Care Home: Steephill

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Steephill Steephill Court Road Ventnor Isle Of Wight PO38 1UH Lead Inspector Mark Sims Key Unannounced Inspection 18th December 2006 16:30 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 Steephill DS0000012539.V316481.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. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Steephill Address Steephill Court Road Ventnor Isle Of Wight PO38 1UH 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) 01983 852652 01983 857776 Islecare `97 Limited Miss Maria Nicholson Care Home 37 Category(ies) of Dementia - over 65 years of age (8), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (37), Physical disability over 65 years of age (13) Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th September 2005 Brief Description of the Service: Steephill is a care home providing personal care and accommodation for up to 37 older people. Miss Maria Nicholson manages the home on behalf of Islecare ’97 Ltd. It is a large, detached, three-storey property located on the western outskirts of Ventnor. The town of Ventnor with its shops and amenities is approximately ¾ mile away. A bus service is available close to the home. There is a range of single rooms on all three levels, accessible via a passenger lift. There is off road parking to the front of the building from which there is level access into the home. The extensive gardens at the rear are available for use by residents. The fees applicable for accommodation at Steephill range from £361.97 to £450.00. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for Steephill, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visit, the actual visit to the site of the home, was conducted over one day, where in addition to any paperwork that required reviewing the inspector met with service users, relatives and staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involved far more pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service, comment cards completed by both relatives and service users and linking with previous inspectors who have visited the home. The new process is intended to reflect the service delivered at Steephill over a period of time as opposed to a snapshot in time. What the service does well: What has improved since the last inspection? The following is an indication of the areas where the service has improved its performance: • • • • Steephill Improved pre-admission assessment tools and practices Removal of slip & fire hazards Replacement of cabinet and drawer doors in the kitchen Improved recruitment process DS0000012539.V316481.R01.S.doc Version 5.2 Page 6 • Installation of new central heating boilers. What they could do better: 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. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 7 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 Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 3: All service users are assessed prior to admission and provided with information relating to the service they can expect to receive whilst resident at Steephill. Standard 6: The home does not provide an intermediate care facility. EVIDENCE: Assessment & Pre-service information: The evidence indicates that service users are made fully aware of the amenities, facilities and services provided at Steephill and that prior to admission they are assessed by a competent person. • On arrival at the home it was noticed that copies of the home’s brochure are available within the main entrance hall and that included within this Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 9 document are details of the services ‘Statement of Purpose’ and ‘Service Users’ Guide’. The brochure, a glossy document, and the enclosed ‘Statement of Purpose’ and ‘Service Users’ Guide’ were noted to be informative literature, which in addition to providing details of the information recommended within the ‘National Minimum Standards’ (NMS), also contains service specific information, as included by the company. A copy of the ‘Statement of Purpose’, included with the dataset information, provided to the Commission in the build up to the inspection, provided the inspector with time to scrutinise the document and to determine, as indicated above that the record is both informative and generated in accordance with the NMS. • Unfortunately, despite sending out a large number of service users’ comment cards only two were returned to the Commission. However, both service users commented on their experience of the admission process and both ticked ‘yes’ in response to the question ‘did you receive enough information about the this home before you moved in so you could decide if it was the right place for you’. Whilst general conversations with service users were possible, more specific questioning was not applicable due to the levels of frailty (physical and mental) exhibited by some clients, although one person discussed her move from another home, which she described as: being given a months notice’ and how ‘pleased and glad she had been to have found Steephill’, confirming the information she has been provided, prior to visiting, had ‘mirrored the arrangements at the home’. In discussion with the manager it was established that the pre-admission or admission process commences when individuals contact the home regarding vacancies. The company operate an initial enquires file, which is used by staff to collect and collate basic information about the prospective client, the person making the enquiry, the client’s present location and the care required. Initial enquires it is understood, often lead to full pre-admission assessments, which are generally completed by the manager or one of the senior staff, although several care plans also contained professional assessment details compiled by care managers. • Generally a corporate assessment document is used throughout the Islecare ‘97 older persons’ homes, this tool consisting of 34 parts, each section considering a potentially