Care Home: Stirlings

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What the care home does well Prospective service users and their representatives are encouraged to visit the home, before making a decision to move in for a trial period. The healthcare needs of service users are fully met. Service users expressed their satisfaction of living in Stirlings, the care provide, accommodation, facilities and meals provided. Staff recruitment procedures are robust. Staff are well trained with the majority of care staff achieving NVQ level II. What has improved since the last inspection? Some areas of the home have been refurbished and redecorated. The requirement made at the last inspection has been complied with. What the care home could do better: Several areas are identified in the body of the report as needing action. These included care planning, risk assessments, appropriate foot wear for service users with restricted mobility, medication, staff meetings and staff supervision. Following the inspection we received an action plan detailing what action has been taken to address the concerns raised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stirlings Garston Lane Wantage Oxfordshire OX12 7AX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Carvell     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 27 Information about the care home Name of care home: Address: Stirlings Garston Lane Wantage Oxfordshire OX12 7AX 01235762444 01235763995 manager.stirlings@osjctoxon.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Orders Of St John Care Trust Name of registered manager (if applicable) Mrs Maggie Knowles Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service user who may be accommodated is 40 The registered person may provide the following category of service only : Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical disability(PD) Dementia (DE) Date of last inspection Brief description of the care home Stirlings is a care home providing personal care and accommodation for forty older people. The care home is managed by The Orders of St John Care Trust, which is responsible for many care homes in Oxfordshire that were formerly provided by the County Council. Stirlings is located near to the centre of Wantage, close to local amenities. The property is a two storey building with a lift fitted and divided internally Care Homes for Older People Page 4 of 27 40 0 40 Over 65 0 40 0 care home 40 Brief description of the care home into five areas. All bedrooms are single and there are no en-suite facilities. The home has well maintained grounds that are easily accessible. The fees range from 562.00 to 700.00 pounds per week. Items not covered within the fees include hairdressing, podiatry, newspapers and magazines, toiletries and contributions to some outings and activities. Information about the home can be obtained by contacting the home or visiting in person. Care Homes for Older People Page 5 of 27 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: The last inspection of this service was completed in January 2007. This inspection of the service was an unannounced Key Inspection. We arrived at 9.40am and was in the service until 5.50pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, Maggie Knowles in August 2008 and any other information that we have received about the serviced since the last inspection. Twelve service users returned completed surveys. We looked at how well the service was meeting the standards set by the government and have in this report made judgement about the standards of the service. We toured the premises, examined a sample of records required to be kept in the home, including case tracking service user files and spent time talking to service users individually and Care Homes for Older People Page 6 of 27 in groups. We spent time with the manager, Maggie Knowles, staff on duty, a visiting care manager and a district nurse. In addition we observed how care was being delivered to service users and joined service users in one unit for the midday meal. At the last inspection one requirement was made that the manager should ensure that service users have a copy of the homes statement of purpose and service user guide. This has been complied with. Feedback was given to Maggie Knowles, during and at the end of the inspection. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 8 of 27 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 9 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their representatives are provided with sufficient information, to make an informed choice about moving into the home for a trial period. Service users are provided with a written contract/terms and conditions. All prospective service users are assessed prior to admission to ensure that the home can effectively meet their care needs. Evidence: All prospective service users are provided with information about the home, including the homes brochure, service user guide and a copy of the last inspection report. This was subject to requirement at the last inspection. Oxfordshire County Council has a block contract with the home for twenty two of the forty registered beds. Ten of the twelve service users who completed a survey confirmed that they had received a Care Homes for Older People Page 10 of 27 Evidence: contract/ terms and conditions. Service users and their representatives are encouraged to visit the home, before deciding whether the home is able to meet their needs. All prospective service users are assessed before being offered a trial period in the home. Seven service users, who completed a survey confirmed that they had received enough information about the home before moving in. Comments included I came here to be looked after, I was not informed by anyone,I came from hospital, Transfered from another home, Family has enquired beforehand. Care Homes for Older People Page 11 of 27 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. Care plans need to be in sufficient detail regarding lifestyle choices and preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed to include how emotional, psychological and social care needs of service users are identified and met. The healthcare needs of service users are fully met. Storage of when required medication, recording of controlled drugs and care plans/guidelines for when required medication is administered need to be more robust. Service users feel that they are treated with dignity and respect at all times. Evidence: At the last inspection a good practice recommendation was made that care plans are further developed to identify the triggers that may lead to residents behavioural Care Homes for Older People Page 12 of 27 Evidence: problems and that strategies to cope with this are described in the care plan. From the sample of service user files case tracked it was evidenced that some improvements had been made to the care