Care Home: Stainsbridge House

What the care home does well People’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. On occasions, the home has undertaken a second assessment, so that any changes in need can be looked at before the person moves into the home. People have individual care plans and regular reports are written about people’s day to day care. People’s weight is being monitored, which helps to Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.2 identify any changes that might be a cause for concern. This provides information for nutritional risk assessments and for closer monitoring of food and fluid intake, if needed. One person, for example, had been on a ‘food chart’ earlier in the year, but had been taken off the chart several months later because their weight had become stable. People generally experience a relaxed lifestyle, with the opportunity to take part in a range of therapeutic and social activities. When we were in the home, volunteers from the ‘Pets As Therapy’ charity visited with a dog, which was of interest to a number of people. A relative commented: ‘They seem to have the necessary knack of involving the residents in so many activities e.g. cake making, flower arranging and many other.’ When we asked in the surveys ‘What does the service do well’, relatives also mentioned the staff, with comments such as ‘very kind and caring’, ‘take a genuine interest in all of the residents’ and ‘welcoming and friendly to friends and relatives’. People are well supported with keeping in touch with their relatives. They can invite friends and relatives to have meals or family gatherings with them. This helps people to feel at home and provides them with a sense of security. People are offered a varied menu. Mealtimes are planned in a way which takes account of people’s individual needs and helps to make the meals enjoyable. The meals that we observed were unhurried and people received individual attention from staff. People in the home are dependent on others to raise any concerns on their behalf. There are procedures in place that help with this. The home’s recruitment procedure helps to ensure that people are protected from unsuitable staff. People benefit from a home’s manager who has brought stability and overseen a number of developments during the last year. What has improved since the last inspection? People are better protected following changes that have been made in the home’s medication procedures and practices. One of the healthcare professionals who completed a survey commented, ‘People generally look more cared for’. Other people mentioned the environment, for example ‘Vast improvement to décor’ and ‘Pleasant environment with adequate areas for privacy’. Refurbishment of accommodation in the original property was carried out while the new extension was being built. People have benefited from improved facilities, such as en-suite areas in their bedrooms and a new lift. Additional bathrooms, W.C.s and communal space have been brought into use. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.2 Externally, a patio area has been built and a new garden is being established. There were further plans for the garden, including some new features. Information, for example about the home’s complaints procedures, social activities and news for relatives, is better displayed within the home. A new reception area has been created in the front hall, with a receptionist employed to assist visitors and to help out with some of the administrative tasks. The menus have been reviewed and a vegetarian option introduced to give more variety. A dedicated activities organiser has been employed to co-ordinate the home’s activities programme and provide more specialist support for people. The home has also recently employed a Registered Mental Nurse in the role of parttime care and training co-ordinator to provide support for the care team and to oversee staff training. Staff supervision is taking place in more planned and consistent way. What the care home could do better: At the last inspection we looked at how people at the home were being protected from harm and from suffering abuse. We had made a requirement about having appropriate risk assessments and behaviour management strategies in place and keeping these under review. There continues to be a significant number of incidents between people at the home which have been referred under the local procedures for safeguarding adults. Other incidents have arisen and been followed up within the home. There has been some increased monitoring in relation to the incidents, which helps to identify any patterns of behaviour. However, the number of incidents involving aggression and abuse between people indicates that either the correct risk and behavioural management strategies are not in place, or they are not effective in protecting people. The home needs to do more in response to these incidents, to ensure that the risk to people is reduced. This includes looking at how well people with different needs are being accommodated within the same home environment, and whether staffing levels are sufficient. We found that the number of care staff on duty was not always being maintained at the level that we expected. We will be asking the home to send us an improvement plan telling us how the risks to people are to managed better. Some staff members had not attended some training sessions. In their surveys, three healthcare professionals mentioned that some staff did not have adequate use of English. Their comments included ‘language barrier is sometimes a problem’ and ‘Some of the staff do not seem to have fluency in English’.Stainsbridge HouseDS0000028415.V378439.R01.S.doc Version 5.2 Sometimes staff administer PRN (‘as required’) medication to reduce people’s anxiety. Protocols for the use of this medication should be written, so that there is clear guidance for staff about people’s individual circumstances and what ‘anxiety’ means in practice. Without clear guidelines there is a risk that the medication is given inappropriately or at times when it is not effective. When we asked in the surveys ‘What could the service do better?’ three relatives mentioned the freshness of some areas. They commented ‘Smells often at weekends’, ‘The dining room and sitting room could smell fresher’, and ‘So it doesn’t smell in the main hall and dining / lounge area’. There were no unpleasant odours at the time of our visits, however in the light of these comments; this may be an area that needs further attention. Some relatives also commented on the laundry arrangements. One person mentioned that their relative in the home had ‘on occasions appeared rather unkempt, particularly due to poor laundering of her clothes’. Another person told us that their relative’s clothes were all named, although the wrong items of clothing were put in their room. We were told that action was being taken to improve the laundry service, and that there were also plans to re-fit the laundry. Key inspection report CARE HOMES FOR OLDER PEOPLE Stainsbridge House Gloucester Road Malmesbury Wiltshire SN16 0AJ Lead Inspector Malcolm Kippax Key Unannounced Inspection 4th November 2009 09:15 DS0000028415.V378439.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. Stainsbridge House DS0000028415.V378439.