said s/he is always offered this but is often happy to have the same as everyone else. We had lunch with people on the second day of our visit. The meal was hot and tasty and clearly enjoyed by all. People were asked what they wanted or shown the meal. Staff treated people with dignity and respect when serving or helping them with their meal. Staff wore aprons that are just kept for meals service. No-one living at the home was vegetarian although people can have a St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 18 vegetarian choice if they wish. Cold drinks were available in jugs on each table and after the meal a pot of tea was also put on each. St Peter`s DS0000035285.V367544.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): 16,17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory complaints management makes sure people living at the home can be confident in raising concerns about any aspect of their care. However, failure to properly record all complaints may mean people’s concerns won’t always be taken seriously. Failure to sort out peoples voting arrangements for them may not keep them in touch with local or national elections or mean they are able to take part in the civic process. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. EVIDENCE: To the questions ‘Do you know who to speak to if you’re not happy?’, only one person said they didn’t but went on to say they rarely speak to anyone. Others told us: ’Yes, we’ve got an officer’ (four similar comments) and: ‘There’s a couple of people in the office I can speak to’. Six people said they know how to make a complaint, but two didn’t. Comments about this included: ‘I’m not sure I would have the confidence or not to be honest. It’s never had to come to that yet’, ‘nothing has ever made me need to make a complaint’ and: ‘oh yes if I had to’. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 20 We looked at the complaints file. One complaint had been recorded since the last inspection. The complaint, about meals service, had been partly upheld. The record showed details of the complaint, the investigation, action taken and outcome. We spoke to the person that made the complaint who also told us of another one about passive inhalation of cigarette smoke coming from other peoples rooms. We discussed this with the manager who told us what was being done about it. However this wasn’t recorded in the complaints file. From the home’s own quality assurance survey report we found that other complaints had been made: ‘I made a complaint about laundry going missing but never got the missing items back’, ‘I wanted to vote but was never given the paperwork to complete (4 similar comments)’. These had also not been recorded in the file. However the issues had been discussed at residents meetings and the actions and outcomes recorded. For both of the above complaints we saw that action had been taken. From the AQAA sent in before our visit, the manager had stated as an action to improve over the next twelve months: ‘The management team will make greater efforts to ensure fuller recording of day to day complaints’. Any or all complaints should be logged in the complaints file to show that staff take any concern or complaint seriously and that they’re dealt with quickly. The manager told us and we saw from the latest residents meeting minutes, that she had discussed with people the idea of setting up a ‘complaints surgery’. This would mean people with ‘less pressing complaints’ could come to the office and discuss their concerns one to one with a member of the management team. Whilst this may be a good idea, any such concern should be dealt with and recorded in the same way as more pressing complaints. People will then be sure that all their concerns and complaints will be taken seriously. With regard to the voting issue, this had clearly been discussed at the residents meeting held in August just before our visit. The minutes showed that people felt they weren’t offered the opportunity to vote at the last election. It was agreed that in future a ‘pre-election’ meeting would be held and everyone could say what sort of vote s/he wants i.e. in person, by proxy or by post. However, the manager should already have this information so that staff can make sure people are able to take part in the voting process. This information should be available in peoples records. One person had said in the home’s quality assurance survey: ‘I would like to vote, and will ask for a postal vote’. Notices of serious incidents or concerns affecting people living at the home are sent to the Commission. This includes any alleged incidents of abuse. No such incidents had been reported since the last inspection. Staff spoken with St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 21 confirmed that they had had training in safeguarding adults from abuse and would be confident of recognising if it happened. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 22 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): 19,22,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well looked after, physically accessible and meets their needs. However failure to manage peoples laundry properly puts them at a disadvantage. Proper cleaning and hygiene makes sure people live in a clean, fresh smelling environment are protected from risk of infection as far as possible. EVIDENCE: St Peter’s has benefitted from having lots of refurbishment and redecoration to communal areas over the past few years. The standard of maintenance and repair is good. However, some bedrooms haven’t been redecorated for years and the wallpaper is similar in a lot of rooms that shows people may not have had a choice of redecoration. A good practice recommendation made at the St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 23 last visit about this had been partly adopted. From the manager’s development plan we saw that she had written ‘we will aim to have all bedrooms identified from our home check – redecorated and re-carpeted this year’. From the residents meeting minutes of 16th August redecoration was discussed: ‘Several rooms are earmarked for redecoration and re-carpeting. These bedrooms have been chosen according to the state of repair’. However we didn’t have the opportunity to see a list of these rooms. Peoples bedrooms are all furnished differently and were very homely to look at. There were few institutional notices in peoples rooms. Around the home toilets are well marked and are separate for women and men. The home has been made as accessible as possible for disabled older people. Grab rails, accessible toilets, level access within the home and a lift to the first floor, uncluttered communal areas all help to support people with physical needs. We picked up the issue of problems with the laundry from the home’s quality assurance survey report: ‘Laundry regularly goes missing but nothing is ever done about it’. We looked at the laundry room and also discussed the issue with staff. The laundry room is well ordered and laid out. People have individual named baskets where clean laundry is put after it’s been washed and ironed. The home doesn’t have a laundry assistant and staff do this as part of