different aspect of that person’s needs: DS0000012539.V316481.R01.S.doc Version 5.2 Page 10 • • Steephill a. Shopping b. Money c. Communication d. Medication e. Family f. Continence g. Bathing h. Mobility, etc. The above list indicating some of the 34 items covered by the assessment tool/process. However, following the last inspection when issues regarding the regularity with which the re-assessment tools were updated/reviewed and concerns over assessments not having been completed: ‘Initial assessments have been undertaken however there have been incidences when prospective residents have been admitted to the home without an assessment having been undertaken’. The manager has revised the assessment tool creating a simpler, more user-friendly tool, which is designed to gather essential information, whilst enabling a fuller assessment to be undertaken as the client settles into the home environment. Four assessments were scrutinised during the fieldwork visit and noted to be useful documents, which provided good levels of information and insight regarding the needs and abilities of the service user. The assessment tool has also been amended to include a section for the recording of each month review and update, which from the assessments seen would appear to be occurring as required. Steephill DS0000012539.V316481.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 7: The home’s care planning process provides sufficient guidance to staff around the service users’ care needs and how these are to be met. Standard 8: The health and social care support needs of the clients are well managed internally and are clearly meeting people’s needs. Standard 9: The home’s medication system is being appropriately managed and is ensuring the service users have access to their medications as prescribed. Standard 10: The rights of the service users to be treated with respect and dignity are not being appropriately promoted by the practices of the staff/home. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care planning: The evidence indicates that the people residing at Steephill are having both their health and social care needs identified, documented and met. • The previous inspector documented within her inspection report: ‘The home provides comprehensive care plans for each resident to inform care staff, of their individual care needs. The welfare of the residents is the home’s priority’. ‘Several residents’ care plans were viewed and were found to have details of the action, which need to be taken by care staff to meet individual’s care needs’. • At this visit the care records of four service users were reviewed and found, again, to be comprehensive documents, which contain clientfocused information, as identified during the initial pre-admission assessment and ongoing reviews and updates. The service users and their families/relatives also appeared satisfied with the care provided at the home, all three relative comment cards indicating that people are satisfied with the overall care provided at the home, additional comments including: ‘The care given to my mother has been first class and the staff from the manager down has made the care home what it is today – a friendly, caring and well run home from home’. ‘We’ve been very impressed with the care my mother W is being given and pop in at all times of the day and I’m always made most welcome’. The two service user comment cards, also indicate that people feel their care needs are being met, both ticking ‘Always’ in response to the question ‘do you receive the care and support you need’, although one of the two individuals also felt that additional staff would make the care and support provided even better commenting: ‘the staff do the best they can with not enough staff. The latter remark not mirroring the feedback gathered on the day of the fieldwork visit, when the clients spoken with some clarity about the staff providing good levels of care and support. Health Care: The evidence indicates that the health care needs of the service users are well managed and attended to at Steephill. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 13 • • As indicated above the findings from the last inspection were that: ‘The welfare of the residents is the home’s priority’, it was also documented that: ‘Health care needs were available in the care plans. Care staff support residents with oral hygiene and know how to identify thrush in the mouth. A dentist from Ventnor will visit the home on request. There are procedures to identify those residents who might be at risk of pressure sores. There were no residents with pressure sores at the time of the inspection. The home operates a key-worker system. Records of medical visits were available. The inspector spoke briefly with the district nurse who has regular contact with the home. Residents’ health is monitored on a daily basis with the use of health charts. All residents are registered with a general practitioner. Residents moving to the home from outside of the Ventnor area would have to change general practitioner. There are two practices in Ventnor and they can choose which one to use. A chiropodist visits the home on a monthly basis, or to attend to emergencies. Any resident requiring access to hearing and sight tests would be referred by their GP to the ear, nose and throat department of St Mary’s Hospital. During this visit a similar picture was identified with each individual’s care plan containing documented accounts of the service user’s involvement with health and social care professionals. The care planning files, also including evidence of the treatment plans, followed re-referrals or follow up appointments attended. • Both service user comment cards returned prior to the fieldwork visit confirm, in response to the question ‘Do you receive the medical support you need’, ‘Always’. The dataset also indicated that people are involved with general practitioners, district nurses, opticians, dentists, chiropodists and other allied health care professionals. During the fieldwork visit the inspector managed to have a brief discussion with a visiting community nurse, who confirmed that a good, professional relationship existed between the home and local health care providers and that service users were well supported by the staff of the home. • • Medications: The evidence indicates that the staff are supporting people appropriately with their medications. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 14 • The dataset establishes that staff are being given access to policies and procedures on the administration and management of medications and that this was last updated in the June of 2005. However, the ‘statement of purpose’ included within the dataset bundle, suggests that only five of the home’s staff have completed any medication administration training, which, including the manager, equates to approximately 22 of the staff team. Feedback from the manager established that the staff are largely the management team and nominated staff, who have been specifically trained to carryout medication administration, however, all staff have access to medication policies and procedures for information. This training need should perhaps be consider for inclusion within the home’s/company’s training plan/schedule for next year. • • Records inspected in respect of service users’ medications identified that the medication administration records (MAR) were being appropriately completed and maintained and that the manager has introduced a monitoring tool, which encourages staff to self-audit their performance at the end of each week. Storage facilities, for medications also appeared satisfactory, with the majority of the medications in use stored within a specific medications trolley that is secured to a pillar when not in use, all stock drugs are held within a locked cupboard within the main office. Details of the medications accompanying clients into the home are listed on admission and provide a baseline for the mapping of medication changes for clients, during their residency at the home. • • Privacy and Dignity: The evidence indicates that privacy and the promotion of dignity for the service users is satisfactory. • The copy of the ‘statement of purpose’, included within the dataset information, establishes for service users and visitors that: ‘Staff are trained to endeavour to preserve and maintain dignity, individuality and privacy, of all within a warm and caring atmosphere and will be sensitive to any residents changing needs’, although given the information relating to training both included within the dataset and the ‘statement of purpose’, it is unclear exactly what the training referred to consists of, which should be more clear. However, the underlying ethos of the privacy and dignity statement, would appear to be being attained, according to the comments provided by relatives: Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 15 ‘The care given to my mother has been first class and the staff from the manager down has made the care home what it is today – a friendly, caring and well run home from home’. ‘We’ve been very impressed with the care my mother W is being given and pop in at all times of the day and I’m always made most welcome’. • During the tour of the premises it was noted and discussed with the manager that all accommodation at the home is single occupancy and observation again supported by the ‘statement of purpose’, which indicates that all 35 rooms within the home are single occupancy. The tour of the premises also, highlighted that the home has excellent communal facilities, which can be utilised by the service users when entertaining in private, if required. 1. Dining room 2. Two large lounges 3. Smoking lounge Each of the above seen to be in use at some point during the fieldwork visit. • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 12: The management team is seeking to establish a social activities programme, which will meet the needs and preferences of the service users. Standard 13: The visiting arrangements at the home meet the needs of both the residents and their relatives and good community links are maintained. Standard 14: The service users are helped to exercise choice and control over their lives. Standard 15: The meals are nutritionally well balanced and appetising. EVIDENCE: Social Activities: The evidence indicates that all service users are afforded the opportunity to participate within activities and entertainments. • The dataset, included details of the activities available generally to the clients’ including: o Film Shows (Videos & DVDs) Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 17 o o o o o o o o o o • Music and movement Games Sing-a-longs Bingo Art Entertainers (non-specific) Hairdressing Church Services (communion) Outings Knights Court & Worsley Court In addition to the activities listed within the dataset the inspector also noticed that forthcoming events/activities are advertised upon the home’s central notice board, items listed including: 1. Christmas Parties (arranged for the 13th, 18th & 20th of December) 2. Minibus trips (commencing on the 25th October 2006 and ending the 20th December, until the spring). The arrangement for the minibus trips were discussed with residents during their meeting of the 17th October 2006, as evidenced via the minutes, which also establish that venues to visit were also chosen by the service users. • Whilst sat chatting to a service user in the main corridor the inspector noticed seven certificates displayed on the wall adjacent to the main lounge(s). In conversation with the manager and the service user it transpired that these certificates were awarded by ‘Somerset Care’ in recognition of the home’s achievements within the gardens and how well presented/maintained the gardens had been that year. One specific certificate had been awarded to the home in recognition of the of involvement of the service users, which the person I was sat talking to explained she had been a large part of throughout the year. • It must also be reported that