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 Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stainsbridge House Address Gloucester Road Malmesbury Wiltshire SN16 0AJ 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) 01666 823757 West Country Care Limited Miss Amanda Pearson Care Home 45 Category(ies) of Dementia (45) registration, with number of places Stainsbridge House DS0000028415.V378439.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 needs on admission to the home are within the following category: 2. Dementia (Code DE) The maximum number of service users that can be accommodated is 45 19th November 2008 Date of last inspection Brief Description of the Service: Stainsbridge House specialises in the care of people who have dementia. The home is situated close to the centre of Malmesbury. There are grounds at the rear of the property. Stainsbridge House is a Victorian property that has been extended and refurbished over the years. A new extension has been brought into use during the last year. This increased the number of places at the home from 24 to 45. Each person at the home has their own room with an en-suite facility. There is a weekly fee for personal care and accommodation. This fee does not include dry cleaning, chiropody, hairdressing, private phone calls and escorting services for hospital and clinic visits. Further information about Stainsbridge House is provided in a ‘Statement of Purpose. The fees are in the range of 425 pounds – 525 pounds per week. A copy of the last inspection report is available from the home. Inspection reports can also be seen on the Commission’s website at: www.cqc.org.uk Stainsbridge House DS0000028415.V378439.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 1 star. This means that people who use this service experience adequate quality outcomes. Before visiting Stainsbridge House, we asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It told us what has happened during the last year and about their plans for the future. We sent surveys to the home, so that they could be given out to the people who use the service, to staff and to healthcare professionals. The people who use the service were also given surveys which they could pass on to a relative. We had surveys back from six people who use the service, four staff members, six healthcare professionals and thirteen relatives. They told us what they thought the service did well and what it could do better. We looked at all the information that we have received about Stainsbridge House since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 4th November 2009. An ‘Expert by experience’ was also present from 9.30 am – 10.50 am. Experts by experience are members of the public who accompany us on some of our inspections. They help us to get a picture of what it is like to use a service. We made a second visit to the home on 9th November 2009 in order to complete the inspection. During our visits we met with a number of people who use the service and with some of the staff. We went around the home and looked at some records. We spoke to the home’s manager, Miss Pearson, and to Mr D. Gillespie, the managing director from West Country Care Ltd. The judgements contained in this report have been made from evidence gathered during the inspection and takes into account the views and experiences of people using the service. What the service does well: People’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. On occasions, the home has undertaken a second assessment, so that any changes in need can be looked at before the person moves into the home. People have individual care plans and regular reports are written about people’s day to day care. People’s weight is being monitored, which helps to Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.2 Page 6 identify any changes that might be a cause for concern. This provides information for nutritional risk assessments and for closer monitoring of food and fluid intake, if needed. One person, for example, had been on a ‘food chart’ earlier in the year, but had been taken off the chart several months later because their weight had become stable. People generally experience a relaxed lifestyle, with the opportunity to take part in a range of therapeutic and social activities. When we were in the home, volunteers from the ‘Pets As Therapy’ charity visited with a dog, which was of interest to a number of people. A relative commented: ‘They seem to have the necessary knack of involving the residents in so many activities e.g. cake making, flower arranging and many other.’ When we asked in the surveys ‘What does the service do well’, relatives also mentioned the staff, with comments such as ‘very kind and caring’, ‘take a genuine interest in all of the residents’ and ‘welcoming and friendly to friends and relatives’. People are well supported with keeping in touch with their relatives. They can invite friends and relatives to have meals or family gatherings with them. This helps people to feel at home and provides them with a sense of security. People are offered a varied menu. Mealtimes are planned in a way which takes account of people’s individual needs and helps to make the meals enjoyable. The meals that we observed were unhurried and people received individual attention from staff. People in the home are dependent on others to raise any concerns on their behalf. There are procedures in place that help with this. The home’s recruitment procedure helps to ensure that people are protected from unsuitable staff. People benefit from a home’s manager who has brought stability and overseen a number of developments during the last year. What has improved since the last inspection? People are better protected following changes that have been made in the home’s medication procedures and practices. One of the healthcare professionals who completed a survey commented, ‘People generally look more cared for’. Other people mentioned the environment, for example ‘Vast improvement to décor’ and ‘Pleasant environment with adequate areas for privacy’. Refurbishment of accommodation in the original property was carried out while the new extension was being built. People have benefited from improved facilities, such as en-suite areas in their bedrooms and a new lift. Additional bathrooms, W.C.s and communal space have been brought into use. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.2 Page 7 Externally, a patio area has been built and a new garden is being established. There were further plans for the garden, including some new features. Information, for example about the home’s complaints procedures, social activities and news for relatives, is better displayed within the home. A new reception area has been created in the front hall, with a receptionist employed to assist visitors and to help out with some of the administrative tasks. The menus have been reviewed and a vegetarian option introduced to give more variety. A dedicated activities organiser has been employed to co-ordinate the home’s activities programme and provide more specialist support for people. The home has also recently employed a Registered Mental Nurse in the role of parttime care and training co-ordinator to provide support for the care team and to oversee staff training. Staff supervision is taking place in more planned and consistent way. What they could do better: At the last inspection we looked at how people at the home were being protected from harm and from suffering abuse. We had made a requirement about having appropriate risk assessments and behaviour management strategies in place and keeping these under review. There continues to be a significant number of incidents between people at the home which have been referred under the local procedures for safeguarding adults. Other incidents have arisen and been followed up within the home. There has been some increased monitoring in relation to the incidents, which helps to identify any patterns of behaviour. However, the number of incidents involving aggression and abuse between people indicates that either the correct risk and behavioural management strategies are not in place, or they are not effective in protecting people. The home needs to do more in response to these incidents, to ensure that the risk to people is reduced. This includes looking at how well people with different needs are being accommodated within the same home environment, and whether staffing levels are sufficient. We found that the number of care staff on duty was not always being maintained at the level that we expected. We will be asking the home to send us an improvement plan telling us how the risks to people are to managed better. Some staff members had not attended some training sessions. In their surveys, three healthcare professionals mentioned that some staff did not have adequate use of English. Their comments included ‘language barrier is sometimes a problem’ and ‘Some of the staff do not seem to have fluency in English’. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.2 Page 8 Sometimes staff administer PRN (‘as required’) medication to reduce people’s anxiety. Protocols for the use of this medication should be written, so that there is clear guidance for staff about people’s individual circumstances and what ‘anxiety’ means in practice. Without clear guidelines there is a risk that the medication is given inappropriately or at times when it is not effective. When we asked in the surveys ‘What could the service do better?’ three relatives mentioned the freshness of some areas. They commented ‘Smells often at weekends’, ‘The dining room and sitting room could smell fresher’, and ‘So it doesn’t smell in the main hall and dining / lounge area’. There were no unpleasant odours at the time of our visits, however in the light of these comments; this may be an area that needs further attention. Some relatives also commented on the laundry arrangements. One person mentioned that their relative in the home had ‘on occasions appeared rather unkempt, particularly due to poor laundering of her clothes’. Another person told us that their relative’s clothes were all named, although the wrong items of clothing were put in their room. We were told that action was being taken to improve the laundry service, and that there were also plans to re-fit the laundry. 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. Stainsbridge House DS0000028415.V378439.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 Stainsbridge House DS0000028415.V378439.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): 3 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’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. EVIDENCE: We were told in the AQAA that the home’s manager, or a senior member of her team, carried out pre-admission assessments. These could take place at a person’s own home, in hospital, or at Stainsbridge House, depending on which was the most appropriate location for the individual. It was reported that the assessment consisted of ‘collating evidence from numerous sources to fully assess the individual’s past and present physical and mental health needs and their likes, dislikes and preferences’. One improvement during the last year had been the recruitment of an experienced Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 11 Registered Mental Nurse, in the role of care and training co-ordinator, to assist with the pre-admission assessment process. During our visit to Stainsbridge House we looked at the assessment records for two people who had moved into the home since the last inspection. The assessment information covered people’s individual needs in areas such as physical support, social, communication and psychological. Risk factors were identified and one section of the assessment form was used to record the person’s feelings about the admission. On occasions, the home had undertaken a second assessment to ensure that there was good information about a person’s current needs. It is good practice to complete this further assessment, as it means that any changes in need can be looked at before the person moves into the home. It was reported in the AQAA that there were plans to develop the pre-admission process further, by completing a series of assessments which would be beneficial for some people. We were also told that there were plans to involve more than one member of staff in the pre-admission assessments. This was so that maximum information could be gathered to enable the correct judgement to be made as to whether the home could meet a person’s needs. Following assessment, a letter was sent to the person or their representative to confirm that the home would be able to meet their needs. Stainsbridge House DS0000028415.V378439.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): 7, 8, 9 and 10 People using the service mostly experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are set out in individual plans. Their health needs are generally being met, although some people should receive further support with their mental health needs, to promote their own, and other people’s, well-being. People are better protected following changes that have been made in the home’s medication procedures and practices. People’s privacy and dignity are respected by staff. EVIDENCE: In the surveys that the people at the home gave to their relatives, we asked ‘Does the care service give the support or care to your friend / relative that you expect or agreed?’ Nine of the people who completed surveys responded ‘Always’ and four responded ‘Usually’. We also asked ‘Do you feel that the Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 13 care service meets the needs of your friend/relative?’ To this question, four people responded ‘Always’ and nine people ‘Usually’. During our visit to the home we saw that information about people’s care was being recorded on computer, using a software programme that had been designed for the purpose. We looked at examples of these records, which included individual care plans for the people who use the service. We looked at four people’s care plans and other records were seen when following up particular aspects of people’s care. Each care plan consisted of a number of sections, which covered areas such as mobility, personal care, and health. Within these areas, the care plans focussed on people’s physical and care needs, such as the support needed with settling at night, with washing and dressing, at mealtimes, and with managing diabetes. Some of the care plans also highlighted matters such as relationships, communication, and expressing emotions, which helped to ensure that staff would be aware of people’s individual circumstances in these areas. Overall, we thought that the areas covered in the care plans showed an individual approach which reflected people’s different needs. There were ‘progress of care’ sections for recording on-going information which was relevant to the care plans. Entries in these sections were being made at least monthly. People’s weight was being monitored, which helped to identify any changes that might be a cause for concern. This provided information for nutritional risk assessments and for closer monitoring of food and fluid intake if needed. We read in one person’s records that they had been on a ‘food chart’ earlier in the year, but had been taken off the chart several months later because their weight had become stable. Other assessments were being undertaken, for example in relation to mobility and to the risk of falling. The home had one portable hoist, which we saw being used during our visits. This hoist needed to be used in different areas of home and taken by lift to the upper floors. The need for a second hoist should be kept under review. Records were kept of people’s appointments with GPs, district nurses, and other health care professionals. We saw that regular entries were being made in relation to people’s care and welfare. Miss Pearson said that nobody had any pressure ulcers at the time of our visit. When we asked in the surveys ‘What does the service do well?’ one person commented: ‘They arrange haircutting, chiropody, doctors’ visits’. Two of the healthcare professionals who completed surveys commented on changes that they had noticed, for the better: ‘Care generally has improved. Not afraid or worried about advice, will ring to clarify’ and ‘Patients generally look more cared for’. The healthcare professionals also mentioned areas that could be improved, such as having a better understanding of continence supplies. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 14 People at the home received support with the safekeeping and administration of their medication. At the last inspection we had found shortcomings in the arrangements being made for medication, which meant that people at the home were not always well protected. We looked at the medication arrangements again during this inspection. The room which was being used for the storage of medication had been made larger, so that it was a better space to work in. There was a cupboard for the safekeeping of controlled drugs, although we were told that these were not being administered at the time of our visits. Details of controlled drugs previously administered had been recorded in an appropriate book. There was a refrigerator for the storage of certain medicines. The temperature was being checked and recorded regularly to ensure that the refrigerator was working correctly. We examined some of the recent records for the administration of medication. These were being consistently completed. The requirement that we had made at the last inspection concerning the recording of medication was being met. A number of people at the home were being prescribed drugs for use on a P.R.N (‘as required’) basis. These included drugs which were classified as minor tranquilizers and had a relatively high addictive potential. The staff member who showed us the medication said that people’s care plans included guidance about for staff concerning their administration. We looked at three people’s care plans which stated that the medication was to be administered when the person ‘reports anxiety or demonstrates symptoms or anxiety’. We talked to Miss Pearson about producing protocols for the use of P.R.N. medication, which would provide information about people’s individual circumstances and what ‘anxiety’ meant in practice. Some of the people who were being prescribed P.R.N. medication had care plans and risk assessments in relation to their mental health and behaviour. We have received notifications from the home and read in people’s records about incidents that have arisen in connection with their mental health and behaviour. The frequency and type of incidents indicated that further support was needed in this area and that the arrangements within the home should be reviewed. We have reported on this under the ‘Complaints and Protection’ section. Several people who completed surveys made comments about how staff approached their caring duties. The comments of the people who live at the home and those of their relatives included: ‘The staff are all very caring’; ‘They are kind and caring and treat my mum with the utmost respect at all times’; and ‘The staff care about all of the residents. I often watch them and am amazed at their patience and kindness’. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 15 The home kept a file of ‘thank you’ cards and records of compliments made. We read for example that a family member had been particularly appreciative of the home’s attention to detail by supporting their relative with the necklaces and brooches that they liked to wear. During our visit we observed several interactions between staff and the people who use the service. At mealtimes, we saw people being supported in a friendly and respectful way. People’s individual accommodation was provided in single rooms with en-suite facilities, which made it easier for staff to provide personal care in private. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 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 generally experience a relaxed lifestyle in the home, with the opportunity to be involved in a range of therapeutic and social activities. People are well supported with keeping in touch with their relatives. People are offered a varied menu. Mealtimes are planned in a way which takes account of people’s individual needs and helps to make the meals enjoyable. EVIDENCE: Information was displayed on notice boards in the home about the regular activities and one-off events that were taking place. Group activites were being held during the week using the communal rooms. These included musical entertainments, art and crafts sessions, and other therapeutic type activities. Two activities organisers were employed and co-ordinating the home’s activities programme. It was reported in the AQAA that there had been an increase in the overall number of activity hours. After our visits we received Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 17 further information from the home about the arrangements being made for activities. We were told that there had been 127 activity hours during the four weeks prior to the inspection. There were plans to recruit a third person to cover one of the activities organiser’s maternity leave, with a view to that person remaining in post. We saw activities taking place during our visits. Two volunteers from the ‘Pets As Therapy’ charity visited with a dog, which was of interest to several people. The activities organiser led another activity preparing for bonfire night, which included creating a ‘guy’. In one of the lounges, the decorations were still up from a Halloween party, which we were told had been very successful. One relative commented in their survey: ‘They seem to have the necessary knack of involving the residents in so many activities e.g. cake making, flower arranging and