their other tasks or as and when they have time. One staff member showed us some items that had been washed but had no names on them. Other staff told us that the night staff used to sew nametapes on clothes but now the day care staff have to do it and don’t always get time. We were unclear why this had happened. There is a clear margin for error if staff don’t have time to do this. There is also a problem that different staff put laundry in the washing machine and put it on the wrong setting, therefore risking ruin to clothes being washed. Staff said this may be a literacy issue for some staff but lots of clothes do get shrunk at times. If this happens replacements are paid for out of the home’s budget. Staff said they have to ‘juggle’ sewing on of name-tapes and sometimes do it in key time whilst chatting with people. None of this is satisfactory for people living at the home. We recommend the manager puts in place a better system of managing peoples laundry so that clothing doesn’t get lost or damaged. We suggest that poor management of laundry is disrespectful to people living at the home as it’s not seen as a priority and therefore lost or damaged clothes don’t matter. To the question ‘Is the home fresh and clean’, everyone who filled in the survey said ‘always’. Comments about it included: ‘it’s all done every day’, ‘yes I think so’ and: ‘yes they do it lovely’. Cleaning staff were seen about the home and all areas were very clean and fresh smelling. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 24 St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. Low numbers of permanent staff and reliance on agency staff affects the quality of life for people living in the home. Progress with National Vocational Qualification in Care training makes sure people are looked after well. Adequate recruitment processes make sure people living at the home are protected from risk. People living at the home benefit from having a well-trained group of permanent staff that are able to meet their needs. EVIDENCE: We asked people if the staff are available when they need them. People told us: ‘There is enough staff and they usually come quite quickly when I ring my buzzer depending on what they’re doing’, ‘Yes. We had a meeting the other week and out of a room full of people only one person said s/he thought there wasn’t enough’, ‘They have a lot of agency staff’, ‘I think on the whole they’re very good’, St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 26 ‘I recognise a couple of them but it’s mostly different staff in and out all the time. I think there’s a lot of agency staff’, ‘They’re always run off their feet, but it’s the same as anywhere else. They cope and manage it very well here’ and: ‘I suppose there is, there’s busier times than others’. Three staff filled in our ‘Have Your Say’ survey for staff. From this answers to the question: ‘Are there enough staff to meet the individual needs of all the people who use the service?’ were mixed. One person said ‘Always’, one said ‘usually’ and one said ‘sometimes’. One staff member commented: There are enough staff allocated for each shift to meet each individual’s needs, although on some occasions the home has to rely on staff covering extra shifts or agency to cover training days, sickness and annual leave’. We had received a copy of the home’s own quality assurance survey that had been done just before our visit. From this some concerns about staffing had been raised by people living at the home: ‘There are a lot of agency staff which makes it more difficult for the regular staff’ (two similar comments also), ‘We need more permanent staff’, ‘Shortages of staff a lot of the time (five similar comments also) and: ‘Not enough staff on duty – only two in the evening’. People had also commented about the quality of their contact with agency staff: ‘Some agency staff are ok but others think we’re idiots’ and: ‘agency staff aren’t as well trained as the permanent staff’. We spoke to both individuals and a group of staff at this visit. They told us: ‘There’s not enough staff – we don’t always feel like staff – more like dogsbodies. There are only three of us on at weekends and we have to fit in key time as well’. We looked at the Annual Quality Assurance Assessment (AQAA) that the manager had filled in and sent to us before this visit. In it she stated: ‘We have currently devised new and improved staff duty rotas which incorporate all new staff and maximises the time allocated. These rotas also hold details about keytime and activities’. However, we looked at a sample of staff rotas covering the two-week period before we visited. It was difficult to see a clear pattern of hours covered, as there were lots of alterations to them. We worked out that in the first week an average of three staff were on each morning until at least lunchtime. In the afternoons and evenings the average was two but sometimes three depending on what time staff went off duty. From looking at the rotas we couldn’t clearly see how key time and activities were being covered. We also found that there were sometimes less staff on duty at weekends. We discussed our findings with the manager who said the hours are worked out according to the number the home is allowed and that cover is always provided. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 27 We saw from the home’s development plan that the aim is for all domestic staff and cooks to do their National Vocational Qualification in Care Level 2 training this year (they already have Level 1). From the AQAA the manager had written that: ‘The majority of our permanent care staff apart from the recent recruitment have undertaken NVQ level 2. All new staff will be required to do so as soon as possible’. However, the AQAA also showed that out of fifteen care staff only five have gained the qualification although three more are working towards getting it. The home is therefore just reaching the recommended 50 minimum number of care staff trained to NVQ. Some of the staff we spoke with said they hadn’t done their NVQ training as there was a problem with getting regular assessors to help train them. All said they wanted to do it. We had recently done an inspection of the City Council’s Human resources (or Personnel) department. This was to check that safe recruitment processes are in place for care services staff. We looked at a sample of St Peter’s staff records and found them to be satisfactory. A separate report is being sent to the Director of Adult Community Care about our findings at that inspection. From staff files looked at in the home we saw that each staff member has a clear photo and proof of identity together with evidence of Criminal Records Bureau checks. The records also include regular agency staff together with details of their training. This is good practice. We looked at staff training records. A requirement made at the last visit about dementia care training was met. On the first day of our visit the manager and some staff were at the recent dementia care training course that has been put on for all local authority care staff. The course, which has been run over a number of different dates in August, had also had an effect on staff