Care Home: Stella House

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What the care home does well People living in the home feel they receive good care from staff. One person said, `staff are very caring and attentive`. Another person said, `staff are always very pleasant and very professional and nothing is too much trouble`. A relative also commented positively about the care their relative received. The home acted quickly when someone became unwell. This helped in making sure people got the right kind of support to help them with their health needs. A health professional said, `staff have a good understanding of people`s needs, we are always kept up to date with any changes`. The environment was clean, comfortable and pleasant for the people living there. Staff said they received good training, which helped to maintain and develop their skills and knowledge and kept them up to date on how to meet the needs of the people in the home. People felt that the management were helpful and approachable. This helped people to feel safe and comfortable in raising any concerns about the home. What has improved since the last inspection? People who needed assistance to take drinks were given this. This helped in making sure that people did not become dehydrated. Better medication systems were in place. This helped in making sure that people received their medications correctly and medications did not exceed their expiry date so were safe to administer. Records are now kept of all medication received in the home and medication that has been carried forward from the previous month`s supply. This meant that medication could be more easily accounted for so that any discrepancies could be identified and acted on promptly. Call bell requests were responded to promptly so that people received support quickly and when they needed it. People`s requests for help were listened to and acted on immediately by caring and respectful staff. What the care home could do better: More personal information could be obtained about individual`s lives and their preferences in the way they are supported. This would enable care to be planned in a more person centred way. The home could look at more suitable ways of monitoring the weight of people who are immobile in order to ensure any health needs in this area can be more easily identified and acted on. More time and activities could be spent with people on a one to one basis so that people`s social needs are met in an individualised way. Lighting could be improved in the dining area and on the downstairs corridor. This would make this part of the environment more pleasant and safer for people. The toilet seat in a downstairs toilet could be repaired to help maintain the dignity and safety of people when using it. To keep people safe from the spread of fire, fire doors could be kept open by more authorised means and not door wedges. CARE HOMES FOR OLDER PEOPLE Stella House Cobblers Lane Pontefract West Yorks WF8 2SS Lead Inspector David White Key Unannounced Inspection 6th January 2009 09:00 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 Stella House DS0000006218.V373484.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. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stella House Address Cobblers Lane Pontefract West Yorks WF8 2SS 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) 01977 600247 01977 600247 jillf.stella@btconnect.com Mr Fieldhouse Mrs J Fieldhouse Mrs Jill Fieldhouse Care Home 41 Category(ies) of Dementia - over 65 years of age (41), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (41), Old age, not falling within any other category (41) Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th January 2008 Brief Description of the Service: Stella House is a care home providing personal care and accommodation for 41 older people. The home is privately owned by Mr and Mrs Fieldhouse and is situated in a residential area outside the centre of Pontefract. Mrs Fieldhouse is the registered manager. The premises, which are mainly purpose built, are situated on the site of a former farm and house and set in well-maintained gardens with parking space for staff and visitors. Bedrooms are located over two floors; there are 39 single bedrooms and one double bedroom. A passenger lift provides access to the first floor for those people with limited mobility. At the time of the inspection weekly bed fees for people living at the home were £398.00 per week. The fees are annually reviewed in line with Local Authority contracts. Information about the home is made available through the home’s Statement of Purpose and Service User Guide both of which are available, on request, from the home. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use the service experience good quality outcomes. The Commission for Social Care Inspection inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations-but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on the 6th January 2009. The visit lasted from 9am until 3.30pm. For some part of the visit, the inspector was joined by an ‘expert by experience’. An expert by experience is someone who has expert knowledge of care services through their own experience of using services. They join the inspector to help them get a good picture of the service from the viewpoint of the people who use it. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include: • • • Reviewing information that has been received about the home since the last inspection. Information provided by the manager on an Annual Quality Assurance Assessment questionnaire. Surveys returned from people who live at the home, staff and health professionals who visit the home. During the visit time was spent talking to people who live at the home, a relative, care staff, a cook, a health professional who was visiting the home and the management. We observed staff caring for people in communal rooms, looked at various records relating to care, staff, and maintenance, and looked at some parts of the building. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 6 The registered manager was available throughout the site visit and the findings were discussed with her, the other joint owner and the assistant manager at the end of the inspection. What the service does well: What has improved since the last inspection? People who needed assistance to take drinks were given this. This helped in making sure that people did not become dehydrated. Better medication systems were in place. This helped in making sure that people received their medications correctly and medications did not exceed their expiry date so were safe to administer. Records are now kept of all medication received in the home and medication that has been carried forward from the previous month’s supply. This meant that medication could be more easily accounted for so that any discrepancies could be identified and acted on promptly. Call bell requests were responded to promptly so that people received support quickly and when they needed it. People’s requests for help were listened to and acted on immediately by caring and respectful staff. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 7 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. Stella House DS0000006218.V373484.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 Stella House DS0000006218.V373484.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): 3 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Proper pre-admission procedures were in place and being followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Written information is also available to them to help them with their decision-making about whether the home can meet their needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provide information about the services on offer at the home. These are updated annually so that people are kept up to date with any changes. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 10 People living in the home who returned surveys to us said that they received a contract on moving into the home and were kept up to date with information about the home. People who are thinking about moving into the home have their needs assessed by staff before admission takes place. This usually involves one of the management team going to see the person either in their own home or in hospital to carry out the assessment. The manager did say that when people are placed at the home for emergency respite care this is not always possible but information is initially obtained verbally about the person’s needs and the manager then records this so that staff get information straight away about what the person’s needs are. In all admissions information is obtained from various sources such as care managers, relatives, GP’s (General Practitioners) and where appropriate hospitals to check that the home will be able to meet the person’s needs. We looked at the care records of a recently admitted person. The assessment information clearly stated why the person had been admitted to the home. Information had been obtained from the local authority about the person’s needs and how these were to be met. There was evidence that the person and their family had been involved in this process. The home does not provide intermediate care. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People’s personal and health needs were met in a way that respected their privacy and dignity. Improvements to the medication arrangements helped in making sure that people’s health needs were properly met and medication practices were safer. EVIDENCE: The care plans contained an assessment of people’s individual needs. From this assessment a care plan was developed detailing how these needs were to be met. The plans were reviewed on a regular basis to help keep the information up to date. The care plans gave information about the care that people needed and had been developed to include more personal information about individuals and their choices. However, further work was needed in this area in order to make sure that the support given was person centred to suit the individual’s needs and wishes. Staff had received updated training about care Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 12 planning to help with this. All the surveys returned by staff said that they were kept up to date about information relating to people’s needs and staff were updated at the start of shifts about this and any other changes. Annual reviews take place to discuss people’s care with their family and others who were involved in their care. A relative said, ‘I am always kept up to date about my relative’s health’. Risk assessments were carried out to identify where people could be at risk from pressure ulcers, falls and nutritional problems. Where people were identified as being at risk a plan was in place on how this was to be managed. The care records of one person showed that the person had been assessed at being at risk of pressure ulcers. The district nursing team had been notified and had provided advice and equipment such as a special mattress to reduce the risk of the problem getting worse. Where people were identified as being at nutritional risk, advice had been sought from a dietician and measures had been put in place to address areas of need. Most people’s weight was monitored on a regular basis. However, this was difficult for people who were immobile and unable to stand up, as the home did not have any equipment to do this. Staff did say that through observation they would know if someone was losing weight and would refer the matter to the GP. However this way of monitoring weight could be unreliable and inaccurate. This was discussed with the manager who will be looking into alternative more suitable means of weighing people who are immobile. Each person had a GP and access to dental and chiropody