throughout the inspection there was an air of excitement and anticipation, as the home was due to have a Brass Band playing at their Christmas party (18th December 2006), at which the manager was due to play, alongside one of the grand-daughters of a resident, the latter being a surprise for the resident. Visiting & Communal Contacts: The evidence indicates that the visiting arrangements at the home met both the service users and/or their relatives/visitors needs: Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 18 • The ‘statement of purpose’ makes clear the visiting arrangements for the home, details of which are also included within the ‘service user guide’, copies of the company document seen on visits to previous ‘Islecare 97’ establishments. ‘The client’s family, relatives and friends are encouraged to visit regularly and to maintain contact by letter or telephone, when visiting is not possible. In these cases, staff will offer to assist the resident to respond where help may be needed. Visitors will be welcome at all reasonable times and are asked to let the Person in Charge know when their arrival and departure from the home. For security and fire safety reasons, visitors must sign the visitor’s book on each occasion. The resident has the right to refuse to see any visitor and this right will be respected and upheld by the Person in Charge, who will inform the visitor/s of the resident’s wishes, if necessary’. • The responses of the three relatives, who completed comment cards, indicate that they find the visiting arrangements at the home satisfactory, ticking ‘yes’ to the questions: ‘ do staff welcome you in the home at anytime’ and ‘ can you visit your relative in private’. An additional remark, already quoted within this report, further emphasises the fact that people are made to feel welcome when visiting the home. • On arrival and departure from the home visitors are expected to sign the visitors book, this providing a degree of security and keeping track of the people in the home in the event of fire, although the log also provides evidence of the visitors to the home and the type of people undertaking the visits, relatives, friends or professionals, etc. Throughout the fieldwork visit the inspector observed several individuals and groups visiting the home, one person discussing how she visits regularly to take her father out and how the staff were always very helpful, polite and friendly. • Choice and Independence: The evidence indicates that the people residing at Steephill are provided with opportunities to exercise their rights to selfdetermination and autonomy. • The ‘statement of purpose’ commits the service to: ‘Giving residents the opportunity to select for themselves from a range of options, which may DS0000012539.V316481.R01.S.doc Version 5.2 Page 19 Steephill be appropriate to themselves’ and ‘Allowing residents to make their own decisions and think and act for themselves’. • During the fieldwork visit the inspector noticed several occurrences that reinforced the above commitment: o Service users were observed making use of the lounges, throughout the day, swapping between rooms depending on the activity or pursuit being undertaken in each location. o Service users were also noted to take themselves off to their bedrooms, as and when they wished, people often migrating between their bedroom and the lounges. o The use of residents’ meetings, copies of the minutes from the last meeting provided to the inspector, which enable people to explore issues and discuss changes within the home i.e. outings and menus, which appear on the last meeting minutes. o Outings with families, as mentioned previously within the report. o Choice of menu, with two main meals prepared daily and a range or selection of teas and supper meals/snacks. • Both of the comment cards returned to the Commission by service users, indicate that they feel supported by staff when making decisions, responding ‘yes’ to the question ‘do the staff listen and act on what you say’, although one person did add ‘the staff do the they can with not enough staff’. The relatives of the service users also felt that people were provided with the right to self-determination but acknowledged via the comment cards that: if your relative is not able to make decisions are you consulted about their care’, all three people ticking ‘yes’ in reply to this question. • Meals & Menus: The evidence indicates that meals are well balanced, nutritious and meet the needs and preferences of the service users: • • The dataset included sample menus, which evidenced that choice is provided over the meals served. Observations of the mealtimes indicated that sufficient staff are available to support the service users with their mealtime care needs, etc and that mealtimes are social events, with each table seeming to enjoy the lunchtime experience. Observations also evidenced that the meals were well presented and served individually, with the staff demonstrating an awareness of the likes/dislikes and/or preferences of the service users. • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 20 • Records also indicated that each service user has his/her right to choice upheld, the menu records completed by staff in the presence of the resident and reflective of the meal they opted for from the choices available. It was also evident from the minutes of the last residents’ meeting, as discussed above, that meals and menus were discussed and that people were generally satisfied with the food provided at Steephill. This observation is further supported by the views of the two service users to have completed comment cards for the Commission, one individuals ticking ‘yes’ in response to the question ‘do you like the meals at the home, whilst the second person ticked ‘usually’. In conversation with service users, over the lunchtime period, the view was far more united, all of the people spoken with praising the catering staff for the meals presented. The tour of the premises established that the kitchen is a