Care Home: St Petroc`s Care Home

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What the care home does well People were all complimentary about the staff. The Expert by Experience observed that there were many positive comments from the staff, they told us, ‘The staff are very willing to help, they are lovely and always there when you need them’ ‘This is a good Home and the staff are very good, in the night, the staff visit me two of three times depending on what I need’ and ‘ Everyone is so good, they couldn’t be kinder to me’. Surveys told us that the home ‘Care for everyone with great patience and understanding some of the residents need a lot of both but they are always given it’. Another said ‘What ever we ask for or suggest it is dealt with immediately I am glad my family found St. Petroc’s for me’. People using the service told us that they liked living at the home and that they felt that their choices were recognised. Again the Expert by Experience observed, ‘Overall the quality of care and lifestyle for people living at the Home appeared to be good, with examples of kindness and care from staff, and with opportunities for people to make choices and engage in appropriate activities encouraged, both in the Home as well as out in the community. People seemed happy with the care and attention they received and were very complimentary about many things’. The home provides a detailed Statement of Purpose/ Service User Guide and also has a web page available to ensure that any prospective person has clear information about the service provided. The care plans and documentation relating to the people using the service was well managed. Staff had sufficient information to be well informed about people’s needs, preferences and choices. People were included in reviews and updates. Meals and mealtimes appeared to be a pleasant social experience and an opportunity for people to meet. The standard and choice of food appeared to meet people’s needs. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 The home is very clean and well managed to ensure that there is a minimal risk of cross infection. The décor of the home is homely and suited to the people using the service. There is an ongoing maintenance plan to ensure the safety of people using the service. What has improved since the last inspection? There has been an ongoing maintenance of the home with new furniture and fittings being provided as needed. The home has improved the documentation relating to care plans and the manager told us that the staff have worked hard to improve them. Daily records are reflective of the care plans in use. The recruitment of staff is ongoing to ensure that any shortfalls in staffing are met. Staff training is well organised and the home has over 50% of staff with a National Vocational qualification. The menu has been developed to provide meals which people using the service have chosen and enjoy. What the care home could do better: The management of medication is generally good however the manager is recommended to ensure that hand transcribed medications are signed by two staff t ensure that there is no error in transcribing. The manager must also ensure that the site of the Controlled Drug Cupboard is reviewed to ensure it is in line with the Royal Pharmaceutical Guidelines. The manager is recommended to continue with the ongoing maintenance of the fabric of the home. Some areas of health and safety need to be addressed. These include the monitoring of hot water delivery and the risk assessment of tall free standing units. This is needed to be ensure the safety of people using the service. The management of communal toiletries needs review to ensure that there is no risk of cross infection from the toiletries. The manager must also ensure that the storage of dental tablets does not pose a risk of accidental ingestion.St Petroc`s Care HomeDS0000051613.V377838.R01.S.docVersion 5.2The manager is recommended to look at the use of alginate bags for washing laundry to prevent the risk of cross infection. Further review of the use of foot operated bins is also recommended to promote good hygiene practices. The management of recruitment is robust however the manager is recommended to ensure that all documentation is signed dated and appropriately completed. The management of people’s monies appears to be appropriate, however clear documentation and evidence of purchase is needed in all instances. Staff told us by surveys that sometimes staffing levels do not leave them time to spend with people using the service. They told us that they are busy and sometimes don’t get the handover of information in good time to ensure that new admissions to the home receive immediately all the care they need. Key inspection report CARE HOMES FOR OLDER PEOPLE St Petroc`s Care Home St Petrocs Care Home St Nicholas Street Bodmin Cornwall PL31 1AG Lead Inspector Gail Richardson Key Unannounced Inspection 09:30 5th October 2009 DS0000051613.V377838.