planning process. However, care plans were still not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided or how. No information is recorded in the care plan about how the emotional, psychological or social care needs are met. Following the inspection we have received an action plan confirming that all care plans will be reviewed by the end of February 2009, that care planning training is to be provided to all senior and care staff and that the Trust is in the process of redesigned all care planning documentation. Ten of the twelve surveys completed by service users confirmed that they always received the care and support needed and two surveys stated that they usually received the care and support needed. Service user files are well organised and contain appropriate risk assessments. Healthcare professionals such as the falls specialist, are involved with risk reduction as necessary. We noticed that several service users with reduced mobility were wearing inappropriate footwear. This was discussed with Maggie Knowles and following the inspection we have received an action plan, confirming that this is unacceptable and will be addressed through staff meetings, supervision and observation. The healthcare needs of service users are met by three GP practices and a wide range of healthcare professionals, including district nurses, who visit the home as required. From discussion with a visiting district nurse, service users, and examination of service user records the healthcare needs of service users are fully met. Ten of the twelve surveys completed by service users confirmed that they always received the medical support they needed, two stated that they usually received the medical support needed. One service user commented I always get a doctor if I need one. Medication is administered by staff who have completed appropriate medication training from a pharmacist. Medication administration records were seen to be up to date with no obvious gaps in recordings. Some areas were identified as needing improvement, these included the storage of when required medication, recording of controlled drugs and care plans/guidelines for when required medication is to be administered. This was discussed with Maggie Knowles and following the inspection we have received an action plan detailing action to be taken including staff training and revised procedures. Time was spent with service users in private and in communal areas. Service users were mostly complimentary about living in Stirlings and the care provided. Comments made by service users included very nice staff, staff are very good. I like it here quite a lot, staff are always very busy, we do not expect attention all the time, staff Care Homes for Older People Page 13 of 27 Evidence: always listen, if they dont know what I am saying they ask me to explain, Im very comfortable, there is always someone around to talk to and everyone is so nice to me, Im happy here, The staff do their best. There is a good rapport in the home between service users and staff, all service users said that they were treated with dignity and respect. Staff were observed addressing service users and visitors in a professional and respectful manner. From discussion with Maggie Knowles, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Care Homes for Older People Page 14 of 27 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. There is a range of activities to meet the social needs of service users, this needs to be evidenced in care plans and daily records. Service users are provided with a varied, wholesome and nutritious diet. Evidence: Two part time activity organisers are in post. One works for twenty hours per week and is responsible for communal activities and the second activity organiser works for eleven hours per week and mainly provides one to one activities, such as reading, chatting, manicures and letter writing. Information about activities are displayed on notice boards around the home. Five of the twelve surveys completed by service users confirmed that there were always activities arranged by the home that they could take part in and seven stated that usually there were activities arranged by the home that they could take part in. Comments included I take part when able, Bingo and singalongs, H is very good at persuading me, I take part most days, Sometimes I choose not to take part, I go to most activities. Although a wide range of activities take place, this is not evidenced in service users care plans or daily records. This should be addressed following the review of care planning. Care Homes for Older People Page 15 of 27 Evidence: Service users meetings take place, these are chaired by the activity organiser. Maggie Knowles attends these meetings occasionally. This was discussed with Maggie Knowles, who has agreed to consider other ways of seeking service users views, such as joining service users for a meal. Many of the service users have friends and family members who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. The home has good links with local schools and four young people assist with activities in the home as part of their work experience for one day per week. Service users said that their friends and family were always made welcome in the home and offered refreshments. Religious ministers visit the home on a regular basis and arrangements can be made for service users to attend local places of worship, if requested. Service users confirmed that the routines in the home were generally flexible, such as being able to choose how to spend their day, when to go to bed and when to get up in the mornings. We were able to join service users in one unit for the midday meal. The days menu was available, but not clearly displayed. A written record of service users choice of meals was available when requested. The meal served was tasty and the member of staff present assisted service users in a discreet and dignified manner. One service user said that the food was passable and that no choice was offered. Six of the twelve surveys completed by service users confirmed that they always liked the meals at the home, four stated that usually they liked the meals at the home and two surveys stated sometimes they liked the meals at the home. Comments made by service users included I would like a bit more to choose from, they are very good. Care Homes for Older People Page 16 of 27 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. Service users are confident that any concerns or complaints would be taken seriously, listened to and acted upon. The recording of complaints needs to be more robust. Policies and procedures are in place to protect service users from abuse. Staff are to be given refresher training in whistle blowing procedures. Evidence: The homes complaints procedure is displayed in the entrance hall of the home and is included in the service user guide. Maggie