large, wellappointed and equipped facility, which is able to meet the catering needs of the home. During the last inspection it was reported that: ‘the kitchen cupboard doors have missing door handles and the paintwork is showing visible signs of wear and tear. Internally the cupboards have wooden shelves, which have become rough, and pose a health and safety risk and the utensil drawers are sticking, one member of staff stated that they had incurred an injury due to this. The fire exit from the kitchen has a sticking door, the fly nets are ripped and the window frames are rusted with a pane of glass cracked. There is an extractor fan and windows can be opened, however the cooks stated that the temperatures in the kitchen becomes unbearable throughout the summer’. These issues have now largely been addressed, with remedial work carried out to replace windows, fly screening, cupboard doors and handles and free up drawers and fire doors. The issue of the temperature cannot be reassessed until the summer, although given the size of the kitchen and the availability of good ventilation, now that the fly screens have been repaired and windows • • • • • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 21 and doors can be open, should help the heating issue within the kitchen. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 16: The service users and/or their relatives feel they are listened to and can approach the staff and management with concerns or complaints. Standard 18: Service users are protected from abuse. EVIDENCE: Complaints: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and confident that the issues will be appropriately handled and addressed. • The two service user comment cards, returned to the Commission, were ticked ‘always’ in response to the question ‘do you know how to make a complaint’. One of the two people adding: ‘We shall never get a more tolerant manager then the one we have, I take all my trouble to our manager as she understands me’. • All three relatives comment cards also indicated that people know how to make a complaint and confirming they have never needed to use the process. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 23 • Details of the home’s complaints process was included within the dataset information provided to the Commission, along with a summary of the home’s complaints activity over the last twelve months: 1. 2. 3. 4. 5. One complaint received in the last twelve months One complaint substantiated No complaints partially substantiated All complaints responded to within the 28 day timescale All complaints resolved. Information relating to each of the complaints is maintained by the home within its complaints log, along with details of the investigation and copies of the response to the complainant. During the visit the manager provided the inspector with sight of the complaint letter from the complainant, as well as details of her response, following her investigation and a confirmation letter from the complainant thank her for the ‘positive approach to managing complaints’. • The ‘statement of purpose’ document, included within the dataset bundle, makes clear reference to the complaints process and the management of complaints, as does the brochure documentation, available within the main hallway, ensuring that people/visitors are able to access details/information about the home’s complaints process if they require it. Protection: The evidence indicates that the service users’ welfare is promoted and that the management and/or staff seek to protect people from abuse and harm by their practices. • The dataset evidences that adult protection/prevention of abuse policies and procedures are accessible to the staff and that these documents were updated in July 2006. The dataset also establishes that no referrals have been made to the local authority adult protection team in the last twelve months and noone has been referred for inclusion/consideration on the ‘protection of vulnerable adults’ (POVA) register. The dataset information also indicates that within the last twelve months staff have received updated training on and around adult protection arrangements and responsibilities. As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing was identified. DS0000012539.V316481.R01.S.doc Version 5.2 Page 24 • • • Steephill • Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. Research of the Commission’s database and information gleaned from previous inspectors involved with the service also confirms that no protection concerns exist at this time. Two of the three staff questionnaires returned also indicate that staff have a fairly good understanding of their roles in protecting people from abuse and promoting their rights to complain, the identifying their willingness to report or bring issues to the seniors/manager’s attention, the third staff member to complete a questionnaire opting not to complete this question. • • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standard 19 & 26: The premises is generally well maintained, clean and tidy and a reasonably pleasant environment for the service users. EVIDENCE: Environment: The evidence indicates that the service users live within a reasonably well-maintained, clean and tidy environment that meets their immediate and long-term care needs. • A tour of the premises was undertaken with the management, when in addition to following up on issues outstanding from the last inspection the inspector also checked the premises for continued compliance with the standards. Issues identified during the last inspection included: Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 26 o ‘In the grounds the paving is starting to break-up in some areas and could be a health and safety risk’. This issue it was noted continues to be outstanding and the manager must consult with estates department staff to ascertain, whether a risk is posed to the residents from any uneven or damaged pathways, etc. o ‘There were cigarette stub ends at the end of the ramp leading from the dining room, which