services. Referrals were made to specialist services as and when required. People living at the home said they always received medical support when they needed it. Healthcare information was well recorded so that staff were up to date about people’s health care needs. A health professional who visited the home said, ‘staff have a good understanding of people’s needs, we are always kept up to date with any changes and the home is very well organised so that everything we need is available for when we visit’. A survey returned by someone living at the home said, ‘staff are very quick to pick up on any problems before they become major’. People spoke well about the care they receive from staff. One person said, ‘staff are very caring and attentive’, another said, ‘staff are always very pleasant and professional’. They said they were encouraged to make their own choices where possible and these were followed. People said they could have a bath when they chose to have one although one person did say this was dependent on if there were enough staff available to help with this. Improvements had been made in the way people were supported with their personal care needs. Those people spoken to said that staff were prompt in responding to call bell requests and this could be seen at the time of the visit. People who needed assistance with drinks and food were given this in an unhurried way and records were well maintained of people’s fluid and Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 13 nutritional input where this was needed. People who needed support to go to the toilet were given this straight away and requests for personal support were acted on quickly. Some people had footstools to help them to rest their legs. Three ladies were observed to have had their nails varnished. Since the previous inspection visit there have been a number of improvements to the home’s medication system. New systems have been put in place to monitor the storage, administration, ordering and disposal of medications. Weekly audit systems were in place and spot checks were regularly carried out to make sure that any discrepancies were quickly identified and acted on. All medication was dated to say when it had been opened and the audits ensured that medication did not exceed the expiry date. The Medication Administration Records were up to date and medication that had been administered had been accurately recorded. A system had been put in place to record all medications received into the home and medications that had been carried forward from the previous month. This helped in making sure that people received their medication as prescribed and meant that medication could be more easily accounted for. Staff who administered medications had received updated medication training. Since the previous inspection visit there had been no reported incidents of any medication errors. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People had opportunity to take part in recreational activities although more consideration could be given about people’s individual social needs. People were encouraged to maintain important links with their family. EVIDENCE: Surveys returned by people living in the home indicated that there were enough activities on offer. Activities were mainly organised in-house although there were occasional trips out in the local community. At the time of the visit people could be seen playing dominoes and bingo sessions were held at the home. There were picture cards in the lounges of olden days. One person said, ‘there’s lots to do, I’m never bored’. Outside entertainers visit the home and there were monthly visits to the home from representatives of the different churches to meet people’s spiritual needs. An outside company called Motivation and Co visits the home monthly to provide activities. Some people recently had a day out at a local shopping centre and there had been an outing Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 15 to a local cinema for those who chose to go. Other people had also enjoyed a meal out at a local restaurant. Some people said that they chose not to join in activities and were not bothered about going out. However more consideration needed to be given as to people’s individual social needs. Most of the activities were organised for groups of people. It was observed that people who spent most of their time in their bedroom mostly received support with their physical needs but little time for any other individual type of activity or interaction. Two people living in the home did say that sometimes staff were very busy and had little time to talk. A relative commented ‘the staff are very good. I would just like to see more time spent with people on a one to one basis’. People said that they were able to make their own choices about their daily lives where possible. One person said, ‘I get up and go to bed when I want’. Visitors could see people whenever they wanted and people who visited the home said they were always made to feel welcome. One person regularly received telephone calls from their daughter and there was a communal telephone at the entrance to the home where people could make calls out in private. Comments about the food were generally positive. A cook confirmed that they were provided with a good supply of fresh products, including meat, fruit and vegetables. People had a choice of two meals at mealtimes and alternative meals were available if people did not like what was on the menu. The cook said that he spoke to the people at the home on a regular basis to make sure the menu was to their liking and changes were made in accordance with people’s wishes. The cook was aware of people’s special dietary requirements. A mealtime was observed to be unhurried. Staff supported people who needed assistance with their eating. One member of staff was stood up whilst assisting one person with their meal and this matter was discussed with the manager. People could eat in their bedroom if they chose to do so and second helpings were offered to people. One person commented ‘the food is nice’. People’s birthdays are celebrated with a birthday tea and cake. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People’s concerns were listened to and acted on. Systems were in place to safeguard people from abuse. EVIDENCE: The home had a complaints procedure and surveys returned by people living in the home indicated that people knew how to make a complaint and who to speak to about any concerns. People said that staff always listened to and acted on what they said. One person commented ‘I can tell the manager anything at anytime’. There have been no complaints made to the Commission for Social Care Inspection about the home since the last inspection visit. The home had received one complaint that had been made directly to them. This had been looked into and the outcome from the investigation had been recorded. Discussion was had with the manager about the system being used for recording complaints. The manager said that a new recording system would be introduced as a result of this. The home’s safeguarding of vulnerable adults policies and procedures were reviewed and updated in line with the local authority’s policies and procedures. There had been some incidents in the home that required safeguarding procedures to be followed. Referrals had been made to the appropriate Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 17 agencies to keep people safe. Staff received training on how to safeguard people from abuse and those staff spoken to understood their roles and responsibilities in reporting abuse. Staff also received training on how to manage people’s behaviour that challenged the service. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home was clean, comfortable and suitable for the needs of the people living there. EVIDENCE: The accommodation was over two floors and could be accessed via a passenger lift. There was also level access to the home so it was suitable for people with mobility problems. There were communal lounges where people could sit and watch television and a conservatory. One of the lounges was a designated smoking area for those people who wished to smoke. The home had 39 single bedrooms and a double bedroom. The bedrooms seen were personalised to suit individual tastes. There were toilets and bathroom areas on both floors and shower facilities on the first floor that could be accessed via the passenger lift. Most toilet and bathroom areas had signage in picture Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 19 format. This helped people with confusion to locate these areas. Handrails and specialist bathing equipment were available to assist people with their independence and mobility. Call bells were accessible in personal and communal areas so that people could seek assistance when they needed it. The home felt warm and comfortable and consideration was given to the age of people living at the home. Extra blankets were available in the communal areas if people wanted extra warmth whilst sitting in there. During a tour of the environment it was observed that the lighting in the dining room area and downstairs corridor was not as good as in other parts of the building. This made these parts of the environment less pleasant and could have caused potential harm to people from tripping, especially for those people with visual impairment. In one toilet on the ground floor the toilet seat was found to be loose. The management of the home agreed to address both of these issues promptly. Surveys returned by people living in the home all said that the home was always kept fresh and clean and this could be seen at the time of the visit. The home had an ongoing programme of re-decoration and the home was well maintained. One staff member said that there was always a good supply of aprons and gloves available for use. This helped to reduce risk from cross infection and staff received training on health and safety, food hygiene and infection control. People’s clothes looked clean and staff were employed to look after the laundry as part of their job role. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People at the home were cared for by a sufficient number of staff who received the training they needed to meet people’s needs. EVIDENCE: On most days there were five care staff on duty in a morning and afternoon and during the night there were three waking night staff. The manager and assistant manager work supernumerary and there were on-call management arrangements when they were not on-site so that staff could seek support and advice at all times if needed. In addition to care staff the home employed catering and cleaning staff. People living at the home who returned surveys to us all said that there were enough staff and that staff were always available. Staff also felt that staffing levels were generally sufficient although one person did say the workload could be difficult if only four people were on duty through the day. The duty rotas showed that this does not often happen and the manager said that sickness at short notice was always covered as much as possible. Staff said that morale was good and that staff retention had improved. A survey returned by one staff member said, ‘this is a lovely environment to work in’. Another staff member spoken to said, ‘we have a really good staff team’. People living at the Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 21 home said that staff were always available when needed and responded to requests for support quickly. One person living in the home said, ‘staff are pleasant and helpful, nothing is too much trouble’. A health professional also commented’ when I visit the home and need some information, there are always staff available to help me’. Staff spoken to had a good understanding and knowledge of the needs of the