many other’. Another commented: ‘Some of the residents may benefit from a few more structured activities, but I understand the difficulties in doing this with so many residents unable to participate’. The ‘Expert by experience’ commented that people may be stimulated by ‘a few seated exercises such as passing balloons to each other’. In response to the Expert by experience’s comment, we have received the following information from the home: ‘We place most emphasis on ‘meaningful occupation’ and ‘activities of daily living’ which include helping to lay tables, fold linen, and prepare the daily vegetables etc. Nonetheless, we do have impromptu exercise sessions and passing an object is one of them (we use a foam ball)’. We were told in the AQAA that the activities organiser conducted one to one activities with people. Each person had an ‘activities profile’, which included an account of their likes/dislikes, history, family, hobbies and past interests. It was reported that people were offered the help and support that was needed to follow faiths and beliefs of their choice. This included accompanying people to a local church or other place of worship. Details of people’s family backgrounds and significant relationships were recorded in their personal records. In their surveys, some relatives mentioned that they visited the home regularly. One commented: ‘Very welcoming and friendly to friends and relatives’. We saw information displayed in the home which would be of interest to relatives. This included invitations to have meals or family gatherings in the home. It is very positive to involve friends and relatives in this way, as it helps people to feel at home and provides them with a sense of security. There was a small lounge near to the reception area and front hall, which we saw being used by the people who live at the home and their visitors. This was a quiet area that provided a more private space than the larger and busier communal rooms. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 18 A room opposite one of the main lounges had been fitted out as a hairdressing salon. During our visits we observed meals being taken in the dining room. Some people were having breakfast when we arrived at the home on 4th November. Staff were on hand to provide assistance and to ask people about their breakfast choices. People were having porridge or cereals, followed by toast and different spreads. One person was using lactose-free milk, which the chef later told us was part of their special diet. We were told that cooked breakfasts were available. A member of staff said that people were able to get up when they wished and that breakfast could be served anytime between about 8am and 11am. It was later reported to us that there were no restrictions on mealtimes, so that although most breakfasts were served between 8am and 11am, this was not always the case and if somebody wanted breakfast at lunchtime then it could be provided. People sat at small tables for breakfast and lunch, which looked like a homely and individual arrangement. People were prompted and encouraged in a sensitive way to eat their meals, and were offered second helpings. We met with the chef who told us that she wrote the menus. She was aware of people’s individual likes and dislikes and there were cards in the kitchen which included this information. The chef confirmed that she could meet the dietary needs of people, which included lactose intolerance and diabetes. We were told that one person had their food blended and the chef explained how this was prepared and presented. The menus that we saw looked varied and alternatives were available. The menus included a vegetarian alternative, which we were told in the AQAA was a recent development to provide greater choice. Stainsbridge House DS0000028415.V378439.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): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s complaints are being acted on. Incidents involving abuse are followed up, although some people continue to be at risk of harm and to be adversely affected by the behaviour of others. EVIDENCE: A complaints procedure was displayed in the home, with up to date details of who to contact with any concerns. Of the thirteen relatives who completed surveys, nine people confirmed that they knew how to make a complaint if they needed to. When we asked ‘Has the care service responded appropriately if you or the person using the service has raised any concerns?’ six relatives responded ‘Always’ and seven ‘Usually’. When we asked the healthcare professionals a similar question, one responded ‘Always’ and three ‘Usually’. Staff members told us in their surveys that they knew what to do if somebody had concerns about the home. We were told in the AQAA that the home had received three complaints during the last 12 months and that these had all been resolved within 28 days. We looked at the home’s records of complaints, which showed how the complaints had been investigated and that the complainants had received written responses about the outcomes. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 20 There was a whistle blowing policy. We were given information in the AQAA about a range of procedures that were in place to ensure that people were protected from ham. These included for example, procedures for staff recruitment and risk assessments in relation to the use of bedrails. It was reported in the AQAA that the manager had attended training on the ‘Deprivation of Liberty Safeguards’ and that the relevant information had been passed on to staff via staff meetings and training sessions. Abuse awareness was included in the home’s programme of mandatory training for staff. The home had copies of the local authority’s procedures for safeguarding vulnerable adults, and the ‘No Secrets’ booklet, which summarised the procedures. There was also a procedure for the reporting of notifications and incidents that needed to be referred to other agencies. We reported at the last inspection that we had been notified of a number of incidents between people who live at the home, which the home had referred for investigation under the local procedures for safeguarding vulnerable adults. These had been discussed at the time with Miss Pearson. We had also looked at the arrangements being made to prevent people at the home from being harmed or suffering abuse. We had made a requirement concerning the need to ensure that appropriate risk assessments and behaviour management strategies were in place and kept under review. During the last year, we have continued to receive notifications concerning incidents that have arisen between the people who live at the home. We were told in the AQAA that there had been nineteen safeguarding adults referrals during the last twelve months, and six safeguarding adults investigations. The referrals related to various incidents in which people had been harmed, or were at risk, because of the actions and behaviour of other people. Some allegations had been substantiated. A number of other incidents had also arisen which were followed up within the home. During our visits we saw that information had been recorded in people’s care records about their behaviour and the risk that this posed to other people. One person, for example had a care plan for ‘Expresses