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Petroc`s Care Home Address St Petrocs Care Home St Nicholas Street Bodmin Cornwall PL31 1AG 01208 76152 01208 264663 stpetrocs@stone-haven.co.uk 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) Stonehaven (Healthcare) Ltd Miss Fiona Mary Searle Care Home 30 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (30) St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of service users not to exceed a maximum of 30 Date of last inspection 6th November 2007 Brief Description of the Service: St. Petrocs Care Home is registered to provide accommodation and personal care for up to 30 older persons six of which may have dementia or three of which may have a mental disability. The home is situated in Bodmin, Cornwall benefiting from its closeness to shops, public transport and local community facilities. It is a detached house, set back from the road within large wellmaintained grounds and ample parking space provided to the front of the property. There are bedrooms on the ground and first floors with a passenger lift and stair lift provided to assist service users. Shared communal space is provided through the lounge, dining room and conservatory areas. The home has been under the ownership of Stonehaven (Healthcare) Ltd since November 2003 and the management of Fiona Searle since December 2002. Additional charges are made for chiropody, hairdressing, toiletries, newspapers, taxis and transport. Prospective residents are sent a brochure containing the home’s Statement of Purpose, Service Users’ Guide and information about Stonehaven Healthcare Ltd. The last inspection report is openly displayed in the front conservatory. The current fee scale (Correct as of the time of this report) is between £400 and £600 per week. This does not include hairdressing, chiropody and newspapers. Included in the price are all activities, outings and fish and chip suppers bought in at the home. St Petroc`s Care Home DS0000051613.V377838.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 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection, which took place over 1 day (6 hours) on the 6th October 2009 by Regulation Inspector Gail Richardson. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. As part of the inspection we used an Expert by Experience who spent 3 hours at the home, spent time talking with people and had lunch with people using the service. This provided us with an insight into what it is like to live at the home. A tour of the home took place and a selection of the bedrooms and all communal areas were seen. There were 24 people currently residing at the home all receiving personal care. The agency’s last key inspection was conducted on 6th November 2007 and since that time the home has had an Annual Service Review on. No visits to the home have been made in the interim period. We spoke to several people using the service, one visitor and five members of staff; the Registered Manager was available throughout the inspection. The home has provided CSCI with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Manager and gives details of all aspects of the home. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and their representatives, GP’s, District Nurses and Care Workers. The results of those surveys are reflected in the body of this report. Records relating to care including three care plans, two staff files, finances and health and safety records were examined. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 Page 6 for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: People were all complimentary about the staff. The Expert by Experience observed that there were many positive comments from the staff, they told us, ‘The staff are very willing to help, they are lovely and always there when you need them’ ‘This is a good Home and the staff are very good, in the night, the staff visit me two of three times depending on what I need’ and ‘ Everyone is so good, they couldn’t be kinder to me’. Surveys told us that the home ‘Care for everyone with great patience and understanding some of the residents need a lot of both but they are always given it’. Another said ‘What ever we ask for or suggest it is dealt with immediately I am glad my family found St. Petroc’s for me’. People using the service told us that they liked living at the home and that they felt that their choices were recognised. Again the Expert by Experience observed, ‘Overall the quality of care and lifestyle for people living at the Home appeared to be good, with examples of kindness and care from staff, and with opportunities for people to make choices and engage in appropriate activities encouraged, both in the Home as well as out in the community. People seemed happy with the care and attention they received and were very complimentary about many things’. The home provides a detailed Statement of Purpose/ Service User Guide and also has a web page available to ensure that any prospective person has clear information about the service provided. The care plans and documentation relating to the people using the service was well managed. Staff had sufficient information to be well informed about people’s needs, preferences and choices. People were included in reviews and updates. Meals and mealtimes appeared to be a pleasant social experience and an opportunity for people to meet. The standard and choice of food appeared to meet people’s needs. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 Page 7 The home is very clean and well managed to ensure that there is a minimal risk of cross infection. The décor of the home is homely and suited to the people using the service. There is an ongoing maintenance plan to ensure the safety of people using the service. What has improved since the last inspection? What they could do better: The management of medication is generally good however the manager is recommended to ensure that hand transcribed medications are signed by two staff t ensure that there is no error in transcribing. The manager must also ensure that the site of the Controlled Drug Cupboard is reviewed to ensure it is in line with the Royal Pharmaceutical Guidelines. The manager is recommended to continue with the ongoing maintenance of the fabric of the home. Some areas of health and safety need to be addressed. These include the monitoring of hot water delivery and the risk assessment of tall free standing units. This is needed to be ensure the safety of people using the service. The management of communal toiletries needs review to ensure that there is no risk of cross infection from the toiletries. The manager must also ensure that the storage of dental tablets does not pose a risk of accidental ingestion. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.2 Page 8 The manager is recommended to look at the use of alginate bags for washing laundry to prevent the risk of cross infection. Further review of the use of foot operated bins is also recommended to promote good hygiene practices. The management of recruitment is robust however the manager is recommended to ensure that all documentation is signed dated and appropriately completed. The management of people’s monies appears to be appropriate, however clear documentation and evidence of purchase is needed in all instances. Staff told us by surveys that sometimes staffing levels do not leave them time to spend with people using the service. They told us that they are busy and sometimes don’t get the handover of information in good time to ensure that new admissions to the home receive immediately all the care they need. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 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 Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people who are thinking about using the service, and/or their representatives, have the information they need to enable them to make an informed decision about moving to the home. The home has assessment procedures in place to ensure that it only offers a service to people whose needs can be met by the home and people are given the opportunity to test-drive the home prior to admission. EVIDENCE: The home provides a Statement of Purpose and Service User Guide to ensure that people considering using the service have sufficient information prior to St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 11 admission, to make an informed decision. This document has just been updated and is very detailed. We examined two pre admission assessments and all contained evidence that people thinking about using the service had been appropriately assessed by the home before a placement was offered. This document is used to provide information to staff in the time before the care plan is completed. People are able to test run the home and the manager explained that the home have families days when people can visit, eat and chat with people currently using the service. People told us that they or their families had chosen the home and that they were satisfied with the choices of home and room. The Expert by Experience observed ‘I met with several people who had lived at the Home for only a few months, as well as people who had lived there for several years, one person said ‘I have been here for eight years and I am very happy and settled now’. I met one person who had come to spend the day at the Home with a view to moving in on a permanent basis she told me ‘ I am here for a trial day and everyone has been so good, I think I will be alright here’ Contracts were examined and were seen to contain sufficient detail of the terms and conditions of residency. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans provide sufficient detail to inform staff of changes in peoples conditions and a plan of care to meet those needs. The homes procedures for the management and administration of people’s medication appear to be well organised and safe. People are treated with dignity and respect by the staff at the home and people value the staff member’s kindness. EVIDENCE: During this inspection we examined three care plans in detail and followed the care of these people through examination of other records such as medication and contacts with health care professionals. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 13 Each of the care plans identified the persons needs and found that there was sufficient detail in the plan of care to inform staff of how to meet those needs. This was in reference to physical, psychological and social needs. The care plans were person centred and contained details of people’s preferences and choices. It was also identified that when peoples needs changed the care plan was updated to reflect those changes. The home undertakes a monthly review. Each review looks at the last months care given and includes accidents, incidents and all changes. A further weekly key worker review also takes place. These reviews include the input and agreement of the person receiving the care. A daily record is maintained and this includes any social activities and the physical and psychological status of the person. Risk assessments are undertaken for people with areas which may present a risk to the person or others at the home. The assessment then has a plan of care to support that person whilst supporting their independence safely. Each person is registered with a local GP. Care plans contained evidence that people have access to appropriate health care professionals including the District Nurse and the Parkinson’s Nurse. The home maintains detailed records relating to the persons contact with health care professionals. Care plans also contained information as to the individual’s preferences with regard to preferred times for waking, retiring to bed, dietary preferences and bathing. People who had specific needs relating to wound care had the regular input