looked unsightly’. This issue would appear to have been addressed, as no cigarette ends were noted around the premises, smoking for service users now confined to the smoking lounge. o ‘A number of pieces of garden furniture were unsafe and the majority were covered in lichen and moss’. Garden furniture has largely been stored for the winter and will require consideration at a later inspection. o ‘The fire escape routes from the upper floors were found to be covered in leaf debris and moss and could be a serious health and safety risk’. A walk around the grounds established that leaf debris no longer occluded the fire exits and a discussion with the manager established that the maintenance personnel now had responsibility for ensuring this issue was addressed. o ‘The kitchen cupboard doors have missing door handles and the paintwork is showing visible signs of wear and tear. Internally the cupboards have wooden shelves, which have become rough, and pose a health and safety risk. The utensil drawers are sticking and one member of staff stated that they had incurred an injury due to this. The fire exit from the kitchen has a sticking door. The fly nets are ripped. The window frames are rusted and a pane of glass was cracked. There is an extractor fan and windows can be opened however, the cooks stated that the temperatures in the kitchen become unbearable throughout the summer’. As reported above the majority of the work in the kitchen has been completed, although the temperature concern cannot, at this time, be adequately assessed. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 27 • The actual tour of the premises was useful to the inspector, who had not visited the home for sometime, as it enabled him to re-orientate himself to the environment and its layout. During the tour one minor issue was brought to the manager’s attention, which will require some attention: • The seat of the bath hoist (top floor) needs replacing. Cleanliness: The evidence indicates that the home is generally clean, tidy and free from odours, although some potential sites for cross contamination of infection were brought to the manager’s attention. • Remarks on the cleanliness of the home would tend to indicate that the service users feel the standards of cleaning at Steephill are satisfactory, both comment cards returned indicating ‘Always’ in response to the question ‘is the home fresh and clean’. The observations, comments and opinions of the service users were largely upheld during the tour of the premises, when the home was noted to be clean and tidy, as reported. However, examination of equipment used in the home i.e. standaids, suggests that the cleaning of these items is not as thorough as it should be, with a clearly visible build up of grime and filth noticeable. It is important that staff get into the habit of clean all such pieces of equipment, hoists, standaids, wheelchairs and commodes, as these items are often used by more than one person and therefore perfect vehicles for the spread or cross-contamination of infectious agents. • Another portal for the spread of infectious agents is the use of shared toiletries, as bacteria or flora from shed skin cells etc, can easily be transmitted between clients. During the tour of the premises, it was noted on several occasions that bathrooms had toiletries left in them, which could encourage sharing, shampoos, soaps, gels, etc. The practice of not bring personal wash items to a bathroom, when delivering personal could also be construed as disrespectful of the residents rights to choice and self-determination, the right to use their own wash items, therefore staff must refrain from using or leaving toiletries within communal bathrooms. • However, on the positive side the fieldwork visit did enable the inspector to observe member(s) of the home’s domestic staff team working around DS0000012539.V316481.R01.S.doc Version 5.2 Page 28 • Steephill the home, cleaning and tidying both communal areas, corridors and residents’ rooms. • The tour of the premises also permitted the inspector to establish that paper towels and liquid soaps are located in each of the communal bathrooms and toilets, along with appropriate bins. The dataset established that infection control training has been provided to the staff team within the course of the last twelve months and that policies and procedures on the management of infection control principles are available to the staff team, although the policies were last updated in 2002 and this should be reviewed. • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 27: Staffing levels are sufficient to meet the needs of the service users. Standard 28: The home has achieved the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. Standard 29: The recruitment and selection practices of the home are sufficiently robust and designed to ensure that the wellbeing and safety of service users is assured. Standard 30: Inhouse training and development opportunities for staff are good. EVIDENCE: Staffing Levels: The evidence indicates that the needs of the service users are being meet by the supply and deployment of staff. • Copies of the staffing rosters, supplied as part of the dataset, suggest that the home is sufficiently well staffed and that carers are available, across the twenty-four hour period to meet the service users’ needs. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 30 • Observations further evidence the fact that adequate staff are available to meet people’s health and social care needs, the staff on duty comprising: 1. 2. 3. 4. 5. 