behaviour which challenges’ and another which related to inappropriate sexual behaviour. Another person had a care plan in relation to ‘… responding to another resident resulting in a VA (Vulnerable Adults) referral’. We read other records which showed that the risk of people being harmed was being identified and incidents recorded. Monitoring charts had been used following some of the safeguarding referrals during the last year. These helped to give information about the events before and after an incident which could then be reviewed, for example to help identify any patterns of behaviour. Assessments had been undertaken in relation to individuals’ behaviours, and some guidance produced for staff about Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 21 the action they could take. This included for example, trying to reduce the person’s anxiety, administering PRN medication and encouraging the person to move to another location. However, the number of incidents involving aggression and abuse between people indicated that either the correct risk and behavioural management strategies were not in place, or they were not effective. We talked to Miss Pearson and Mr Gillespie about the arrangements being made for protecting people and for meeting the needs of people with ‘behaviour which challenges’ within the same home environment. We read in the home’s Statement of Purpose that ‘individuals who exhibit persistent physical aggression that that endangers other residents or staff’ cannot be accommodated. We also read in the pre-admission assessment records of occasions when people were admitted who had been physically aggressive. Although this aggression may not have been ‘persistent’, it highlighted the need for the home to have very effective systems in place for protecting people who may be at risk as a result of such behaviour. We talked to Miss Pearson and Mr Gillespie about how people with different needs were being accommodated within the same home environment, and whether the current staffing levels are sufficient. We found that the number of care staff on duty was not always being maintained at the level that we expected. See ‘Staffing’ section of this report. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 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 have accommodation which meets their needs. The environment continues to be enhanced through refurbishment and the provision of new facilities. EVIDENCE: Stainsbridge House is situated in a residential area close to the centre of Malmesbury. There were grounds at the rear of the home, and a parking area close to the front door. During the last year the number of places at the home has increased from 24 to 45. This has come about following the completion of a new extension. Refurbishment of accommodation in the original property was also carried out while the new extension was being built. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 23 People have benefited from improved facilities, such as en-suite areas in their bedrooms and a new lift. Additional bathrooms, W.C.s and communal space have been brought into use. A new reception area has been created in the front hall. Externally, a patio area has been built and a new garden was being established. There were further plans for the garden, which included some new features. The new extension and facilities were looked at during a previous visit to the home, which was made in connection with the increase in places. It was later confirmed that the new accommodation was ‘fit for purpose’ and could be brought into use. During this inspection we went around the home and were shown some of the bedrooms. We saw windows on the first floor and above that had been fitted with fastenings, which restricted the amount that they could open. This reduced the risk to people from falling out. It was reported in the AQAA that all the bedrooms had radiators with thermostatic valves fitted, so that the temperatures could be individually controlled. Controls had also been fitted to limit the temperature of the hot water, which reduces the risk of scolding. There was also a system in place for staff to check water temperatures when supporting somebody with having a bath. Staff call alarm points had been fitted throughout the accommodation. There were also pressure floor pads in people’s rooms, which would alert staff if people left their beds and they needed assistance during the night. On previous visits to the home we have talked about creating an environment that meets the needs of people with dementia. Mr Gillespie (responsible individual) has received advice in connection with this. Miss Pearson has also attended courses which have provided information in this area. Initial work included painting the toilet doors in a contrasting colour, so that they could be more easily identified. We saw that personalised photo/memory boxes had recently been fitted by several bedroom doors, so that it would be easier for individuals to identify their own rooms. During our visits, and in their surveys, people commented on the changes that had taken place in relation to the environment. Their comments included ‘Vast improvement to décor’ and ‘Pleasant environment with adequate areas for privacy’. In their surveys, we asked the people who use the service, ‘Is the home fresh and clean’. Four people responded ‘Always’ and two ‘Usually’. When we asked in the surveys ‘What could the service do better?’ people’s comments included ‘The dining room and sitting room could smell fresher’, ‘Smells often at weekends’ and ‘So it doesn’t smell in the main hall and dining / lounge area’. Overall, the accommodation that we saw looked well decorated and clean. There were no unpleasant odours at the time of our visits. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 24 There was a system in place for the disposal of clinical waste into bins that were located outside the home. We were told in the AQAA that soap, paper towel, and sanitising handwash dispensers were located in all the bedroom ensuites, bathrooms and WCs. We saw evidence of these facilities and antibacterial hand gel was also available in the front porch. There was a laundry room on the first floor. Some people commented on the laundry arrangements in response to the question ‘What could the service do better?’