Care Home: Stella Maris

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What the care home does well In talking with individuals who live in the home it was evident that they receive the care they need from a staff group who are committed to providing good quality care. Individuals said of the care "you can`t fault it" "I get the care I need" "staff respect you and all very helpful and friendly its a lovely home". The home has retained a number of staff over many years and this helps in providing a continuity of care with staff who have a good understanding of the needs of those who live in the home. The environment is well maintained and has a homely and welcoming atmosphere and there is a good effort to provide activities which appeal to those that enjoy the social life of the home. There are opportunities for individuals to voice their views about the service they receive through the use of questionaires and resident meetings. Individuals said that they "feel able to say what I think and something is done if I am unhappy about anything", "you only have say if you are unhappy and something is done to make it better". What has improved since the last inspection? There were no requirements made at our last inspection of this service. What the care home could do better: We have made a number of requirements as a result of this inspection including improving the homes Statement of Purpose so that it provides the information needed about the service provided at Stella Maris. This will then help individuals make an informed choice about living in the home and their knowing the service, such as staffing arrangements, they can expect. The home doesn`t provide waking night staff and to make sure that there is clear evidence that individuals do not require this level of service part of the individuals care plans must include an assessment looking at any potential care needs and routines during the night time period. We have also set a requirement about the undertaking of risk assessments in order to clearly identify potential risk to individuals health and welfare and provide staff with written guidance as to how to respond to any risks identified through this process. For all individuals there must be a moving and handling assessment identifying the arrangements in assisting and supporting individuals in any moving and handling tasks that staff may undertake with the individual. Whilst we recognise the training of staff in the home we noted in this inspection that a number of staff had not undertaken Safeguarding Adults training which is seen as a mandatory area of training. It was also noted that staff had not completed Mental Capacity Act training and would certainly expect the manager and senior staff to complete this training which includes deprivation of liberty training. Key inspection report Care homes for older people Name: Address: Stella Maris 8 Ellenborough Park South Weston Super Mare North Somerset BS23 1XW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Clarke     Date: 2 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Stella Maris 8 Ellenborough Park South Weston Super Mare North Somerset BS23 1XW 01934632817 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: stellamarissueb@aol.com Mr Ralph Timothy Morris care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate 18 persons aged 65 years and over requiring personal care. Date of last inspection Brief description of the care home Stella Maris provides care and support for older people. Situated close to the beach and parks in the southern part of Weston-super-Mare, the home is well positioned for the local amenities and services. The accommodation comprises two floors, the upper floor being served by a stairlift and a ground floor extension to the rear. The majority of rooms on the ground floor (12) seven of which have en-suite facilities; there are six rooms on the first floor and landing of which three have en-suite facilities. The home also benefits from two lounges, one a designated quiet lounge with library facilities. There is a large dining area. The home is sited within walking distance of the seafront and overlooks a private park. Stella Maris is situated near community facilities such as churches and shops. 0 Over 65 18 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of an inspection. We looked at a number of records relating to the quality of care provided in the home to help us in making a judgement about the service provided at Stella Maris. We looked at care planning, medication arrangements, staffing recruitment and training. There was an opportunity to talk with individuals who live in the home and members of staff. As part of this inspection we sent Have Your Say questionnaires to individuals and members of staff and received responses from 6 individuals who live in the home and 4 members of staff. Their responses helped in making a judgement about the quality of care. Care Homes for Older People Page 5 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 6 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes thorough admission assessments so that they can make an informed judgment about the capacity of the home to meet the identified care needs of the individual. The homes Statement of Purpose fails to provide the necessary information so that individuals can make an informed choice about living in the home and have sufficient information to make such a decision. Evidence: We looked at three pre-admission assessments and these provided good information about the health and social care needs of the individual. The home also obtains copies of any local authority assessment. We looked at the homes Statement of Purpose and found that it failed to give sufficient detail about various aspects of the care provided by the home. These were Care Homes for Older People Page 9 of 25 Evidence: specific details about the managers qualification and experience, staffing arrangements in the home including qualifications i.e. number of staff with NVQ qualification and night time staffing arrangements. They did not set out their admission criteria or aims and objectives of the home. Information about the accommodation including number of rooms and facilities is not included or details as to how individuals can make a complaint and what to do if they are unhappy with the homes response. Since our inspection we have been advised that some of the above information is available separate to the homes Statement of purpose namely Aims and Objectives, Complaint procedure. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 completes care plans which generally give clear information to staff about the care needs of individuals living in the home however they could be improved particularly around the completing of risk assessments so that as far as possible the health and care needs of individuals are protected. The homes practice in the administering and management of medication protects the health needs of individuals living in the home. The health needs of individuals who live in the home are protected and individuals are treated with respect. Evidence: We looked at care plans for a number of individuals and they showed good information about the care needs of individuals and associated tasks. Risk assessments had been completed for individuals relating to falls and leaving the home. One individual had a colostomy and another catheter however there was no risk assessment completed for these areas of care. Reviews had been held regularly and local authority reviews and in one instance a new care plan assessment had been completed as a result of the review of care. Psychological assessment had been completed for one individual we looked at and for another there was a Long Term Need Assessment Care Plan. For one Care Homes for Older People Page 11 of 25 Evidence: individual there was Skin Integrity plan however no Waterlow or similar tool had been completed or Moving and Handling assessment. This individual had high dependency needs and required full assistance with moving and handling. There were no night time care plans. We looked at the medication arrangements and found that there is secure storage with separate controlled drug storage. We looked at administering records for a period of 3 weeks and found they had been completed as required with no gaps in recording. Controlled drugs are recorded with two signatures. We checked the stock recorded against actual stock and found this was correct. There were separate records for use of paracetamol and individual personal stock. We checked the quantity against that recorded for 4 individuals and found there was significant difference from stock to actual for one individual. It was noted that the manager was aware of this difference. Records showed that individuals who live in the home have access to community health services such as chiropody, optician and community nurses. All those individuals who live in the home who responded to our Have Your say questionnaire (6 individuals who live in the home and 4 members of staff) said that Always receive the medical care they need. We spoke with individuals who live in the home about how they felt they were treated by staff specifically whether they felt treated with respect. All of those we spoke with said yes definitely, staff always treat me how I like to be treated and spoken to. We also observed staff supporting and assisting individuals and this was always with sensitivity and in a supportive caring manner. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The homes practice and routines are flexible and enable individuals who live in the home to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. Evidence: We spoke with individuals living in the home about the activities provided by the home. They told us theres enough going on enjoy the outings like to have more entertainment. We received 6 responses to our Have Your say questionnaire and they said: Always 4 Usually 1 Sometimes 1 to the question Does the home arrange activities you can take part in? Activities organised include bingo, films, music and various day trips. Staff told us they felt this was one of the strengths of the home and that they always have time to sit and chat and spend time with residents. One individual told us her visitors were always made to feel welcome another said they could have visitors whenever we want theres no restrictions. We asked individuals who live in the home about the meals provided and they told us Care Homes for Older People Page 13 of 25 Evidence: that there is a good variety of food and that they are always offered choice if we dont want whats offered though one individual said the home could offer better choice. We looked at the menus and there was a wide variety of meals available and certainly the meal on the day we visited was appealing and enjoyed by those we spoke with. Respondents to the questionnaire said they Always 5 Usually 1 like the meals in the home. One individual commented the food is 1st class and quite a variety another the food is excellent. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible individuals who live in the home are protected from harm by having a policy and procedure about Safeguarding Adults and providing training to all staff in this area. Evidence: We spoke with individuals about what they would do if they were unhappy about the quality of care they were receiving or had worries about anything. They told us they would talk with staff, would talk with one of the carers. Another person said Sue (the manager) is very good I can always go to her with a problem and she will sort it out. People we spoke with said they knew they could make a complaint if I wanted too. All respondents to our questionnaire said they knew how to make a complaint. We spoke with the manager and owner of the home about a complaint they and ourselves had received. This related to medication and we are satisfied from our discussion that the home acted in good faith and professionally in dealing with this matter and have responded to the complainant about the issues raised. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and hygienic environment for people who live in the home and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. Evidence: In looking around the home it was evident that there is a good standard of maintenance and decoration. The communal areas are well decorated and offer a warm inviting atmosphere. All individuals accommodation is in single rooms with level access on the ground floor and stair lift for upper floor. The home has been the subject of extensions and these have been well fitted with the necessary rails and facilities as in the older part of the home. The dining room is a pleasant welcoming environment. The laundry facilities have been updated with a modern commercial washing machine providing efficient cleaning of laundry including where needed a sluice facility for any items particularly requiring this level of cleaning. The home has recently purchased a standing hoist for the use of individuals and to support staff with moving and handling tasks. This will enable staff to assist and support individuals in a safe manner where mobility may be very limited. Individuals we spoke with all said how the home is always very clean its always well kept. On the day of our visit the home was clean and free from any odours. Care Homes for Older People Page 16 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides staffing which meets the care needs of individuals in the home however the home needs to evidence that the arrangements whereby there are no waking night staff is legitimate. Staff generally undertake the necessary training however there is a failure to make sure that all staff have completed Safeguarding training and other training which they need to undertake their role and responsibilities in a safe and competent manner. The recruitment and selection practice of the home helps in making sure that the health and welfare of individuals is as far as possible protected. Evidence: We looked at the staff rota for a period of 4 weeks and they evidenced 2 or 3 staff on duty am, 2 pm and 2 evenings and sleep in with one on call during the night. There is no waking night staff. Individuals we spoke with told us the staff always respond to us get the help when we need it. Another individual said that staff are very good and very attentive ring the bell and they come. The four staff members who responded to our questionnaire said that there is Always 2 Usually 2 enough staff to meet the individual needs of people? We spoke with staff and they told us that they felt they worked well as a team. The home has a good history of retaining staff with some staff having worked in the home for a number of years. Recruitment and selection records for 4 members of staff showed that the required Care Homes for Older People Page 17 of 25 Evidence: procedure had been followed with Criminal Records Bureau checks and POVA1st being undertaken. Two references are obtained for applicants and staff undertake the Skills For Care Common Induction Standards. We looked at training records for 3 individuals two of whom had NVQ 2 professional qualification. They all had completed First Aid, Medication and Fire training. None had undertaken Safeguarding training and two had no Moving and Handling training. However we have since been told that one of the staff whose records we looked at is no longer employed at the home. We did look at training records for a further eight members of staff as to whether they had completed Safeguarding training and found that only one had not undertaken this training. Care Homes for Older People Page 18 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 is managed by an individual who has the necessary competence and experience to fulfill the duties of a home manager. The practices of the home with regard to health and safety help in protecting the welfare of those that live and work in the home. Evidence: The manager has worked in the home since 1989 having been a care worker and in 1998 became manager of the home. She has the relevant training and management qualification. Individuals we spoke with were all very positive about her approach someone we can talk too always around if we want her and staff also described her as approachable. The home holds regular Residents meeting and importantly questionnaires including an Activity questionnaire. This enables individuals who live in the home to express their views about the service they receive. There is also an audit process to look at systems and procedures in the home and a Medicines audit was held in February 2009. Care Homes for Older People Page 19 of 25 Evidence: Following a visit from Avon Fire and Rescue service the home is updating their fire alarm system and installation of detectors where these have not been fitted. The fire system is serviced regularly the last being 20/08/09 and fire alarms are tested weekly with emergency lighting tested monthly as required. A Fire Risk Assessment has been completed along with environmental risk assessments. Care Homes for Older People Page 20 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered manager 30/10/2009 shall make sure there is a Statement of Purpose which shall consist of the homes aims and objectives and matters as listed in Schedule 1. This refers to making sure that information supplied to individuals in the homes Statement of Purpose is detailed and provides all that is required about the service individuals can expect from the home. 2 7 12 The registered manager 30/10/2009 shall make sure that the care home is conducted so as to make proper provision for the health and welfare of individuals who live in the home. This refers to the need to undertake assessment of care needs during the Care Homes for Older People Page 22 of 25 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action nightime period to evidence that the staffing arrangements during this period meet the needs of individuals. 3 7 5 The registered manager 30/09/2009 shall make sure that there are suitable arrangements to provide a safe system for moving and handling individuals. This refers to moving and handling assessments being completed for individuals who need assistance in transferring and moving and handling. This is so that staff have explicit instructions to safeguard the individual and member of staff. 4 7 13 The registered manager shall make sure that unnecessary risks to the health and welfare of individuals who live in the home are identified and so far as possible eliminated. This refers to specific risk assessments being completed so that staff are given clear guidance in the care of individuals who have for example catheter or colostomy. 30/10/2009 Care Homes for Older People Page 23 of 25 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 30 18 The registered manager to make sure that the persons employed by the home receive training appropriate to the work they are to perform. This relates to all staff completing Safeguarding Adults and Moving and Handling training. 30/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 To use an assessment tool for the assessment of nutritional needs of individuals to safeguard health needs and identify risks to individuals health where nutrition is a significant factor. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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