Care Home: Stanton Hall

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What the care home does well The Registered Providers had provided a statement of purpose and Residents Guide to the Home, and all new Residents applying to the Home would be appropriately assessed by the Manager, or senior nursing staff, before an admission was arranged. The senior staff and care staff were found to be attentive and supportive of people staying in the Home, and completed a satisfactory level of administration to support this level of care. The people spoken with also said how helpful staff were to them, which was observed during this visit to the Home. Residents were found to be appropriately protected by the Complaints procedure and the Safeguarding Adults procedure in the Home. The Home was found to be well maintained throughout. The majority of the administrative arrangements to ensure that the Home met the standards set by law were found to be in place. What has improved since the last inspection? The last inspection took place in September 2007. Improvements have been made to the Home in the following area: Risk assessments had been undertaken for all people who wished to selfadminister their medication to demonstrate that they had the capacity to do so safely. What the care home could do better: Appropriate individual and accurate plans of care need to be drawn up for all people staying in the Home. Medication must be given out as detailed on the Medication Administration Record (MAR) sheets and not altered by nursing staff. A record of the application of creams and embrocations to peoples skin must be maintained. Nursing staff needed to record more accurately when additional medication was stated as needed by Doctors for those staying in the Home. When nursing staff enter a `O` on a MAR sheet this must always be defined.All staffing in the Home must be given up to date training on Safeguarding Adults and Whistle Blowing. A number of issues within the building of the Home were needed to ensure the Home is maintained at a good level. The Manager must ensure, when appointing new staff, that all the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004, are obtained. This issue is outstanding from the inspection report completed in September 2007. All new staff to the Home must be given copies of the General Social Care Council`s code of conduct and practice. The Home must be `inspected` by a senior manager or Registered Provider at least one a month. All care staff need to be supervised at regular intervals of time. CARE HOMES FOR OLDER PEOPLE Stanton Hall Main Street Stanton By Dale Ilkeston Derbyshire DE7 4QH Lead Inspector Steve Smith Unannounced Inspection 18th August 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanton Hall Address Main Street Stanton By Dale Ilkeston Derbyshire DE7 4QH 0115 9325387 0115 9442054 stantonhall2006@aol.com 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) Excelsior Health Care Limited Teresa Swales Care Home 45 Category(ies) of Dementia (45), Old age, not falling within any registration, with number other category (45), Physical disability (45) of places Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2007 Brief Description of the Service: Stanton Hall is a Grade II listed building set within extensive landscaped gardens. The Home is situated in a small village, which is served by a bus route enabling access to the towns of Ilkeston, Sandiacre, Stapleford and Long Eaton. The Home is registered for the care of 45 older people, and at the time of the inspection people within the Home were predominately older people with nursing needs. The Home also offers four day care places. There are three lounge areas within the home, and a conservatory. The accommodation provided is 20 single bedrooms with en-suite facilities, and 9 double bedrooms without en-suite facilities. There are sufficient toilets and hygiene facilities provided throughout the home. The Home is staffed twenty-four hours per day. Full meals are provided each day, personal laundry is attended to, and a programme of leisure and social activities are available. The extensive gardens can be accessed by wheelchair and seating is provided. Further information regarding the service and accommodation provided at Stanton Hall are available within the Home’s Residents Guide and brochure. Information provided on 18 August 2008 stated that the fees for the Stanton Hall Care Home were from £365.00 to £600.00 per week, depending on the level of care needed and bedroom required. Details of previous inspection reports can be found at the Home, or on the Commission for Social Care Inspection’s website: www.csci.org.uk Stanton Hall DS0000002111.V370243.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 that people who use the service experience Good quality outcomes. The focus of inspections, undertaken by the Commission for Social Care Inspection (CSCI), is upon outcomes for people and their views of the service provided. This process considers the Home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. This inspection visit was unannounced and took place over a period of approximately 7 hours. In order to prepare for this visit we looked at all of the information that we have received, or asked for, since the last key inspection of the Home, which took place on 6 September 2007. This included: The ‘Annual Quality Assurance Assessment’ (AQAA). This is a document completed by the Registered Providers of the Home that focuses on how well outcomes are being met for people using the service. What the service has told us about things that have happened in the service. These are called ‘notifications’ and are legal requirements. The previous ‘Key Inspection Report’, and the results of any Other Visits that we have made to the service in the last 12 months. Relevant information from Other Organisations, and what Other People have told us about the service. Surveys returned to us by people