. Somebody mentioned that their relative in the home had ‘on occasions appeared rather unkempt, particularly due to poor laundering of her clothes’. One person just commented ‘The laundry needs improving’. Another person told us that their relative’s clothes were all named, although the wrong items of clothing were put in their relative’s room. We discussed the laundry arrangements with Mr Gillespie and Miss Pearson. They were aware of problems with the carrying out of laundry, which had had an impact on the service that people received. We were reassured that action was being taken which would result in an improved service. It was reported in the AQAA that there were also plans to re-fit the laundry Most of the comments made by the ‘Expert by experience’ concerned aspects of the environment: • ‘Inside the building I found very dull although the furnishings were very comfortable especially the easy chairs. I noticed that there were hand rails around the walls of the corridors which I found very helpful being registered as a disabled person. There were no unpleasant odours’. ‘Toilets on the ground floor were very clean and tidy’. ‘I entered the kitchen which seemed extremely busy with staff preparing luncheon. The whole area appeared to be very clean, well equipped and tidy’. ‘There was a convenient lift to the first floor. I there found bedrooms well furnished and fairly modern and seemed fit for purpose’. ‘Beds looked very comfortable and the linen was fresh and appeared to be of a good quality’. ‘Some bedrooms were decorated in a lighter shade and this certainly lightened the whole room’. ‘The bedrooms were of a good size and many had en-suite facilities which were clean and tidy’. • • • • • • Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 25 • ‘The outside garden area was delightful with trees and I saw that work was being carried out to construct a gazebo for next spring’. The ‘Expert by experience’ also commented on their first impression upon arriving at the home: • ‘I arrived at the premises by car having had some difficulty in finding the address. There was no sign outside the premises with the name ‘Stainsbridge House’ thereon. The only indication of the name was on a stone pillar at the entrance to the car park and this was carved into the stone and was hard to see due to wear and tear. It would concern me that an ambulance crew at night seeking the premises would find difficulty in seeing the entrance to the premises’. ‘Parking in the car park was most difficult there were no marked ‘disabled’ parking bays and vehicles were parked all over the car park area in a haphazard manner. It was noticed that there was building work taking place on the premises and there were a number of builder’s vehicles in the car park’. • The ‘Expert by experience’ did not give any feedback to the manager or to us before leaving the home. However, we did follow up their concern about the ‘Stainsbridge House’ name sign, which had been temporarily removed at the time of the visit. We read in the home’s Annual Development plan that there were plans to mark out spaces in the car park. Other work identified in the plan had already taken place, for example replacement of the dining room carpet and creating the reception area. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 26 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): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from more individual support which comes with higher staffing levels and the consistent deployment of staff. Procedures are in place, which help to ensure that people are supported by staff who have been safely recruited. The staff training programme should be improved by a more planned and consistent approach. EVIDENCE: It was reported in the AQQA that there were seventeen permanent care staff members, the majority of whom were part-time. This included five staff who were designated as senior carers. We were also told about new posts that had been created during the last year. These included an activities organiser and a part-time care and training co-ordinator. The manager was supernumerary and received support with administrative tasks from the home’s receptionist. Other members of the staff team were deployed to cover the cooking, cleaning and laundry duties. Before visiting the home as part of this inspection, we had discussed future staffing levels with Mr Gillespie in relation to the new extension and the Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 27 additional people who were to be accommodated. It had been agreed that staffing levels would increase in a phased way, in line with increases in the number of people at the home. We received confirmation of the intended staff levels from Mr Gillespie. This set out the different staffing levels for occupancy of 25 – 31; 32 – 36; 37 – 40; and 41 – 45. During the visit we were told that occupancy levels had been within the 25 – 31 range, taking into account people who were temporarily in hospital. The intended staffing level was five care staff working from 7.30am – 2pm, and four care staff from 2pm – 9.30pm. Three waking staff were to be deployed during the night. This took into account the layout of the home, which included accommodation over three floors. We discussed current staffing levels with Miss Pearson and looked at records of their deployment. We found that on occasions only four care staff were working from 7.30am – 9am. There were also days when the staffing level in the afternoon had dropped to three care staff. This was a reduction on the staffing levels at the time of the last inspection, when there were four care staff for occupancy of up to 24 people. We also found that the number of waking staff working at night varied between two and three. We were told in the AQAA there was a carefully planned rota which demonstrated the staffing levels for each shift. We looked at a staff rota, which had a number of hand written amendments to show when changes of carers had taken place. We received further information about the staff rotas after our visits. We were told that a ‘Shift changes sheet’ and another computer based rota were also being maintained, so that there was an accurate record of who was working in the home. Staff members responded ‘Usually’ when we asked in the surveys whether there were enough staff to meet the individual needs of the people who used the service. The healthcare professionals commented positively in their surveys about staff being helpful and dealing with things in a caring way. The Expert by experience also commented that ‘The Care Home staff were very helpful and kind during my visit’. Three healthcare professionals mentioned that some staff did not have adequate use of English. Their comments included ‘language barrier is sometimes a problem’ and ‘Some of the staff do not seem to have fluency in English. This can cause problems’. One health care professional added ‘Some times the staff seem stressed - ?understaffing’. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 28 In their surveys, we asked the healthcare professionals ‘Do the service’s managers and staff have the right skills and experience to support people’s social and health care needs?’. Four people responded ‘Usually’ and two ‘Sometimes’. New staff took part in an induction programme which included familiarisation with the home’s procedures, in areas such as fire and health and safety. We saw examples of the induction booklets that staff had used. We were told in the AQAA that all staff had completed induction training to ‘Skills for Care’ standards. It was reported that the induction booklets were part of a comprehensive induction pack that was given to new staff. This pack also included details of their mentor, job description, contract, performance records and direction to the home’s policy folders. We asked staff in their surveys ‘Did your induction cover everything you needed to know to do the job when you started?’