Care Home: Stocks Hall

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What the care home does well The home has a good approach to assessing residents before they are admitted to the home. This enables the home to determine if they are able to provide the support that each individual needs. The relationship between the staff and the residents is positive and the atmosphere in the home is calm and relaxed. The staff are interested in the residents and are aware of their support needs. They are courteous in their approach to residents and are sensitive to their needs. One relative wrote `the residents are always treated with great care and respect`. The staff are positive in their approach and are benefiting from new management arrangements and improvements to the way the home is run. The home welcomes the input and support from a range of social care and health professionals.Stocks Hall presents as a clean, tidy and comfortable home. Improvements are continually being made to the environment and the home has recognised areas it can further improve. Systems and equipment are serviced appropriately to help ensure that the environment is safe. Staff are safely recruited and receive good support from the management team. There are good training opportunities for the staff and they have taken advantage of these providing them with a range of skills and experience. To date 65% have achieved a nationally recognised qualification in care and many of the remainder of the staff team are keen to gain a qualification. Resident`s monies are well managed with records being accurately kept. Policies and procedures in relation to resident`s money and financial affairs protect the resident as far as possible. The home has a number of quality assurance monitoring systems in place which are carried out to identify any concerns, these plus meetings with staff have helped identify where the home needs to improve. Although many improvements have been made to the way in which the home is run, the parent company and manager are keen to continue make more changes so that the care and support provided to residents improves and the staff team are better supported and motivated. What has improved since the last inspection? Since the last inspection the home has improved in many ways following the appointment of an acting manger at the end of December 2007. The manager has succeeded in introducing many changes to the home and by working with and supporting the staff has improved the standard of care that the residents receive. Care plans in the main body of the home have been rewritten and are much more person centred in their approach. This has helped staff to provide specific care and support as the plans contain clear and detailed guidance as to how they should meet the needs of the residents. The plans have been developed with residents and relatives where appropriate and have been reviewed on a monthly basis to reflect the changing needs of the residents. Plans of care are being followed in day-to-day practice and records are also kept to show that this is happening. A wide variety of risk assessments are in place to help reduce possible risks for residents and these too have been reviewed on a monthly basis. Medicines handling has improved, medicines record keeping was in the main clear and accurate. Checks showed that medicines are usually administered correctly and medicines arrangements considered when people are away from the home. This helps ensure the good health and wellbeing of residents. The meals provided at the home have improved, with residents being given more choices at meal times. Most of the food is prepared from fresh ingredients. Equipment has been purchased to keep the meals warm and covered as they are moved around the home. The home has started to keep a more detailed record of any complaints and concerns reported to them. This means that they can be monitored more closely and will help the home to identify any trends, which can then be addressed. Details of how to report any concerns about the home are now available in each of the resident`s bedrooms. Since the last key inspection there have been no major complaints or safeguarding adult issues raised about the home. Some improvements have been made to the environment since the last visit to the home. A new bath has been installed in one of the downstairs bathrooms; a new nurse call system has been installed and a keypad has been fitted to the front door to improve security at the home. The offices within the home had been tidied and documents were well managed to allow staff to access records easily. On the day of the site visit a delivery of tables for use on the dementia unit was made and new carpets were being fitted in the offices. There has been much less use of agency staff in the home and this has resulted in residents been supported more effectively by a more consistent staff team. The staff team has also benefited from this as they now feel they belong to a strong team with morale having improved over the last few months. Staff are better supported and are benefiting from regular formal supervision, team meetings, clearer lines of accountability and strong leadership. All of the homes policies and procedures were reviewed at the end of 2007 and the home has introduced the `policy of the month`, which is discussed at team meetings. This helps to give staff a better understanding of the aims and objectives of the home. Additional monitoring systems have been developed and introduced to ensure that the home meets its aims and objectives, including internal audits that look at the management of medication and checks to ensure that care plans are accurate and up to date. New fire records have been established since the last inspection indicating that the relevant checks on the equipment are undertaken. CARE HOMES FOR OLDER PEOPLE Stocks Hall 76a Nursery Avenue Nursery Lane Ormskirk Lancashire L39 2DZ Lead Inspector Val Turley Unannounced Inspection 4th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stocks Hall DS0000005909.V360861.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. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stocks Hall Address 76a Nursery Avenue Nursery Lane Ormskirk Lancashire L39 2DZ 01695 579842 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) sandradonaldson@stockshall-care.co.uk Stocks Hall Care Homes Limited Position vacant Care Home 45 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (18) of places Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 45 service users to include: Up to 18 service users in the category OP - (Old age, not falling within any other category) needing personal care only Up to 27 service users in the category DE (E) Dementia (service users who are over 65 years of age) needing personal care only. Date of last inspection 11th and 18th December 2008 Brief Description of the Service: Stocks Hall care home provides 24-hour personal care and accommodation for the elderly and people who have care needs associated with dementia. It also has an 8 bedded unit within the home providing Intermediate Care for those residents who are preparing to return to their own homes Stocks Hall is owned by Stocks Hall Care Homes Limited and is one of five homes managed by the company. The home is situated in a quiet area of Ormskirk, close to the town centre, near to shops, pubs and post office. Car parking is available at the front entrance with garden areas and a larger garden at the rear of the home. The premises are a two storey purpose-built property. Bedroom accommodation is on both floors. All bedrooms are single and several of these rooms have an en-suite facility. Lounges and dining rooms are also located on both floors. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedroom and living rooms. Charges at the home range from £434 - £495 per week. There are additional charges for chiropody, optical care, dental care, outings and hairdressing, toiletries, papers and magazines, transport and private telephones. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection that took place over a six-month period and culminated in a site visit to the home in June 2008 by three regulatory inspectors. The inspection involved discussion with people living at the home where this was possible, discussion with staff, observation of staff supporting the residents and an examination of records, policies and procedures. Every year the registered persons are asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. We use this information, in part, to focus our inspection activity. Information was also provided through surveys recently completed and returned by 8 residents living at the home, 5 relatives and 8 members of staff. As part of the inspection, the inspectors used ‘case tracking’ as a means of assessing some of the National Minimum Standards. This process enabled the inspectors to focus on four of the people living at the home. Records relating to those individuals were inspected and discussion took place with them where possible and with the staff team in relation to their support needs. What the service does well: The home has a good approach to assessing residents before they are admitted to the home. This enables the home to determine if they are able to provide the support that each individual needs. The relationship between the staff and the residents is positive and the atmosphere in the home is calm and relaxed. The staff are interested in the residents and are aware of their support needs. They are courteous in their approach to residents and are sensitive to their needs. One relative wrote ‘the residents are always treated with great care and respect’. The staff are positive in their approach and are benefiting from new management arrangements and improvements to the way the home is run. The home welcomes the input and support from a range of social care and health professionals. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 6 Stocks Hall presents as a clean, tidy and comfortable home. Improvements are continually being made to the environment and the home has recognised areas it can further improve. Systems and equipment are serviced appropriately to help ensure that the environment is safe. Staff are safely recruited and receive good support from the management team. There are good training opportunities for the staff and they have taken advantage of these providing them with a range of skills and experience. To date 65 have achieved a nationally recognised qualification in care and many of the remainder of the staff team are keen to gain a qualification. Resident’s monies are well managed with records being accurately kept. Policies and procedures in relation to resident’s money and financial affairs protect the resident as far as possible. The home has a number of quality assurance monitoring systems in place which are carried out to identify any concerns, these plus meetings with staff have helped identify where the home needs to improve. Although many improvements have been made to the way in which the home is run, the parent company and manager are keen to continue make more changes so that the care and support provided to residents improves and the staff team are better supported and motivated. What has improved since the last inspection? Since the last inspection the home has improved in many ways following the appointment of an acting manger at the end of December 2007. The manager has succeeded in introducing many changes to the home and by working with and supporting the staff has improved the standard of care that the residents receive. Care plans in the main body of the home have been rewritten and are much more person centred in their approach. This has helped staff to provide specific care and support as the plans contain clear and detailed guidance as to how they should meet the needs of the residents. The plans have been developed with residents and relatives where appropriate and have been reviewed on a monthly basis to reflect the changing needs of the residents. Plans of care are being followed in day-to-day practice and records are also kept to show that this is happening. A wide variety of risk assessments are in place to help reduce possible risks for residents and these too have been reviewed on a monthly basis. Medicines handling has improved, medicines record keeping was in the main clear and accurate. Checks showed that medicines are usually administered correctly and medicines arrangements considered when people are away from the home. This helps ensure the good health and wellbeing of residents. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 7 The meals provided at the home have improved, with residents being given more choices at meal times. Most of the food is prepared from fresh ingredients. Equipment has been purchased to keep the meals warm and covered as they are moved around the home. The home has started to keep a more detailed record of any complaints and concerns reported to them. This means that they can be monitored more closely and will help the home to identify any trends, which can then be addressed. Details of how to report any concerns about the home are now available in each of the resident’s bedrooms. Since the last key inspection there have been no major complaints or safeguarding adult issues raised about the home. Some improvements have been made to the environment since the last visit to the home. A new bath has been installed in one of the downstairs bathrooms; a new nurse call system has been installed and a keypad has been fitted to the front door to improve security at the home. The offices within the home had been tidied and documents were well managed to allow staff to access records easily. On the day of the site visit a delivery of tables for use on the dementia unit was made and new carpets were being fitted in the offices. There has been much less use of agency staff in the home and this has resulted in residents been supported more effectively by a more consistent staff team. The staff team has also benefited from this as they now feel they belong to a strong team with morale having improved over the last few months. Staff are better supported and are benefiting from regular formal supervision, team meetings, clearer lines of accountability and strong leadership. All of the homes policies and procedures were reviewed at the end of 2007 and the home has introduced the ‘policy of the month’, which is discussed at team meetings. This helps to give staff a better understanding of the aims and objectives of the home. Additional monitoring systems have been developed and introduced to ensure that the home meets its aims and objectives, including internal audits that look at the management of medication and checks to ensure that care plans are accurate and up to date. New fire records have been established since the last inspection indicating that the relevant checks on the equipment are undertaken. What they could do better: A number of recommendations have been made as a result of this inspection. The home has achieved a great deal over the last few months and the Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 8 recommendations should be viewed as an extension of the work and improvements that have already taken place. The pre-assessment process should be more person centred in the Intermediate Care Unit so staff have a better idea of how they can met the needs of the people moving into the home. Similarly the care plans in this unit should be also be more person centred so staff have a clearer idea of how they may support people. Care should be taken to ensure that the bumpers used to cover bed rails are fastened to the rails to prevent them from falling off and leaving the resident at risk of injury. Any unexpected changes in people’s medication should be followed up and when a resident is discharged from hospital, two people should check their medication to reduce the risk of mistake. Some work needs to be undertaken to ensure that activities are appropriate for the residents and that the activities programme is followed so that residents are able to plan their days. The programme should be displayed more clearly so that it can be easily understood by the residents. Some further improvements should be made to the environment. The home would benefit from the development of a kitchen on the first floor so that staff do not have to leave the unit to make drinks or snacks for residents. The temperature in warmer weather should be better controlled so that the home is more comfortable for everyone. The daily menu should be displayed more clearly so that residents are able to read it easily. The Statement of Purpose and Service Users Guide should be amended to include the correct contact details of the Commission for Social Care Inspection should residents or relatives wish to report any concerns about the home. An audit of accidents and incidents should be undertaken to help identify any trends or common threads that can be acted upon to prevent a re –occurrence. 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. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 9 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 Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 10 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): 1and 6 Quality in this outcome area is good. Residents are assessed before they are admitted to the home, enabling the home to determine if they are able to give them the support that they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the site visit to the home we looked at the files of four residents in detail to see if their support needs had been thoroughly assessed before they moved into the home. Each of the residents had been assessed prior to their admission to the home and the information collected at this time enabled the home to decide if they were able to provided the support and care needed by those residents. The Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 11 information was then used to develop a care plan for each of the residents informing staff of their individual support needs. It was recommended that the home make its pre-admission process more person centred for the Intermediate Care Unit so that staff have a better idea of how they can meet the needs of people moving into the home. The home’s intermediate care unit provides short-term intensive rehabilitation to those residents who are placed there, to enable them to return to their own homes. The unit has its own dedicated space and staff team. It has equipment and facilities to promote everyday activities of living and enjoys good working relationships with relevant health and social care professionals who provide additional support to the residents in the unit. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. The care planning process has improved considerably to help ensure that the residents receive good care and support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit we ‘tracked’ the care of four residents to see if they were receiving the right sort of care and support. The care plans we looked at in the main body of the home were excellent and included all of the resident’s needs that were identified in the pre-admission assessment. The plans were person centred and provided the staff with clear and detailed guidance as to how they should met the needs of the residents. Where appropriate the plans had been agreed with the resident’s and/or their family. Any changes in a residents care needs were reflected well within the care plans. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 13 We spoke to several members of staff who were able to talk about the residents support needs in detail and obviously had a good knowledge of their support needs. We saw that plans of care were being followed in day-to-day practice and records were also kept to show that this was happening. A wide variety of risk assessments were in place to help minimise the possible risks to the residents. These and the care plans were reviewed on at least a monthly basis to help ensure that the residents were cared for appropriately and safely. We looked at a care plans on the rehabilitation unit. These were of an acceptable standard in that clear guidance was provided to the staff so that they could provide the support that the resident needed, but could have been more detailed in relation to the social care and rehabilitation needs of the resident. This would help ensure that all needs are identified and met by the care team. There was evidence that a number of different health and social care professionals provided additional input to the home and residents were supported to attend out patient appointments. Bed rails were being used for those residents were it was assessed that they were needed to help keep them safe, but it was noted that the bumpers used to cover the rails were not always secured to the rails and could have been easily removed. This could leave the resident at risk of injury. In total 10 residents were spoken to. They said that they were all happy with the care and support that they received. Comments from them included: ‘The staff are lovely. They really do care’ and ‘the staff respect me and my dignity is respected too’. Medicines were generally handled safely, the service showed good practice in some areas. Records were good for the receipt of medicines into the home and for the safe disposal of unwanted medicines. We looked at the medicines stock and records and found, with the exception of a rare discrepancy, these ‘added up’, showing medicines had been given correctly. Regular audits (checks) are carried out to make sure that medicines are handled in accordance with procedures. The service was putting protocols in place for giving ‘when required” medicines’ such as painkillers and sedatives to make sure people received them in the right dosage, and only when they were needed. The home kept mostly good records of communications with, and advice from, health care professionals such as doctors so, in most cases it was clear when medicines had changed. But, we saw one example where a person’s medicines Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 14 had changed whilst they were in hospital. Staff were uncertain about whether two medicines should be continued or not now the person was back home. To reduce the risk of mistakes, care needs to be taken to promptly follow-up any unexpected changes to people’s medicines. We observed part of the morning medicines round. Medicines were administered with care, by trained staff. Patient support was offered where people needed help with taking their medicines. We saw that medicines were given at the correct time of day and care was taken to ensure any special instructions such as ‘before food’ were followed. Consideration was normally given to peoples medicines when they where away from the home. Assessments were carried out to help ensure people can continue to take their medicines in the safest and best way when away from the home. We saw two recent examples where medicines had been missed when people were away but staff spoken with said they were now aware of what they should do. The home had arrangements in place so that non-prescribed medicines for the treatment of minor ailments could be given. This benefits residents as they can receive treatment for conditions such as minor pain without delay and without the need to see the doctor. Controlled drugs handling was clearly recorded in a proper register and a new cupboard had been bought to ensure they are safely stored in accordance with current law. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Residents are given opportunities to make choices and decisions about their daily life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From talking to the residents living at the home and observing the staff who were supporting them it was clear that the routines within the home are flexible and residents could make decisions themselves as to what they would like to do. One resident said that she had got up late that day out of choice and that breakfast was prepared for her when she got up. Another explained that she was asked what she would like for her meals and then goes along to the dining room to eat them. The chef said that there are three choices at mealtimes and everyone is asked what they would like. Residents were observed being offered Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 16 a variety of choices at lunchtime. The chef was seen to be involved in the serving of meals and speaking to residents to make sure they were happy with their meals. A selection of drinks was served at lunchtime. Residents were offered help sensitively and one meal was reheated, as the resident was slow in eating. Soft diets were served on divided plates so that the different tastes were kept separate. One resident said ‘the meals are excellent’. The meals were prepared from mostly fresh ingredients and the soup was home made. A new bain-marie had been purchase to keep meals hot as they are moved about the home and ‘top hats’ had also been purchased to cover the meals. Dining tables were tastefully laid before people went in to eat their meals. The menu choices of the day were written on a blackboard in each unit and these were difficult to read. It was recommended that an alternative method of displaying the menu be used. A programme of activities was displayed in the home and although activities were organised in the home these did not correspond with the programme displayed. The programme should be followed to allow residents and their visitors to plan the day. There were no specific activities arranged for people with sensory problems such as poor sight. The activities programme was handwritten. It was recommended that this be typed in a larger sized print with pictograms etc to make it easier to read and more interesting. A notice in the reception area of the home displayed forthcoming events. There were weekly minibus trips to places of interest and monthly barge trips. The residents spoken to confirmed that these took place. The manager of the home said that the activities organised in the home were something that was under review and it was planned that some changes would take place in the near future. Visitors were seen to be made welcome to the home and were able to visit at any reasonable time. A public telephone was available for use by the residents in a quieter part of the home. Private telephone lines had been installed in some bedrooms. Information was also available in the home for both residents and relatives of how to contact external advocates who could act on behalf of the residents. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. The home is effective in the way it responds to complaints and has improved the way in which it delivers care and support to the residents, helping to keep them safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has good policies and procedures in place that give clear information as to how complaints can be made and how they will be addressed. Similarly policies and procedures dealing with safeguarding vulnerable adults are clear. Staff have received training in these areas and those spoken to on the day of the site visit and all but one of those who completed a survey prior to the site visit, knew who to speak to if they had any concerns. Residents spoken to on the day of the site visit were also aware of who to speak to should they have any concerns about the home, as did those who had completed a survey. Since the last inspection the home have started to keep more detailed records about the concerns and complaints they have received and how they have responded to them. This means that they can be monitored more closely and will help the home to identify any trends that can then be put right. The complaints policy is displayed in the home but in addition the home has now Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 18 made the statement of purpose and service users guide available in each bedroom. These documents also contain information about how to report any concerns and complaints residents or visitors may have about the home. It was recommended that these documents be amended to ensure that the correct contact details of the Commission for Social Care Inspection are included. Since the last key inspection there have been no major complaints or safeguarding adult issues raised about the home. A number of minor complaints have been dealt appropriately. The acting manager has worked positively with the staff team to help improve the standard of care provided in the home and in doing so has helped to protect and maintain the safety and well being of the residents. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 19 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 20 Quality in this outcome area is good. The home provides a clean, comfortable and homely environment for both residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Stocks Hall presents as a home that is clean, tidy and comfortable and is well maintained. On the day of the site visit the weather was warm and sunny and residents and visitors were using the patio area to the rear of the home. The reception area was welcoming with a number of information booklets displayed for the convenience of residents and visitors. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 20 Some improvements have been made since the last visit to the home. A new bath has been installed in one of the downstairs bathrooms; a new nurse call system has been installed and a keypad has been fitted to the front door to improve security at the home. The offices within the home had been tidied and documents are well managed to allow staff to access records easily. The day of the site visit was very busy with engineers calling to repair or replace laundry equipment, repair the fax machine and to adjust the security the front door to ensure the keypad worked effectively. A delivery of tables for use on the dementia unit was also made and new carpets were being fitted in the offices. It was clear from discussion with both the management and staff that a number of other improvements to the home are in the pipeline. New dining room furniture has been ordered for the dementia unit and new crockery has been ordered. There are also plans to relocate the laundry to an adjacent building which will allow the kitchen to be extended and refitted. It is also planned to install a small kitchen on the first floor. The manager stated that once the major and urgent improvements had been made to the home they would recommence the rolling programme of redecoration and refurbishment. One resident said ‘I am quite content with my room. It is very spacious’ Her bedroom was tastefully decorated and furnished and she had personalised it with some of her own belongings. Domestic staff work at the home seven days a week providing enough cover to maintain the standards of cleanliness at the home. The domestics said they had enough equipment and cleaning supplies to do their job. The home are continuing with discussions on how best to use the space they have available to them and give the residents more choice of living space. Staff have received training in infection control and health and safety and there were no issues with infection control during this visit to the home. It was very hot in the home on the day of the inspection and it was recommended that the home address this to make the environment more comfortable for both residents and staff in the better weather. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. Staff are safely recruited and are provided with good training opportunities to enable them to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the files of three members of staff. The records showed that all staff had been recruited safely with all the expected checks and references having been undertaken. A member of staff spoken to during the site visit confirmed that she had not been able to start work at the home until all of the checks had been completed. This thorough approach to recruitment means that residents are protected as far as possible. The manager stated that there had been much less use of agency staff over recent months and this was confirmed by members of staff. The residents benefited from this as they have enjoyed a continuity of support and the staff spoken to said they benefited from this as they feel better supported and part of a strong staff team with morale having improved over the last few months. Staff said that there are occasions