Knowles confirmed that since the last inspection in January 2007, the home has only received one written complaint and that verbal complaints are not currently recorded as they are dealt with immediately. She has agreed that in future all written/verbal complaints will be recorded and include action taken and outcome. Ten of the twelve surveys completed by service users confirmed that knew how to make a complaint, two surveys stated that the service users did not know how to make a complaint. Comments received included I would go to the office, I would go to the office or the manager, No cause to, but would go to the office. Service users spoken to were clear that any concern or complaint would be taken seriously, listened to and acted upon. Since the last inspection we have not received any information regarding complaints about this service. Care Homes for Older People Page 17 of 27 Evidence: All staff receive training in the homes policies and procedures for protecting service users from abuse. This was confirmed by examination of training records. Not all staff were familiar with the homes whistle blowing policy. Information in the staff handbook about the procedure refers the member of staff to request information from the manager. This was discussed with Maggie Knowles who gave a verbal undertaking to discuss the policy with all staff at the next staff meeting. No safeguarding adult referrals of safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. The home has a copy of the Oxfordshire safeguarding adults procedures. Care Homes for Older People Page 18 of 27 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 safe, well maintained and comfortable accommodation. Evidence: The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities and grounds. All bedrooms are for single occupancy, although it would be possible to provide a double bedroom if requested. None of the bedrooms have en-suite facilities. However, communal bathrooms and toilets are in sufficient numbers throughout the home. Service users are encouraged to personalise their bedrooms, with items of furniture and personal effects. Communal areas of the home have been made comfortable, welcoming and have a homely feel. There is a programme of refurbishment and redecoration and we were advised that all bathrooms and toilets are to be refurbished within the next year. At the last inspection a good practice recommendation was made that some of the older beds should be replaced and Maggie Knowles confirmed that this had happened. All areas of the home were seen to be clean and housekeeping staff were observed cleaning bedrooms and communal areas including shampooing carpets. On the day of Care Homes for Older People Page 19 of 27 Evidence: the inspection, some areas of the home smelled strongly of stale urine. From discussion with Maggie Knowles, staff on duty and the visiting district nurse it is acknowledged that this was not usually the case and staff were working hard to eliminate the source of the problem. Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment procedures are robust and protect service users from possible harm. Staffing levels appear adequate to meet the needs of the service users. Staff are well trained and are able to carry out their duties with confidence. Service users benefit from a low turnover of staff. Evidence: From discussion with the manager, Maggie Knowles, staff on duty, examination of duty rosters and direct observation, staffing levels appear to be adequate to meet the needs of the service users. The home currently has one staff vacancy for a care assistant to work part time. Service users benefit from a low turnover of staff. Members of staff are encouraged to undertake NVQ ( national vocational qualification) training. The four care leaders have achieved NVQ level III and eighteen of the twenty care assistants have completed NVQ level II. From examination of a sample of staff personnel files, the homes recruitment procedures are robust. Personnel files evidenced that all prospective members of staff complete an application, which details full employment history, written references and police checks are obtained and a formal interview takes place which is conducted by two senior members of staff. Care Homes for Older People Page 21 of 27 Evidence: The home has a training and development programme in place. All staff undertake induction training, appropriate to their role once in post, complete mandatory training and specialist training, as appropriate. Staff on duty spoke positively about the training provided and felt that this gave them confidence in carrying out their roles and assisted with career development opportunities within the Trust. Care Homes for Older People Page 22 of 27 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 run by an experienced and qualified manager. Since the inspection areas identified as needing attention have been addressed. Evidence: Maggie Knowles is an experienced and qualified care home manager. She is supported by an experienced administrator and four care leaders. In discussion with staff on duty, service users and health and social care professionals, all expressed the opinion that the home was well managed and run in the best interests of the service users. Staff described Maggie Knowles as a manager who is fair, consistent and approachable. Procedures are in place for dealing with service users monies and valuables held in safekeeping. Care Homes for Older People Page 23 of 27 Evidence: It was not evidenced that staff receive formal supervision at least six times per year. Maggie Knowles accepted that the current practice needed developing and did not meet the standard required. Following the inspection we received an action plan confirming that staff supervision would be discussed at the senior staff meeting at the end of January and that staff supervisory training was booked for all senior staff to attend in early March. Staff on duty confirmed that handovers take place at the beginning of each shift. It was not clear if staff meetings take place on a regular basis. Following the inspection we received an action plan confirming that staff meetings will be planned for the year and in future each meeting will consist of a planned agenda item relating to changes in policy and issues relating to the running of Stirlings. Detailed minutes of meetings will be available. Policies and procedures are in place and are reviewed on a regular basis. Reports written by a cluster manager, who is also a registered manager of a OSJCT home, completes a written report on behalf of the provider, following a monthly visit to the home, these were available for examination. A sample of records relating to health, safety, fire and service user welfare were examined and found to be up to date. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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