. Three staff members responded ‘Very well’ and one responded ‘Mostly’. We saw a training matrix, which showed the training that staff had attended, as at 3rd November 2009. This covered a range of statutory and specialist training. There were a number of gaps, where some staff members had not attended some training sessions. We have had correspondence with the home after our visits and received further information about the plans for staff training. This included confirmation that all staff will receive certificated training in dementia care within 3 months of commencing work at Stainsbridge House. It was reported in the AQAA that the home only recruited staff who commit to enrolling on NVQ (National Vocational Qualification) training, or equivalent. We were told that 12 out of 17 care staff had a NVQ at level 2 or above. We looked at the recruitment records for three staff members who had been employed since the last inspection. The recruitment procedure included Criminal Record Bureau (CRB) and protection of vulnerable adults list (POVA) checks. Written references, proof of the applicants’ identities, and their authority to work, had been obtained. The staff members had completed application forms, which included questions about their health and employment history. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service mostly 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 a manager who has brought stability and overseen a number of developments during the last year. People who use the service are benefiting from improvements. However there are areas that should receive attention, to ensure that people’s needs are well managed and people are better protected as a result. EVIDENCE: The home had a number of managers in a relatively short space of time before Miss Pearson was appointed in July 2008. Miss Pearson had a range of qualifications, which included NVQ at level 4 in Health and Social Care, and the Diploma in Person Centred Dementia Care. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 30 At the time of this inspection, Miss Pearson was undertaking the Leadership and Management for Care Award and studying for the Diploma in Dementia Studies with the University of Bradford. We reported at the last inspection that the home did not have a deputy manager, although the position had been advertised. A deputy had not yet been appointed although we were told this was still under consideration. Other appointments had been made, which had strengthened the management and staff team in different areas. One of the healthcare professionals who completed surveys commented: ‘I am impressed with the establishment since its redevelopment and change of management. Another told us ‘It’s been a difficult few years for Stainsbridge with lots of changes’. As previously reported, there have been a number of developments associated with the new extension and the refurbishment work that have improved the facilities for people in the home. We saw an Annual Development plan for 2009, which set out the action to be taken to improve and develop aspects of the home. This included changes to the garden and further refurbishment work within the home. It was reported in the Annual Development plan that monthly audits of key aspects of the home were to be started, for example in relation to food and to staff performance. As previously reported, staffing levels and the arrangements in place for protecting people are two areas that require further attention. The home had a policy for quality assurance. In addition to internal audits, surveys were being used to gain the views of the people who use the service, and their relatives. Reports had been produced of the survey findings during 2009. The surveys had provided some useful feedback in terms of what the service did well and how it could be improved. We talked to Miss Pearson about the arrangements being made for staff supervision. We had made a requirement at the last inspection that an appropriate system of staff supervision must be in place. This requirement was being met. Staff told us in their surveys that their manager gave them enough support and met with them regularly to discuss how they were working. We were told in the AQAA that the home had appointed a finance manager who was available to discuss any financial or funding concerns with the people who use the service and their representatives. The home had facilities for the safekeeping of people’s money and valuables. Records were being maintained of items that were kept on behalf of people. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 31 Information was provided in the AQAA about the arrangements being made for health and safety. This included the servicing dates for items such as the hoist, lift, electrical equipment and fire precaution systems. The home has sent notifications to the Commission in connection with certain events and accidents that have occurred in the home. We looked at some health and safety records during our visits to the home. A fire risk assessment had been undertaken in April 2009 and there was a procedure for the emergency evacuation of the premises. This had been reviewed in October 2009. Other risk assessments had been carried out, for example in relation to accessing the garden area; windows; the use of cleaning materials (including latex); and legionella. We read that all the windows had restricted openings. Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 2 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 33 Are there any outstanding requirements from the last inspection? Yes Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 34 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 OP18 Regulation 13(6) Requirement Arrangements must be made to prevent people being harmed or suffering abuse, or being placed at risk of harm or abuse. This includes ensuring that appropriate risk assessments and behaviour management strategies are in place and are being kept under review. This requirement from the last inspection has not been met in full. Some action has been taken with the introduction of monitoring charts, which give information about the events before and after an incident has taken place. However further attention must be given to producing comprehensive strategies which are effective in reducing the risks and in protecting people. See also Recommendation 2. Staff must be working in the home in such numbers as are appropriate for the health and welfare of the people who use the service. Staff must receive training that is appropriate to the work that they perform. This includes appropriate training in dementia care. DS0000028415.V378439.R01.S.doc Timescale for action 31/01/10 2. OP27 18(1) 08/01/10 3. OP30 18(1) 28/02/10 Stainsbridge House Version 5.3 Page 35 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 OP9 Good Practice Recommendations Protocols for the use of PRN (‘as required’) medication should be written, so that there is clear guidance for staff about people’s individual circumstances. Without clear guidelines there is a risk that the medication is given inappropriately or at times when it is not effective. That a review is undertaken which looks at how well the needs of people whose behaviour is known to include physical aggression are being met in the home. The review should take into the account the need to ensure that the people who use the service are protected from harm. 2. OP18 Stainsbridge House DS0000028415.V378439.R01.S.doc Version 5.3 Page 36 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southwest@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). 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