of the visiting District Nurse and records were maintained at the home. Throughout the day we were able to observe staff interactions with the people living at the home. These were noted to be kind and respectful. People looked clean and well attired. People told us that staff were always kind and thoughtful. People told us, ‘Staff look after me very well, they are very good to me, they come anytime when you buzz day or night’ and ‘The staff are all very kind and considerate’. A visiting health professional survey told us that ‘ Staff always interact with people very well’. We and the Expert by Experience had noted’ ‘Two people who I had visited in their rooms. Neither of the people had a call bell within easy reach; one didn’t have a drink in her room. As the rooms of the Home were fairly spread out, it was possible that people could need help and would unable to call for it and most of the bedroom doors were pulled to as they did not have fire safety closure devices fitted’ . St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 14 The home does not employ any male staff but the manager explained that the choice of gender would be addressed if it occurred. The medication systems appeared to be well organised and managed to ensure safe practice was maintained. The home uses a pre packed blister pack system. People using the service have the option to self medicate should they want to and risk assessments are in place to ensure safe practice is maintained. The manager is recommended to ensure that all hand transcribed medications are signed by two staff to ensure that there is no risk of error in transcribing. The manager is also required to ensure that the Controlled Drugs Cupboard is recited to ensure it is on a fixed plate or wall. This is in line with the Royal Pharmaceutical Guidelines. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people are given the opportunity for social stimulation and community contact. People are offered a wholesome and varied diet and the home has created a pleasant dining environment. EVIDENCE: People told us that there are sufficient activities provided by the home. They told us that they could choose to join in or not. The home provides in house entertainment which includes visiting musicians and trips out shopping or sight seeing. People told us that the hairdresser and Chiropodist visit the home. A local clergy attends the home to attend to someones specific spiritual needs. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 16 The home does not have a designated activity coordinator and activities are managed by the registered manager and a senior carer. Planned activities are advertised on a notice board in the main hallway. The Expert by Experience observed, ‘The day for people living at the home appeared to have some flexibility of routine, and people told me that they were able to get up late or go to bed early if they wanted to’. One person said ‘ I like to go to bed early as I love to be able to stretch out and my bed is lovely and comfortable, I sleep a bit during the evening and then wake up and watch TV a bit ’ Another person told me ‘I love to go to bed when I feel ready and I do go early most nights’ Another person said ‘I get up when I want and some mornings; I do get up a bit later’ Care plans gave some indications into peoples preferences but most people were able to say what they liked and wanted to do. Daily records indicate that people have a variety of pastimes and are supported to maintain these. People also told us that they had made friendships in the home and visited each other there. The Expert by Experience observed, ‘There was a Notice Board in the hall -way, which displayed details and notices of special events and meetings e.g. The date of the next residents meeting, details of the Church Service, shopping trip to local supermarket, a visit from the Chiropodist. There was also a list which gave details of activities available throughout the week e.g. quizzes, card games, bingo session, ‘Who wants to be a Millionaire’ game. As I met and spoke with people in the Home, they were happy with the range and frequency of activities provided. The trips to the local supermarket seemed to be especially popular, also the bingo and quizzes. One person commented on the visit by the minister from the local church, saying, ‘I really appreciate being able to take Communion here and having the minister from my church coming to the Home ‘ Several people told me how much they had enjoyed a recent’ Fish and Chip supper’ that had been organised. Fish and chips had been brought into the home instead of the normal tea-time menu and it seemed to have proved very popular. People in the Home told me that they enjoyed having the opportunity to engage in individual activities such as reading and watching TV in their rooms, people had personal items of furniture and photographs etc. in their bedrooms. One person told me , ‘I am able to spend most days outside in my wheelchair, St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 17 I am used to being outside and I enjoy the fresh air, I go home for the day every two weeks to see my family, I go in the St John’s Ambulance bus’. One person I met had been out for the morning to a local Age Concern Club in Bodmin’ The home has regular residents meetings and these are used as an opportunity to discuss activity preferences. The Expert by Experience told us. ‘The people I met with all appeared satisfied with the level of support provided by the staff within the Home to enable them to maintain interests in things important to them. People told me that the