using the service, from the relatives of those staying in the Home, and from the staff working in the Home. For this inspection of the service the Commission’s Residents questionnaire (a ‘survey’ mentioned above) was sent to 10 people staying in the Home, and 4 were returned. Ten questionnaires were also sent to staff, and 3 were returned. During this visit to the Home ‘case tracking’ was used as a system to look at the quality of the care provided. This involved the sampling of a total of four peoples records, being a cross-section of people staying in the Home. Their care plans and care records were examined, and their private bedrooms and Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 6 the Home’s communal facilities were seen. Discussions were held with people, if they were able, by an Expert by Experience, about the care and services the Home provided. In addition, discussions were held between the Inspector and the Deputy Manager of the Home about its general operation. Discussions were also held with staff about the arrangements for peoples care, and also about the staffs recruitment, induction, deployment, training and supervision. What the service does well: What has improved since the last inspection? What they could do better: Appropriate individual and accurate plans of care need to be drawn up for all people staying in the Home. Medication must be given out as detailed on the Medication Administration Record (MAR) sheets and not altered by nursing staff. A record of the application of creams and embrocations to peoples skin must be maintained. Nursing staff needed to record more accurately when additional medication was stated as needed by Doctors for those staying in the Home. When nursing staff enter a ‘O’ on a MAR sheet this must always be defined. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 7 All staffing in the Home must be given up to date training on Safeguarding Adults and Whistle Blowing. A number of issues within the building of the Home were needed to ensure the Home is maintained at a good level. The Manager must ensure, when appointing new staff, that all the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004, are obtained. This issue is outstanding from the inspection report completed in September 2007. All new staff to the Home must be given copies of the General Social Care Council’s code of conduct and practice. The Home must be ‘inspected’ by a senior manager or Registered Provider at least one a month. All care staff need to be supervised at regular intervals of time. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 & 6. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. All new people moving to the Home were appropriately assessed prior to their admission, so that they were reassured that their needs would be met. EVIDENCE: The Registered Providers had provided a statement of purpose for the Home together with a Resident’s Guide, which informed people staying in the Home, and their relatives, of what the Home provided. The Guide was well completed, and contained information on how, if necessary, people staying could contact the Commission, the local Social Services Dept and the local Health Authority. However, the Deputy Manager said that a copy of the Residents Guide was not left in each person’s bedroom, for the person, and their relatives, to refer to when necessary. In the Annual Quality Assurance Assessment, completed by the Manager, she had written – ‘All initial enquiries are dealt with by a senior member of the Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 10 nursing team. Prospective clients and/or their families are shown around the home and informed of the services available. A detailed brochure, including photographs, is provided along with a guide to choosing a care home and a copy of the terms and conditions. Clients are invited to have a trial visit/stay if they wish to do so. This ensures that they/their families are able to make an informed choice with regard to where they wish to live. Prior to admission detailed pre–admission assessments are carried out and documented by qualified nursing staff to ensure that the needs of the client can be met by the home. Residents and their representatives are given time to discuss their needs and expectations with staff prior to admission in order to ensure a smooth transition process. The information gathered is then used in the compilation of the clients care plan.’ In the questionnaire, sent out to people staying in the Home, none commented specifically about the admission process, except to say that they were happy with the process. Staff, who also completed a questionnaire, said that they were given good information about the care and support needs of people staying in the Home. The records of four people staying in the Home were examined during this visit and a copy of the statement of terms and conditions of residency or a contract, if purchasing their care privately, were available to examine. This ensured that peoples legal rights were protected. When new people were admitted to the Home, the Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting each person, copies of which were seen. The Manager, or senior nursing staff, also assessed all people sponsored by Social Services Depts. If the person was self-funding from the outset, the senior staff completed their own summary of needs, which were also seen during this visit. Standard 6 does not apply to this Home. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Plans of care were appropriately completed to record peoples health and personal care needs. A robust system of recording the distribution of medication was needed to ensure that peoples wellbeing was not adversely affected. EVIDENCE: Four records of people staying in the Home were examined, or case tracked, to ensure that suitable records were being maintained. Satisfactory initial assessment records were made by the manager, or senior staff, during their first visit to the potential new people in their own homes, or hospital placements. This was found to be followed up by individual plans of care and risk assessments for each person whose files were looked at. However, the individual plans were, in the main, printed out sheets with parts crossed out or filled in where necessary. This meant that care plans were very repetitive in all of the four records examined. The information written in them was very general. For example, in one record it said that mobility was to be Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 12 provided by two staff, but the record did not detail what the staff actually had to do. In another record it said - ‘Identify how much assistance (the person) requires’, - but again did not detail what the need was or what staff should actually do to meet the need. However, other parts of the care plans were satisfactorily completed Formal six monthly review of care were not found in any of the four records examined. Good daily records were maintained by the Home’s staff, and peoples care files were well organised, with different sections. In the four files seen neither the person staying, or their representative, was seen to have signed the care records to indicate that they had read them. Despite this, the files did have detailed monthly summaries contained within them. Staff were observed talking and assisting people in the lounges and dining rooms. This was seen to be done very positively, with a relaxed atmosphere, which was enjoyed by the people staying in the Home. In the care plans of two people staff had written ‘Please observe’ with respect to a particular need of the person. However, other staff did not refer to this need when completing their notes about the person’s needs on subsequent shifts/days. In the questionnaires completed by those staying they said that staff were attentive to their needs. One person had written – ‘Staff are very helpful.’ In the Annual Quality Assurance Assessment the Manager had written – ‘Care plans are reviewed monthly, or more frequently if necessary, in order that the current needs of the individual are reflected in the care plans.’ The records of peoples health needs were observed and a good record was found to be maintained. In the Annual Quality Assurance Assessment the Manager had recorded – ‘Specialised equipment is available for all clients to ensure that that lives are as comfortable as possible …’ All medication and the method of distributing it to people staying in the Home was examined. This showed that a satisfactory record was kept, although the following issues needed to be addressed: In a number of places on the Medication Administration Record (MAR) sheets the pharmacy had recorded that a Senna medication was to be given daily. However, staff in the Home had altered this to a PRN medication, that is, to be given when necessary. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 13 The MAR sheets also recorded that a number of creams/embrocations were to be applied to peoples skin. However, there were no entries on the MAR sheets to indicate that this had been done. While reviewing the MAR sheets, a large number of signature gaps were seen. In a number of places on the MAR sheets a ‘O’ had been used to indicate that a medication had not been given to a person. However, at the foot of each MAR sheet the entry ‘O’ was described as ‘To be defined…’, but this had not been done. In a number of places on the MAR sheets medications had been crossed out by nursing staff. The Deputy Manager said that these were medications that a Doctor had stopped. However, the nursing staff entry had not been checked and signed by two staff, to ensure it had been correctly completed, nor was the date the medication was to end recorded or the name of the Doctor who authorised the medication to end. In the questionnaires completed by those staying in the Home they had all recorded that they received the medical support they needed. In the Annual Quality Assurance Assessment the Manager had recorded – ‘Medications are managed within current guidelines. Residents who wish to self-medicate are assessed by a senior nurse, and their GP, to ensure that they have the capacity to do so safely. Lockable storage facilities are available for those clients who wish to self-medicate. Clients within the Stanhope Unit will have individual lockable medicine storage units in their rooms as opposed to a general medicine trolley leading to reduced risk of errors occurring.’ Discussion was held with people staying in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and respect. As a result, they felt very safe in the Home, and had a strong sense of well being. One Resident said - ‘It is very nice. I like it here and think I will stay. The staff are very good and the food is all right’ - another said – ‘Everyone is very kind here. All the staff are very nice, and they are very good to me. They always come if you ring for them, and they try to do everything you ask, if they can.’ In the questionnaires completed by those staying in the Home, people had written that staff were good at listening and acting on what they wanted. They also recorded that staff were always available when they needed assistance. All staff were observed to be very caring in their dealing with people in the Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 14 Home, and spoke to them in a caring manner. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Peoples preferred lifestyles were respected by the Home, and people were given a wholesome and appealing diet in pleasant surroundings, that enhanced their well being. EVIDENCE: People staying in the Home were asked about the activities provided. Those spoken with said that regular activities took place. One person said that bingo and word games were played, and that outing to restaurants or cafes were organised. This person said that they were sometimes taken to a café in the village for coffee. Another person said that they liked to join in activities, but there had been less organised recently. Staff spoken with said that quizzes, singing events, bingo and ball games were regularly available, but not at the usual level, as they have been awaiting a new Activities Coordinator. The Deputy Manager said that the Activities Coordinator had recently left the Home, but that another person had just been appointed and it was expected that activities would again be operating fully in the near future. In the Annual Quality Assurance Assessment, provided by the Manager she had Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 16 written – ‘We have regular outings to the pub or garden centre for lunch and in house entertainment and motivation. We maintain excellent relationships with the local churches and ministers from various faiths to ensure that clients spiritual needs are met as far as practically possible. There is a designated secure area of the gardens for clients with dementia, in which they can walk around under the supervision of a carer.’ A notice in the Home, provided by the Manager, reminded people that a Pet Therapist regularly came to the home with a dog. People were also reminded that the Home had a Nintendo Wii for people to play bowls, golf and other games. Relatives and friends of people staying in the Home were able to visit at any time, and could always be seen in private. One person said – ‘Visitors can come at any time.’ When this person was asked if she spoke to her visitors in the lounge, she said that she did as her room was on the second floor, however, they could have a private area if they wanted to talk. Another person said – ‘Visitors are allowed at any time. We can go to my room, if we want to.’ Staff spoken with confirmed this, saying that people could see their visitors in their bedrooms or in the lounge, as it was each person’s choice. In the Annual Quality Assurance Assessment the Manager had commented – ‘We have a policy of open visiting and clients may go out if they choose and it is safe to do so. Clients may also have visitors in their rooms for more privacy if they wish to.’ One or two people felt that the Home needed more staff. For example, one person said that they needed two staff to assist them to move and – ‘you have to wait a long time sometimes, for instance to go to the toilet.’ However, this person was also pleased to be in the Home because – ‘It is good that someone is there if I want them. In the night, there is a bell by the bed and they come.’ People staying in the Home were able to say that the Home provided good meals and that – ‘There is a choice of two things. I am quite pleased. There is sufficient’ – and another person said – ‘The food is very good. There is a choice and they give you lots. After a big lunch, I do not want a lot of tea’ – and another said – ‘The food is all right. You cannot suit everyone all the time. If you do not like something, you can choose something else.’ One person said that some people liked to sit outside to have their lunch, when the weather was good. People who completed questionnaires also said that the choice of meals was good. Staff spoken with were able to confirm that a choice was available at every meal time. Two staff were also asked, when people needed assistance to managed their meal, how many people they might help at the same time. Both staff said that they knew they should only assist one person at a time, but often they assisted two people at the same table. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 17 In the Annual Quality Assurance Assessment the Manager had written – ‘Residents are given a variety of choices at all mealtimes and staff are always available to assist with meals if required. Residents are encouraged to sit at the table for meals and through the visitors charter we promote protected mealtimes. A member of staff is provided purely for serving breakfast to clients unable to feed themselves and assisting them to eat it.’ Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Complaints made to the Manager were addressed to meet peoples needs. The protection policies and procedures provided meant that people staying in the Home were well protected. EVIDENCE: People spoken to said that if they had a complaint to make they would tell the Manager or a senior member of staff - ‘I don’t know because I have not had one. I think I would ask the staff to get the Manager to come and speak to me. Or, I would ask my daughter to deal with it’ – and – ‘I would tell the Matron. She will listen to you.’ The Commission had not received any notice of complaint since the last visit to the Home, in September 2007. The Home had good procedures for both written and verbal complaints. Senior staff recorded complaints, which were then passed to the Manager who investigated and reported back to the complainant. However, during this visit to the Home only the record of the concerns/complaints listed by senior staff was available. The Manager’s response to these were filed elsewhere in the Home and so were not available. The Registered Provider’s complaints procedure detailed that all complaints would be responded to by the Manager within at least 28 days. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 19 In the Annual Quality Assurance Assessment completed by the Manager she had written – ‘The complaints policies and procedures are available to clients, representatives and staff. They clearly state the appropriate procedure to follow in the event of a complaint. The procedure is available on notice boards around the home, in the service user guide and in the statement of purpose. All complaints received are addressed to meet the residents needs. We have now included a ‘Concerns’ form in the care plan for those who have a concern as opposed to a ‘complaint.’ The Registered Providers had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy, which staff spoken to were aware of. This meant that a procedure was in place to allow staff to inform the Manager of any inappropriate actions by other staff. The Registered Providers had copies of the Public Interest Disclosure Act of 1998, and of the Dept of Health’s policy called ‘No Secrets’. The Deputy Manager confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. The staff spoken with understood that people staying in the Home might, on occasion, show anger and aggression. The training received on such issues was described by the staff, however, one member of staff stated that the training she had undergone was a good while in the past. The Deputy Manager said that a policy was available to staff stating that they could not benefit from peoples wills, which was also understood by the staff spoken with. In the Annual Quality Assurance Assessment, completed by the Manager she had written – ‘There is a Whistleblowing policy in place and staff are made aware of it during induction and again during recognising abuse training and the consequent updates. The Safeguarding Adults procedure also includes copies of the Public Interest Disclosure Act, the Data Protection Policy and the Mental Capacity Act. There is also a copy of the DoH No Secrets. The policies and practices laid down by the home ensure that staff understand physical and verbal aggression by clients and the limits of restraint. Staff attend annual training in Recognising and Alerting Others to Abuse as per Derbyshire County Councils Adult protection policy. The feedback from this is very positive. Clients have access to Age Concern, PALS and IMCA to advocate on their behalf.’ Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, 25 & 26. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. The Home was well maintained throughout, providing all people staying in the Home with a safe, comfortable environment in which to live. EVIDENCE: A tour was made of the public areas of the Home, and included a number of the bedrooms of people staying in the Home. The grounds of the Home were seen to be extensive, and were well maintained. A large patio area was seen outside the lounges of the Home, furnished with tables and chairs for people to use. The Home was most pleasantly decorated throughout, and the lounges and dining room were pleasant to sit in. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 21 The bedrooms seen provided sufficient space and provision for each person staying in the Home. The Registered Providers had also provided appropriate furnishings in almost all locations seen during this visit. Many of the bedrooms were also very pleasantly decorated by the person staying with pictures of their lives prior to moving to the Home. Toilets were easily available to everyone staying in the Home, were clearly marked, and were provided with handrails where necessary. A call system was also available throughout the Home. All radiators were appropriately guarded, and could be controlled within each bedroom. The Home had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. In the Annual Quality Assurance Assessment completed by the Manager she had written – ‘The home is well maintained through a continuous refurbishment programme. Annual environmental risk assessments are carried out and acted upon as necessary. The grounds are extensive and well laid out. There is disabled access to the patio area and plentiful seating and umbrellas. There is a separate secure area of the garden for our clients who have dementia to walk freely around. There is a variety of specialist equipment in order for our clients to maximise their independence, such as tracking hoists, Rotalite turning aids, stand aids and many more items of equipment. The Stanhope Palliative care unit has been furnished and equipped to make it both homely and practical for looking after clients with end of life needs. Clients bedrooms provide satisfactory personal space for each client. Some clients have adapted our larger rooms as bed sitting rooms. Clients are encouraged to bring in their own belongings and personal items if they wish to do so. The home is clean, hygienic and pleasant to be in. Quality assurance questionnaires are completed by clients, relatives and visitors to show that they are satisfied with the environment in which the client lives.’ However, the following issue needed attention: The entrance to the Home is via the conservatory. On the day of this visit the roof to the conservatory was found to be leaking, in at least 2 places, by the Inspector and be the Expert by Experience. The conservatory was being used as a sitting area by both people staying in the Home and by staff. People said that they needed to make sure they were not sitting under a leaking area when choosing were to sit. A double bedroom was seen to lead off the entrance area to the nursing office. Outside this office and bedroom staff were able to hang their coats, and as a result staff were seen to use this small area as a ‘staff Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 22 room’. Nursing staff were also observed using the area to talk to staff about their duties for the shift, and some of these issues were confidential. However, all conversations could be over heard within the bedroom. By the Manager’s office a door was seen marked by the Fire Service as ‘To be kept locked shut’. However, it was found to be open. The gas boiler, in the toilet opposite the bedroom called Garden Suite 4, was found to have gas controls and water controls uncovered. A cover was needed for all of these controls. In the bedrooms visited armchairs were seen to be plastic covered, making them uncomfortable to sit upon. Armchairs should be provided with more modern covering, making them pleasant to sit on, while still being suitable to people needs. In bedrooms throughout the home only one armchair was provided, even though the National Minimum Standards recommends two armchairs. Continence aids were seen to be stored in peoples bedrooms, often piled on armchairs leaving no where for the person or their visitors to sit. Alternative storage areas were needed for these aids. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. A good level of care staffing was provided to meet the needs of people staying in the Home. Recruitment practices were always followed when recruiting new staff, so that Residents welfare was always safeguarded. EVIDENCE: Levels of nursing and care staffing were examined for the 4 weeks beginning 14 July 2008. This showed that a good level of staffing was being provided. The Annual Quality Assurance Assessment completed by the Manager said that – ‘Staffing levels are set according to the Residential Staffing Forum. Extra staff are brought in at peak times of extra activity i.e. serving breakfasts and feeding those who require more assistance.’ The Deputy Manager was not aware of those care staff who held at least an NVQ level 2 in Care. However, the two care staff spoken with both said that they held an NVQ level 2 in Care, one was currently undertaking her NVQ level 3 in Care. The records of two new staff employed during the past 12 months were examined to see whether the Manager had obtained all relevant information about them. It was found that almost all information had been obtained. The history of employment of both staff members had only been taken over the previous 10 years, and not back to when they had left school. This was Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 24 needed to allow the Manager to check whether the potential member of staff had worked in care in the past, to allow contact to be made with that care agency, to ensure the person had not been dismissed due to offences against those looked after. All other information was found to be satisfactory. Staff spoken with had been given copies of the General Social Care Council’s code of conduct and practice, and had been given a statement of the terms and conditions under which they were employed. The Deputy Manager said that all new staff were provided with induction and foundation training, which was confirmed by staff, and by the Manager’s Annual Quality Assurance Assessment. The Deputy Manager also said that all care staff were provided with at least three paid days training a year, which again was confirmed by staff spoken with. In the staff questionnaires all said that induction training and ongoing training were provided at a good level. All staff also had an individual training and development assessment and profile. Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 & 38. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Management arrangements at the Home were in place to ensure that peoples care was maintained at a positive standard. EVIDENCE: The Manager was appropriately qualified to manage the Home, having an NVQ level 4 qualification in Management, and she also held a nursing qualification. The records of the monthly ‘inspections’ of the Home, carried out by a senior manager, were examined, and it was found that the Home only had records of visits made up to February 2008. None were available after that date. Quality Assurance information about the Home was not available during this visit. However, surveys were undertaken of peoples views on what it was like Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 26 to live in the Home, and surveys were also taken of relatives views on the way the Home was achieving goals for those staying. The results of these surveys were published and could be found on a notice board within the Home. In the Annual Quality Assurance Assessment completed by the Manager she had written – ‘A quality assurance system is in place and the information collated and acted upon where appropriate and necessary. Internal audits and risk assessments are carried out annually. There is an annual business plan readily available to staff, clients and visitors.’ The Registered Providers held a number of accounts for peoples money, which were held in a bank for safe keeping. It was seen that this was managed effectively for those staying in the Home. However, no interest was paid on the amounts held. Advise was given on the amount of money it was appropriate for the Home to hold for each person. Two members of the care staff were asked about the supervision they received from the Manager or other senior staff in the Home. They said that this was done on approximately a 2-3 monthly basis, but only ‘staffing needs’ were discussed. A copy of the supervision rota was also seen. The training required by the Regulations was discussed with staff. They were able to say that the vast majority of training had been provided. However, the training provided for the staff as a whole was not available during this visit to the Home. In the Annual Quality Assurance Assessment provided by the Manager she had written – ‘New staff have an induction to TOPPS standards and are supported through out their training period by senior staff. Most care staff have achieved NVQ 2 and we have several working towards level 3. Staff have a training and development programme to ensure that they are competent to do their jobs and are actively encouraged to attend study days and training. Staff have received training in Dementia Awareness, Palliative Care, Motor Neurone Disease and Multiple Sclerosis in order to meet the needs of the clients who are admitted under the new categories of DE and PD. Training is also provided in Health and Safety, Safe Moving and Handling etc. We have recruited 4 senior nurses including a deputy to support the clients and the staff with their own individual knowledge and skills.’ Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 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 2 X 3 X 3 3 X 3 Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 Reg 13(2) Requirement The correct medication is always recorded on the Medication Administration Record (MAR) sheets by the pharmacy, for staff to follow. Nursing staff must not alter a given medication without consultation with a Doctor. This is to ensure that medication is always given out correctly. A record must be maintained of the application of creams/embrocations to peoples skin. This is to ensure that people are receiving the correct medication at all times. When distributing medication to people staying in the Home nursing staff must always sign the MAR sheets on every occasion. This is to record that the medication has been given out to each person, and taken, at the required dose and at the required time. When nursing staff enter a ‘O’ on the MAR sheet they must always follow the instruction given at Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 29 Timescale for action 30/11/08 the foot of the MAR sheet and define why a ‘O’ was used. This is to ensure that the entry ‘O’ is understood by all staff. 2. OP19 Reg. 23(2)(b) The roof to the conservatory must be repaired to prevent leaking at times of rain. As this area is used as a sitting area by those staying it must be addressed as soon as possible to provide a pleasant area in the Home. The door to the cupboard marked ‘to be kept locked shut‘ must be locked shut after use, as required by the Fire Service. The gas boiler, in the toilet opposite to the bedroom called Garden Suite 4, must be fitted with a cover over the gas and water controls. This is to prevent those staying in the Home from altering the controls and endangering themselves and the Home. 3. OP29 Reg. 19(1) & Sch 2 The Manager must ensure, when appointing new staff, that all the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004, are obtained. This is to ensure that new staff recruited are suitable people to provide care in the Home. (This issue is outstanding from the inspection report dated 6 September 2007) The Registered Providers must ensure that the Home is inspected on an unannounced basis, at least once each month in line with the requirements DS0000002111.V370243.R01.S.doc 31/10/08 Reg. 23(4)(a) 13/10/08 4. OP31 Reg. 26(3),(4) & (5) 13/10/08 Stanton Hall Version 5.2 Page 30 listed in Regulation 26. This is to ensure that the circumstances of people in the home, staff provision and the condition of the Home are maintained at a good standard. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP1 No. 1 Good Practice Recommendations A copy of the Residents Guide should be present in each person’s bedroom for the person or their representative (or relatives) to refer to when necessary. A detailed, individual and accurate plan of care should be completed for each person staying in the Home. The Manager should formally review each person’s Plan of Care and risk assessment at 6-monthly intervals. The formal review should include the person themselves, their representative and, if appropriate, their other relatives, the Manager and other involved staff. One of these reviews could be conducted by the Social Services Dept, although the Manager should provide formal written input to the review of the welfare and care provide to the person. Staff should show or read the care plan to the relevant person, or their representative, on approximately a monthly basis, and invite them to sign the record to show that they had seen the record. In peoples records of care, when staff request other staff to ‘Please observe’, concerning an aspect of care, subsequent entries should address the request to observe, until the member of staff (or manager) making the request states in the record it is no longer needed. 2. OP7 3. Stanton Hall OP9 When altering a Medication Administration Record (MAR) DS0000002111.V370243.R01.S.doc Version 5.2 Page 31 sheet, after a Doctor has changed medication for a person, nursing staff must always ensure that two staff have checked the entry and both have signed it, stated the date the medication is to change/end and record the name of the Doctor who authorised the alteration. 4. OP12 A review should be made of the amount of staffing provided to ensure that people are not having to wait long periods for assistance, for example, when they needed assistance to go to the toilet. Staff should only be required to assist one person at a time with their meal. If necessary, other people awaiting their meal should be left in the lounge, or in their bedroom, until a member of staff was able to assist them with all of their meal at one time. Meals should be kept hot to allow this to take place. Attention should be paid to the area outside the nursing office and adjacent double bedroom. Conversation in this area could be heard by people using the bedroom. The area should not be used by staff as a ‘staff room’, or by nursing staff as an area to talk to staff about peoples confidential needs. Armchairs in bedrooms were plastic covered. These should be changed to armchairs with a more modern covering making them comfortable to sit upon and adapted to peoples needs. At least two armchairs should be provided in all bedrooms throughout the Home, including the Stanhope Unit. Continence aids should be not be stored in peoples bedrooms, as this was seen to leave nowhere for the person or their visitors to sit down. The bedrooms also lost their pleasant appearance when filled with these aids. 7. OP35 The Registered Providers should consider paying interest to the people whose money was held within the banking system. The Registered Providers should consider only holding the amount of money for each person suggested during the visit made to the Home. 8. Stanton Hall 5. OP15 6. OP19 OP36 Formal supervision should include discussion with staff about the care provided to those staying in the Home. DS0000002111.V370243.R01.S.doc Version 5.2 Page 32 Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stanton Hall DS0000002111.V370243.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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