when they feel they do not have enough staff on duty but the manger said that she was looking at the different options Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 22 open to her to help ensure that sufficient staff are on duty especially at the busy times times. These include employing more staff when the number of residents increases and the possibility of changing the times of some shifts. The use of bank staff has helped to cover any staffing shortfalls. The staff are provided with a range of training opportunities and records showed that they had a good mix of skills enabling them to meet the needs of the residents. The courses they have attended include some specialist training including pressure wound care, care of the dying, and dementia care. Of the staff team, 65 have achieved a nationally recognised qualification in care and the manager said she was particularly pleased that many of the rest of the staff team had decided to work towards a qualification. Staff confirmed that they had attended all of the mandatory training courses. There was evidence that newly recruited staff were given induction training as they started work at the home and a recently appointed member of staff confirmed this. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36 and 38 Quality in this outcome area is good. The management of the home has been significantly improved and as a result the care and support provided for the residents has improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home experienced some difficulties last year because of inconsistent management arrangements. This difficulty has now been resolved with the appointment of an acting manager at the end of 2007. The acting manager is in the process of applying for the post of registered manager. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 24 Since the appointment of the acting manager clearer lines of accountability have been established within the home and the staff team are benefiting from clear leadership and good support. The process of managing the home has become much more open. Regular meetings with all staff have been established and there are additional opportunities for the care staff to meet with the managers should they wish. Staff are now receiving formal supervision giving them opportunities to reflect on their practice and to develop their careers. Staff are much more aware of their responsibilities and the aims and purpose of the home. All of the homes policies and procedures were reviewed at the end of 2007 and the home has introduced the ‘policy of the month’, which is discussed at team meetings. This helps to give staff a better understanding of the aims and objectives of the home. The home has a number of quality assurance monitoring systems in place. It has achieved the Investors in People Award which is a quality assurance award accredited by an external body. A survey of relative’s views of the home had been undertaken in November 2007. Fourteen of these had been returned and of these twelve relatives said they were generally satisfied with the service the home provided. There were no major criticisms of the home. A monthly monitoring visit is made to the home when residents, staff and any visitors are spoken to and the environment is checked and any issues are highlighted. Additional monitoring systems have been developed and introduced to ensure that the home meets its aims and objectives, including internal audits that look at the management of medication and checks that care plans are accurate and up to date. Resident’s monies are well managed with records being accurately kept. The home is generally well maintained with all systems and equipment being checked and serviced appropriately with a view to promoting the health, safety and welfare of the residents and staff. New fire records have been established since the last inspection indicating that the relevant checks on the equipment are undertaken. It was recommended that an audit of accidents and incidents in the home be undertaken to identify any trends or common threads. This may help the home to prevent them from happening again. Records showed that the staff team had received training in health and safety, including moving and handling and infection control. Staff spoken to on the day of the site visit confirmed this. Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 3 Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations The pre-assessment process should be more person centred in the Intermediate Care Unit so staff have a better idea of how they can met the needs of the people moving into the home. Care plans in the Intermediate Care Unit should be more person centred to give staff more information about the service users support needs. Bumpers used to cover bed rails should be fastened securely to the rails to prevent them from being removed and leaving the resident at risk of injury. When people return from hospital their discharge medicines should be checked in by two people to reduce the risk of mistake. To reduce the risk of mistakes, any unexpected change in people’s medications should be promptly followed up. DS0000005909.V360861.R01.S.doc Version 5.2 Page 27 2 OP7 3. OP7 4 5 OP9 OP9 Stocks Hall 6 7 8 9 OP12 OP12 OP12 OP16 10 11 OP19 OP15 The daily programme of activities should be displayed more clearly so that it can be easily understood by the residents. The activities programme should be followed so that residents are able to plan their days. Activities for residents with sensory problems should be provided giving them an opportunity to participate if they wish. The Statement of Purpose and Service Users Guide should be amended to include the correct contact details of the Commission for Social Care Inspection should residents or relatives wish to report any concerns about the home. Care should be taken to ensure that the temperature in the home is comfortable during the hot weather. A kitchen should be developed on the first floor to allow staff to make snacks and drinks for residents without leaving the unit. The daily menu should be displayed more clearly within the home so that residents are able to read it easily. An audit of accidents and incidents should be undertaken to help identify any trends or common threads to prevent a re-occurrence. 12 13 OP15 OP38 Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Stocks Hall DS0000005909.V360861.R01.S.doc Version 5.2 Page 29 - 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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