6. The manager The assistant manager Five care staff One catering staff One ancillary/Domestic staff Two maintenance persons (estates team staff) • Feedback from the service users was united in the fact that people feel at times there are inadequate numbers of staff around to meet their needs, one person remarking: ‘sometimes I have to wait longer than I’d like for assistance on and off the toilet’, the second person adding: ‘this home needs extra staff’ and ‘staff are limited with what they can do with not enough staff’. The relatives of service users, however, seem to feel there are sufficient staff available, all three ticking ‘yes’ in response to the question: ‘in your opinion are there always sufficient numbers of staff on duty’. A view supported by the sole health care professional to comment on the service, this person is clear that the needs of the service users were being well met at the home’. Other issues which tend to suggest that sufficient staff are available within the home are: o The activities programme and outings o Observations during the visit o A call system monitor, which records staff response times to ringing call bells and which appears to indicate satisfactory responses. o Observations of the previous inspector who recorded: ‘the staffing complement has sufficient numbers and skills mix to meet the needs of the residents’. • • • Training & Development: The evidence indicates that the training opportunities for the staff are good. • As part of the dataset information the manager included copies of the home’s forthcoming teaching session and details of both the mandatory and non-mandatory courses completed by all staff since their employment. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 31 Mandatory: o o o o o Infection Control Food Hygiene Fire safety Manual Handling Health and Safety Non-mandatory: o Dementia Awareness o Adult protection Forthcoming events: o o o o • Palliative Care Dementia Awareness Fire safety Health and Safety, including – health and hygiene, manual handling, fire training and food hygiene. In discussion with staff it was quickly established that training opportunities are continuously made available at Steephill, events arranged and delivered at Islecare ‘97 main offices in Shanklin. The questionnaires returned by three care staff largely support the feedback from the staff seen during the fieldwork visit, two ticking ‘yes’ in response to the question: ‘does the home provide funding and time for you to receive relevant training’, the third person opting to tick ‘do not know’ and stating ‘most training is done inhouse’. Two of the staff also listed courses completed this year including: ‘manual handling, fire safety, food hygiene, health and safety and adult protection’ It was also clear, given the dataset information and feedback from staff during the visit, that they are also being supported when accessing National Vocational Qualifications (NVQ) level 2 courses or equivalent. The evidence within the dataset indicating that the home has met and surpassed the 50 ratio recommended within the National Minimum Standards, the actual percentage holding an NVQ 2 or above being 72 , this potentially rising to above 83 in 2007 when a further two staff are due to complete their NVQ course. • • • • Recruitment & Selection: The evidence indicates that the home’s recruitment and selection process is now being appropriately managed. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 32 • During the last inspection the visiting inspector noted: ‘Seven staff files were viewed and were found to contain two references. There was no evidence of Criminal Record Bureau (CRB) checks or Prevention of Adult Abuse checks (POVA). The assistant manager did have a copy of her CRB disclosure available for inspection. None of the staff files had evidence that identification had been supplied. There was not a staff file available for the member of pool staff’. • At this visit the files of two newly appointed staff were reviewed and each was found to contain the following information: o o o o o o o o o o An application form Details of interview Contracts Induction information Employment correspondents Two references Protection of Vulnerable Adults clearance Criminal Record Bureau Check outcome Supporting identification and documents Supervision record • The company’s induction, which has been viewed on visits to other Islecare 97 establishments, is fully compliant with the ‘Skills for Care’ common induction standards and requirements, although an additional inhouse introduction tool is still available for orientation purposes. Feedback taken from the staff questionnaire indicates that people’s experience of the recruitment process is largely positive, all three carers acknowledging that they had: o o o o o o Completed application forms Provided two references Been required to submit to CRB and POVA checks Received and induction Received a Contract Been supplied with a job description. • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 33 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 31: The manager possesses both relevant managerial and care qualifications and is an experienced leader. Standard 33: The home’s quality assurance systems ensure the home is run in the best interests of the service users, although some internal monitoring of the staff’s performance is required. Standard 35: The arrangements for handling service users’ monies are satisfactory and designed to ensure people’s financial interests are safeguarded. Standard 38: The health, safety and welfare of both the service users and staff team are appropriately managed and promoted. Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 34 EVIDENCE: The evidence indicates that the home is well run and managed and that the service users, their relatives and staff are appropriately protected from harm and injury. • Information contained within the previous inspection report indicates that the manager possesses both the National Vocational Qualification (NVQ) level 4 in Care and the Registered Manager’s Award (RMA): ‘The manager has completed NVQ level 4 and the Registered Managers Award’. • This finding is further supported by the company’s ‘statement of purpose’ document, supplied as part of the dataset bundle, which lists the skills and qualifications of the all employees at Steephill and identifies some of the managers qualifications/experiences as: o o o o • Registered Managers Award Level 4 NVQ level 4 in care 3 years as assistant manager 7 years as registered manager Further evidence of how well the home is run comes from the relatives comment cards, with people commenting: ‘The care given to my mother has been first class and the staff from the manager down has made the care home what it is today – a friendly, caring and well run home from home’. ‘We’ve been very impressed with the care my mother W is being given and pop in at all times of the day and I’m always made most welcome’. • Feedback taken from the staff questionnaires also indicates that the staff feel the home is well managed, two of the three people ticking ‘yes’ in response to the question: do you feel that you have enough support from your manager to help you begin working with the service users’, the third person ticking ‘no’ but deciding not to elaborate on this statement. However, perhaps most poignant is the observations of the service users, one person in particular singling the manager out for praise, as indicated earlier in the report, the person remarking: ‘We shall never get a more tolerant manager than the one we have, I take all my trouble to our manager as she understands me’. • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 35 Quality Audit and Assurance: The evidence indicates that service users and/or their relatives are afforded the opportunity to comment on the service provided at the home. • As previously documented within this report residents’ meetings are regular events, designed to ensure the observations, views, feelings and wishes of the service are taken into consideration. The minutes of the last meeting indicating that people were consulted on: o Activities and Outings o Meals and Menus o Laundry and clothing selection. • The use of this process to consult with service users was also identified at the last inspection, as was the company’s use of annual surveys to gauge opinions on wider issues, the inspector recording: ‘Residents are consulted with on a daily basis and are also able to air their opinions through the residents’ meetings, which are held every three months. Islecare undertake an annual survey with the use of resident questionnaires’. • Another important element of any quality auditing system is the work undertaken with the staff, which from a training and development perspective is reasonable, as evidenced earlier within the report. Staff also confirmed, during conversations, that team meetings and appraisals are regular occurrences and that generally they found or considered these events useful and productive. A view mirrored by the response two of the three staff to complete a Commission questionnaire, both tick ‘yes’ in response to the question: ‘do you have team meetings regularly’, the third person again electing to respond ‘no’. • • Service Users’ Monies: Evidence indicates that no changes have occurred in how service users’ monies are managed and that previously the home’s management of service users’ finances has been considered appropriate and satisfactory. • The last inspector to review this standard reported ‘the inspector viewed the home’s handling of finances and was satisfied that all financial transactions are recorded accurately and that residents’ monies are handled appropriately. DS0000012539.V316481.R01.S.doc Version 5.2 Page 36 Steephill • The manager explaining that where the home is involved in managing the finances of service users all recommended safeguards and precautions have been adopted. This included: 1. 2. 3. 4. Obtaining receipts Balancing accounts Providing appropriate storage facilities Individually held and maintained monies/accounts. • The dataset further establishes that ‘all service users receive their full personal allowance to dispose of as they wish’ and ‘records are kept of the management of personal allowances’, as confirmed above. The dataset also indicates that the home has a policy available to staff on the management of service users’ finances and that this was last updated or reviewed in July 2006. There is no indication that the finances of the service users are not being appropriately managed and safeguarded at all times. • • Health and Safety: The evidence indicates that the health and safety of the service users and staff is being appropriately managed. • • • No immediate health and safety concerns were identified with regards to the fabric of the premises during the tour of the premises. The dataset establishes that full health and safety policies/guidance documents are made available to the staff. Health and safety training is clearly made available to staff, with the dataset evidencing that staff complete fire safety, moving and handling, infection control and food hygiene. Access to paper towels and liquid soaps within bathrooms and toilets are indicators of attention to infection control, as is the availability of a specific infection control policy, as listed within the dataset and the training opportunities, as delivered earlier in the year. However, attention is required to the cross contamination risk posed by dirty or unclean equipment and attention to should be given to paths, etc ensuring they are even and well maintained. • • Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 37 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 38 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 OP19 Regulation Requirement Timescale for action 20/02/07 2 3 OP19 OP26 4 OP26 Regulation Damaged pathways to be 23 repaired or replaced. This requirement remains outstanding from the last report. Regulation The damaged hoist seat must be 23 replaced. Regulation Equipment used in the care of 13 the service users must be appropriately cleaned and maintained. Regulation Toiletries must be taken to the 13 bathroom, on individualised bases; and not shared to limit the possibilities of crosscontamination of infectious agents. 20/02/07 20/02/07 20/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 39 Steephill DS0000012539.V316481.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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