residents meting were good and that their requests were listened to’. Visitors were seen throughout the day of inspection and people using the service confirmed that they are always made welcome. We spoke with people about the quality and choice of meals at the home. Everybody spoken with was complementary about the standard of food. Menus are set by the cook and the input of people using the service is sought at residents meetings. People can eat in either the dining room or have meals delivered to their rooms. The Expert by Experience observed, ‘The notice board in the hallway of the Home had a copy of the variety of breakfast menu items that were available each day, there was a good selection. The lunchtime menu for the day, was also on the board, the choice available, was cottage pie and vegetables, bacon, or salads, and pudding, and was pears with custard. The times of meals were listed, along with the times that drinks and snacks were provided throughout the day. The last meal of the day was 5pm and people told me that they could choose what they wanted to eat at this time and that staff would come around after lunch to take their order for what they wanted for tea. People told me that they were offered a milk drink about 8pm in the evening, along with biscuits’. ‘The Dining Room was arranged well, with space to move around, it was adjacent to the main kitchen. The tables were set, with linen table cloths and napkins, place mats and cutlery. Jugs of water and condiments, were on the tables and also, small colourful silk flower arrangements. Those people, who found eating difficult, were given tabards to protect their clothes. The meal was brought from the kitchen by the staff, to people seated at the tables, it was ready plated. Where people found eating difficult, the plates had St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 18 plate guards on to help them get food onto their cutlery easier. Most people were independent and able to feed themselves, but where help was needed staff were helpful in a sensitive and kindly way. Some people did not come to the dining room, but preferred to stay in their room for lunch. The food looked appetising, was well cooked and tasty. Everyone I spoke with about the food, appeared to be satisfied one person told me ‘the food is always very good, with good variety and choice, it’s like home cooking’ another said ‘the food is very good and the choice is good’ another said ‘I especially like it when we have fish on the menu’, another said ‘you can really have what you like it’s good’. ‘I saw the Deputy Manager going round with the menu, asking people what they wanted for tea, there were four options to choose from, one person who didn’t want anything from the choices offered, was able to choose something else and this did not appear to be a problem’. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and staff are confident in the management of the home to address any concerns The home takes appropriate steps to reduce the risk of harm or abuse to people living at the home. EVIDENCE: The home displays a complaints procedure within the home and a copy is available in the Statement of Purpose /Service User Guide. The home has not received any complaints since the last key inspection. Staff confirmed that they would feel confident in raising concerns, if they had any, with the manager. People using the service who spoke with us, all told us that they would talk with the manager and had confidence that the appropriate action would be taken. The home has a range of policies and procedures available to staff to ensure that people are protected from the risk of harm or abuse. Not all staff has received appropriate training in abuse awareness as an individual training subject; however abuse awareness is included in the Common Induction Standards as part of the homes induction program. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 20 Some complaints policies in use were seen to contain previous contact details for the previous regulatory body. It was discussed with the manager that the old policies should be replaced to provide clear directions. All new staff recruited to the home has a Criminal Record Bureau Check (CRB) and Protection of Vulnerable Adults (POVA) check prior to starting work. The home has registered all people using the service to vote in any forthcoming electoral process. Currently all people using the service are able to manage their affairs independently or have family/ representative support. The home has access to independent advocacy support should this be needed. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, homely and pleasant environment for people to live in. People are supported to decorate and furnish the room to their personal tastes. Some areas require some development to ensure the safety of people using the service. EVIDENCE: The home is a converted building which comprises of an older converted building and the addition of a newer annex. The home has single and double bedrooms over two floors accessible by stair lift and shaft lift. The lounge, conservatory and dining rooms are on the ground floor. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 22 There are assisted bathrooms available on both floors. The home is a No Smoking home. A wide selection of bedrooms and all communal areas were viewed during this inspection. It was apparent that people are encouraged to personalise their rooms and small pieces of personal furniture were evident. Most rooms have en suite facilities. One person using the service told us ‘St Petroc’s is a well maintained residence catering for all personal needs. Residents are able to have their own furnishings to make rooms pleasant and comfortable’. The standard of furnishings, fixtures and decor in bedrooms and en suites were of a very good standard. The home is a grade 2 listed building and has an ongoing maintenance plan. Some walls were observed to be damaged and in need of repair and the manager confirmed that refurbishment plans are underway. The Expert by Experience observed ‘My first impression of the Home was that it was a bright cheerful place, the main entrance was through a Conservatory, where there were easy chairs set out, where people could sit together and look out over the front car park and garden area of the Home. There was a cold water drink dispenser in the entrance hall, where people were able to help themselves to a drink as they needed it. The communal areas of the Home were equally bright and homely albeit that the decor was a little dated ’. ‘In the main the rooms were fresh and clean smelling, with a strong smell of ‘Home Cooking ‘evident in the background. The Home appeared to be running smoothly and people looked cared for, they were wearing appropriate clothing and footwear and had hair that looked well groomed’. It was observed that freestanding wardrobes had not been secured to the wall, this may create a tip hazard, this was discussed with the manager who will organise them to be secured as a matter of priority. There is a range of bathrooms and toilet facilities with equipment for bathing either assisted or unassisted available to support people with personal hygiene. Some hot water outlets are fitted with thermostats to ensure that they do not exceed the Health & Safety Executive recommended upper limits. Outlets checked at this inspection were noted to be hot and in excess of the outer limits. One bathroom was noted to be very hot and we were told was no longer in use. The manager confirmed the next day that the taps had been disabled to ensure the safety of people using the service. The manager states that hand sinks which were also identified as being very hot will be audited and the thermostatic valves adjusted or appropriate signage put in place to indicate to people that the water is hot. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 23 It was observed that in two bathrooms there was a collection of communal toiletries such as shampoo and body wash. This practice is recommended to be reviewed as this may create a risk of cross infection. Specialist equipment was seen where there was an assessed need and this included pressure relieving equipment and wheelchairs.. The home takes some steps to reduce the risk of the spread of infection. Liquid soap and paper towels are provided in some areas and staff have access to a good supply of disposable gloves and aprons. It was observed that not all areas have bins which were foot operated; this is recommended to reduce the risk of cross infection. The home employs one domestic staff over 25 hours each week. The home appeared to have a very good standard of hygiene and was fresh smelling. People using the service told us that the home is always clean. The laundry has adequate equipment to meet people’s needs. There is a policy for staff about the management of laundry. However there did not appear to be a clear system in place to identify clean and dirty areas of the laundry. Also the home is recommended to use alginate bags for the laundering of fouled linen to ensure the safety of staff involved. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from a stable staff team who know and understand the needs of the people using the service. Staff training is provided to support staff to provide a good standard of care. EVIDENCE: People told us that there were enough staff working at the home and staff were almost always available when you needed them. One person said ‘Staff are available most of the time’. Some staff members also told us that they felt there was not always enough staff to meet peoples needs within good time. The home has undergone a change in staff and recruitment is underway. There were two care staff on shift throughout the day and they appeared to be busy at all times. The layout of the building would require that staff need time to access some areas. Staff rotas were examined and this level of staffing would appear to be consistent. One staff member told us ‘‘It is a very nice Home, I have worked here for several years, I don’t want to move and work anywhere else, and it’s very good’ St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 25 The deputy manager told us that the level of staff provided is reviewed on a daily basis and that more staff can be provided if the level of dependency increases. Staff told us by surveys that sometimes staffing levels do not leave them time to spend with people using the service. They told us that they are busy and sometimes don’t get the handover of information in good time to ensure that new admissions to the home receive immediately all the care they need. One person told us that you can ring anytime and they will come. The home has not used agency staff. All people using the service who spoke with us were complementary about the care provided and about the kindness and thoughtfulness of the staff. People told us that they felt safe and well cared for. We were informed that over 50 of staff has achieved a minimum of an NVQ Level 2 in Care. This exceeds the recommendation of the National Minimum Standards. Records confirmed that mandatory training is maintained for all staff and that further training is encouraged. The deputy manager is qualified to training in moving and handling. All staff have completed training in moving and handling and fire safety and the home has a qualified first aid staff member on each shift. Recruitment files were examined and found to be well organised and compete. The exception was noted to be one application form and declaration which was not dated when signed. It was also noted that an employment history was not reflective of part time work undertaken. These areas are recommended to be reviewed to ensure the safety of people using the service. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from effective management systems where an open and inclusive style of management is promoted. The home reviews the quality of the care provided and uses the views and findings to change care practices. Supervision of staff is ongoing to promote current best practice. The home mostly follows correct procedures to ensure the health and safety of people at the home. EVIDENCE: St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 27 There have been no changes to the management structure since the last inspection. The registered manager is Fiona Searle who is an experienced and appropriately trained manager. She has experience of caring for older people and she promotes an open, positive and inclusive style of management. Both staff and people using the service told us that she was very supportive and approachable. Annual Quality Assurance questionnaires were sent out in January 2009. The results have been collated and the views and opinions have been used to develop and change some areas of practice. People told us that they are encouraged to express their views at any time. Documents within the home are stored securely and maintain the confidentiality of people using the service. All staff is supervised at least 6 times a year to ensure that any areas of concern can be discussed and any training needs identified. The registered manager is supervised by the directors of the service. The home maintains records for all accidents. Records were examined and were found to contain appropriate action taken and any follow up action. These records are then used to inform care plan reviews. Systems for managing personal monies were examined and found to be satisfactory, with clear records maintained of all transactions and receipts retained. Only one receipt was noted to be missing and there was insufficient detail of what had been purchased. The manager will investigate this area. All monies are audited regularly to ensure a clear audit path is available. Health and Safety records are maintained to ensure the safety of people using the service. Some areas of health and safety require attention. These include there securing of free standing units which may present a tip hazard. (See Standard) The manager must ensure that the storage of dental tablets is reviewed. Risk assessments must be undertaken whenever the tablets are stored and appropriate action taken to ensure that there is no risk of accidental ingestion. St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 28 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 2 2 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 3 3 X 3 3 3 2 St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 29 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 The registered manager is required to ensure that the site of the Controlled Drugs Cupboard is in line with the Royal Pharmaceutical Guidelines. The registered manager is required to ensure that all staff application forms including the declaration of the Rehabilitation of Offenders Act are both signed and dated to ensure that a clear audit trail is available of recruitment processes. The registered manager must ensure that all hot water outlets are monitored monthly and that the temperature of the hot water delivered is within the Health and Safety upper limits. This is to ensure that there is no risk of burns to people using the service. The registered manager must ensure that the storage of all dental tablets is risk assessed and appropriate storage provided to prevent the risk of accidental ingestion. The registered manager is DS0000051613.V377838.R01.S.doc Timescale for action 27/11/09 2. OP29 19 27/11/09 3. OP38 12 15/10/09 4. OP38 12 15/11/09 5. OP38 12 15/11/09 Page 30 St Petroc`s Care Home Version 5.3 required to ensure that toiletries are not communally used and are removed from bathrooms. This is needed to prevent the risk of cross infection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations The registered manager is recommended to ensure that continuing maintenance includes the dame to the walls and fabric of the building to ensure a safe environment for people using the service. The registered manager is recommended to have foot operated bins in areas where personal care is provided to reduce any risk of cross infection. The registered manager is recommended to risk assess all freestanding units including wardrobes and take the appropriate action to reduce an risk of tip injury. The registered manager is recommended to ensure that all transactions recorded of peoples personal monies have a receipt and clear records of purchase to ensure that people know how their money has been spent. The registered manager is recommended to review the homes management of soiled laundry and consider the use of alginate bags to protect from the risk of cross infection. 2. OP38 3. OP38 4. OP35 5. OP26 St Petroc`s Care Home DS0000051613.V377838.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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