people they care for at the home. From observation it was evident that they provided support in a sensitive, calm and patient manner and responded appropriately to requests for help. Three staff recruitment files were looked at. These showed that all the necessary checks had been carried out before people started working at the home. This helped to make sure that only suitable people were employed to work there. Surveys returned by staff said that they received good training to support them in doing their jobs. One person spoken to said, ‘the training is very good’. The manager keeps records of staff training in each member of staff’s individual files. The training records showed that staff were kept up to date with training in safe working practices such as moving and handling people. Other training was given in areas specific to the needs of people at the home. This included dementia care training. New staff had induction to prepare them for their new jobs and to make sure they did not carry out any tasks they were unsure of. A survey returned by one staff member said, ‘I thought the induction was very good and got a lot of information from it’. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home was well managed in the best interests of the people who lived there. Whilst overall proper attention was given to maintaining people’s health and safety, one fire safety issue needed to be addressed. EVIDENCE: The manager and her assistant were very experienced in running the home. People living in the home spoke positively about the way the home was managed. One person said,’ all management staff are extremely approachable’. Surveys returned by staff all indicated that they received good support in doing their jobs. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 23 The home had systems in place to seek people’s views about how it was performing and areas for improvement. Annual surveys were sent out to people living at the home and to healthcare and other professionals who visit there. The recent survey results provided positive feedback about the home. A summary of the findings from the surveys could be found on display on a notice board in the home. Meetings were held with people living at the home to discuss such things as meal choices. Staff meetings were also held to enable staff to be involved in the running of the home. Staff said they received regular supervision to provide them with support and to identify any training needs. The home still had the Investors in People Award for the quality of the care and services they provide to people who use their service. The home holds monies on behalf of people. The owner said that these were kept in a separate account to the business account. Records were made of any incoming and outgoing monies so that monies could be easily accounted for. People could have access to their monies at any time. The self-assessment form completed by the home indicated that all the required maintenance and servicing of equipment was up to date and the records looked at confirmed this. The electrical wiring certificate was not available at the time of the visit. However, the Commission for Social Care Inspection received information shortly after the site visit confirming that the electrical wiring systems in the home had been tested and were safe. During a look around the environment in the old part of the building it was observed that a number of bedroom doors had wedges to keep them open. The owners of the home said that this was because some people liked their bedroom door to be open whilst they were in there. They also said that the fire authority had been aware of this practice and had advised that the arrangements were satisfactory if risk assessments supported this. The fire authority was contacted about this matter in order to confirm that they were satisfied with these arrangements. They visited the home shortly after the inspection visit and carried out a fire audit of the premises. They recommended that alternative authorised devices and not door wedges should be used for people who wish to have their bedroom door kept open in order to reduce potential risks from fire. The manager gave assurances that recommendations from the fire authority would be acted on and will write to the Commission for Social Care Inspection confirming what actions have been taken. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 24 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 Requirement To reduce the risk from the spread of fire, fire doors must not be held open by unauthorised means such as door wedges. Timescale for action 06/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations People’s care plans should be further developed to contain more personal information about people and the way they prefer to be supported. This will help in making sure that the support they receive is person centred. The home should have a better system in place for monitoring the weight of people who are immobile. This will help in making sure that any health issues in relation to people’s weight can be identified and addressed. The home should look at ways of developing more one to one time and activities with people. This will help to meet people’s individual social needs. The home should look at improving the quality of lighting in the dining area and on the downstairs corridor. This will DS0000006218.V373484.R01.S.doc Version 5.2 Page 26 2. OP8 3. 4. OP12 OP19 Stella House 5. OP19 help to make the environment more pleasant and safer for people when using it. Measures should be taken to address the problem with the broken toilet seat in the downstairs bathroom. This will help to maintain people’s dignity and safety. Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Stella House DS0000006218.V373484.R01.S.doc Version 5.2 Page 28 - 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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