rotas and availability. Fifteen care staff and all the management team had done the course or were booked on the remaining dates. From the AQAA the manager had written that: ‘New staff who were appointed were given a full induction in a structured training environment but within the home. A trainer from the training department and myself facilitated this and it was very successful’. From the staff surveys we received two staff confirmed that they ‘mostly’ received an induction that covered everything they needed to know although one person stated it ‘partly’ covered her/his needs. One person wrote: ‘I started working at St Peter’s on a temporary basis although I have worked in other homes. I was more than satisfied with my induction. Anything I was unsure about I would always ask’. Staff told us that they found the dementia training ‘really good’. They said they had also done other training such as Control of Substances Hazardous to Health, moving and handling and fire safety. All those we spoke with told us they had done safeguarding adults from abuse training or were doing it shortly. This had also been a requirement at the last visit. We saw that a St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 28 further training session in the subject was being held on 2 September ’08. Some staff told us they would like to do first aid training as they had never done it. Staff training records we looked at showed the range of training each person had done. They confirmed they have regular staff meetings where training is discussed. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 29 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): 32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and experienced manager, who understands peoples needs, makes sure they are well cared for. Suitable ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Peoples finances are well managed that makes sure they are protected from financial abuse. People get consistent care from a staff team that have opportunities to regularly reflect on their working practices. Satisfactory management of health and safety in the home makes sure people are kept safe. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 30 EVIDENCE: The manager of the home Ms Lorraine Knight, is trained and experienced having been a manager at different homes for a number of years. She was welcoming, open to the inspection process and willing to be advised on actions to take to improve the home further. Staff we spoke with said they felt very well supported by Ms Knight and the management team. The home had had its annual quality assurance survey done in July ’08. The survey is done by an independent organisation and we had been sent a copy of the report. This year an ‘action points’ page has been added to make it easier for managers to pick up comments that need further examination or action. This can be added to the existing development plan for the home. Each part of the report is linked to the National Minimum Standards and scores are given out of a 100. Five out of seven areas scored over 80 with two areas, ‘choice of home’ and ‘complaints’ scoring lower at 79 and 78 each. We did a random check of peoples money held for them at the home. From this the amounts held tallied against the cash sheets and all were correct. A new sheet put in place to safeguard peoples finances if staff take money to buy things for them, was seen that makes sure peoples money is kept safe. Receipts are attached to cash sheets and balances are checked weekly by management staff. We looked at staff supervision records. Each staff member should have one to one supervision sessions with a member of the management team at least six times a year. Further, each staff member has a yearly appraisal – which is an opportunity to look back and review how the work has been done and pick up issues that need further attention. From the sample of records looked at it was clear that enough supervision and yearly appraisal sessions had been held. This will help staff to reach the number as set out in the Council’s own policy on supervision and be of greater support to them in their daily work. Regular checks of health and safety issues and equipment were recorded. These include fire safety, water temperatures and Legionnella testing among others. All electrical equipment is tested to make sure it’s safe for people to use. Staff had all done fire safety training and fire drills had been held regularly. A new fire safety risk assessment was seen that was done in June ’08. Comments seen in the home’s own quality assurance survey report show satisfaction with all the above: ‘The managers are easy to talk to and you can go to them with any problems’ (3 similar comments) St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 31 ‘Good managers’ ‘Staff are supervised well’ (2 similar comments) ‘It feels safe and secure here’ (2 similar comments) and: ‘Health and Safety is good’. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 32 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 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 3 3 X X 3 X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 3 X 3 St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 33 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 OP9 Regulation 13(2) Requirement Medication that has a short life must be dated when opened and discarded when date is reached. The registered provider must take action to make sure a decision is reached about nonprescribed, ‘over the counter’ medications When medications such as creams and gels are prescribed the Medication Administration Sheets must be filled and signed. This will make sure people are kept safe. Rotas must be managed in such 01/11/08 a way as to make sure the same numbers of staff are on duty each day, including weekends. A review of staffing levels must be done and results sent to the Commission. Regular agency staff must be treated in the same way as permanent staff i.e. training opportunities and supervision must be offered to them. St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 34 Timescale for action 22/11/08 2. OP27 !8(1)(a) This will make sure people get a consistent standard of care from staff that they know and trust. 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. 2. Refer to Standard OP9 OP16 Good Practice Recommendations People that self-medicate should sign when a new supply of medication is given to them. Any concern or complaint should be properly recorded in the file kept for the purpose. This will make sure that people can be sure their concerns will be treated seriously and quick actions taken on their behalf. A survey of peoples voting wishes should be done and action taken to make sure their preferred method is in place. This will make sure people are able to take part in civic processes. A better system of making sure clothing is marked for people should be put in place. This will make sure people can keep track of their clothes. 3. OP17 4. OP26 St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Peter`s DS0000035285.V367544.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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