Care Home: Stokeleigh Residential Home

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What the care home does well The manager and staff of Stokeleigh have a strong commitment and drive in wishing to provide a good service at the home. The home has a number of methods to ensure that people`s needs and wishes are known, recorded and responded to in a `person centred way`. This is undertaken through such methods an an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care, residents, staff and team meetings to ensure that all are consulted. There are clear lines of accountability within the home. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of needs were undertaken. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individual`s needs and the service is tailored accordingly. Those living at the home said: "I am very happy living here", "Staff here are very kind". Staff have developed sound relationships with those who live at the home and have aclear understanding of the individual needs, wishes and aspirations of those who live at the home. The home are currently piloting a new electronic, hand held computer system for the monitoring, recording and administration of medication. This was seen by us to be an excellent use of technology to ensure that medicines are given in a safe manner, therefore, protecting those who live at the home. The home is comfortable, homely and well maintained. The house is well furnished and those living at the home have personalised their rooms and showed a sense of pride when showing us their room. Throughout our visit the manager demonstrated good, effective leadership skills that relate to the aims and purposes of the home. It was evident the management and staff are a stable team that supports a commitment to providing quality of care for the benefit of the people living in the home. As well as being organised and skilled in aspects of running the home, the registered manager, actively seeks and value the opinions of staff, residents, relatives and visiting professionals. The manager works closely with staff to establish, maintain and seek to improve communication/relationships and to develop skills, thus supporting the staff group in working together as a cohesive, caring team. What the care home could do better: There had been no previous requirements or recommendations at our last visit to the home. We recommend that the home incorporate an assessment of peoples ability to make decisions in line with their mental capacity, this should be part of the pre-admission process and also be incorporated within people`s plan of care. At this visit we found that one bedroom had a worn carpet and was a potential tripping hazard, this must be replaced to ensure that an accident does not occur and to demonstrate a well maintained environment for the people who live at Stokeleigh. We recommend that staff compete training in both mental capacity awareness and dementia care. It is also important that staff levels and the needs of those who live at the home are closely monitored and kept under review. This is to ensure that their are appropriate numbers of skilled staff to meet the varied and changing needs of those who live at the home. In line with the Care Quality Commissions currently methodology this random visit was completed instead of a full key inspection. A key inspection reviews all of the `Key` National Minimum Standards. A random inspection is a more focused, targeted visit and no rating of a service is given. The previous rating for this service as recorded at our visit in 2007 was one of `good`. It should also be noted that if this visit had been a full key inspection it is anticipated by us that the rating would continue and would have been denoted as one that provided `good` quality outcomes for those who use the service. Random inspection report Care homes for older people Name: Address: Stokeleigh Residential Home 19 Stoke Hill Stoke Bishop Bristol BS9 1JN two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Odette Coveney Date: 2 8 0 6 2 0 1 0 Information about the care home Name of care home: Address: Stokeleigh Residential Home 19 Stoke Hill Stoke Bishop Bristol BS9 1JN 01179684685 01179687552 stokeleigh@hartfordcare.co.uk www.hartfordcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Tracy Louise Bird Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hartford Care Ltd care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accomodated is 30 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Stokeleigh Residential Home is registered to accommodate up to 30 residents, aged 65 years and over, who require assistance with their personal care. The home also offers respite care. It is situated close to The Downs in a quiet residential area and benefits from large grounds that are well maintained. Accommodation is provided in 26 single Care Homes for Older People Page 2 of 13 Brief description of the care home rooms, each with its own en suite facilities, there are also 2 double rooms that are only utilised as a double if requested by a married couple or relations. The upper floors are accessible via two lifts. The cost per week to reside at Stokeleigh Residential Home is is variable and is dependent upon the assessed needs of individuals. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Care Homes for Older People Page 3 of 13 What we found: This unannounced random inspection took place at the home and was completed in five hours by one inspector. The registered manager was present during the inspection and fully participated and engaged in the process. Evidence for our opinion about the service and the quality of care provided was gained from a whole range of different sources, including talking with people who use the service, talking with staff who are employed at the home. And a review of records seen by us at the home and discussions with the registered manager. At this visit we also reviewed the information forwarded to us by the manager in the Annual Quality Assurance Assessment questionnaire (AQAA), completed prior to our visiting the service. The AQAA had been completed in depth and the information provided within this gave detailed examples of how the service meets its aims and objectives, as outlined within the homes statement of purpose. The AQAA was well-written and the information provided evidence and examples of the good quality standards provided at Stokeleigh. The purpose of the visit was to establish if the service provided at Stokeleigh is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals who use the service. We also spoke with the registered manger, Ms Tracy Bird about the new Health and Social Care Act 2008 and the responsibilities of the service. Information was left with the service about the forthcoming registration process to compliment the information they already had. The home has in place a detailed, well written Statement of Purpose. We saw that information was included within this document about the rights of those who live at Stokeleigh. People would be respected in relation to their rights, ensuring they will be treated with dignity and respect, with their right to privacy and maintaining their civil rights being upheld. The Statement of Purpose also detailed the staffing arrangements for the home, the range of services, which can be provided, and how individuals will be supported with their health, personal care, social and emotional aspects of their life. The information within this document was fairly comprehensive and contained clear information for residents and their relatives about the services and facilities provided at the home. Furthermore, this document contained information about the admission process into the home and how to raise issues of concern and showed to the reader how these would be responded to. The manager of the home carries out its own care needs assessment for all referrals recieved by visiting the new service user prior to the service starting. Evidence was seen of these assessments in both of the files examined at the home for the two people who were recently admitted into the home. Individuals care records four four of the people who live at the home were reviewed at this visit and it was found that the plans in place had been generated from a care management assessment and the homes own detailed assessment. Information contained within care records included: Information about the Care Homes for Older People Page 4 of 13 reason for the placement being required, health care support services involved, next of kin, family contact details, power of attorney arrangements and medical history. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. A new care plan format has recently been introduced and those seen by us evidence that a person centered approach had been incorporated evidencing involvement of the service user in order that their wishes and choice are known. We saw that care plans are regularly reviewed and there is an ongoing assessment and monitoring of individuals needs and the service is tailored accordingly. The care plans give detailed information about the needs and wishes of the service users and clearly state the actions that staff need to take to meet the assessed needs. Each person also had risk assessments, records of health professionals visiting, daily records of individuals routines, medication information as well as a care plan. The care plan identified the areas in which the individual required support and detailed how staff intervention and support would be provided, the support and the situation is evaluated and dated. Within peoples notes we saw that staff monitor peoples wellbeing on a daily basis, people are supported well, ensuring that they were receiving the care and support needed as outlined within their plan of care. Care workers are encouraged to report any changes to service users needs to the manager and this will initiate the updating of care plans more frequently. The manager confirmed that staff contribute to the review of care plans and are able to feedback information to the manager and know that it will be actioned. There are people who live at the home who have a diagnosis of a dementia, we spoke to the manager about the rights and choices that people make and spoke in length about the Mental Capacity Act 2008. Ms Bird was able to demonstrate a good understanding in this area. We did note that the home have obtained information from relatives who have Power of Attorney arrangements to act on behalf of their relatives best interests and this is in line with current good practice. We also found that peoples emotional and mental health support requirements were well recorded and how staff should support people in this sensitive area. However, we felt that more information to evidence that the mental capacity and the ability to make decisions (or not) which affect individuals lives could be better recorded at the home both in the pre admission assessment and care planning processes. A recommendation to incorporate this within the homes assessment and documentation was made by us during this visit. People living in the home are registered with a local doctors practice. And access healthcare services as needed. The home are currently piloting a new electronic monitoring system for the recording and administration of medicines. This is in the form of a hand held computer. The manager explained the system to us and told of its effectiveness. We saw the equipment in use and spoke to a staff member who was using the device when giving out the lunch time medication. They told us that this new system removed the margin of error and informed us of other functions of the devise such as the booking in of medication and the identification of potential risk of residents being admitted into hospital. Medicines are supplied to the home using a weekly blister pack system. All the medicines used in the home are given by staff who have been trained and deemed competent to Care Homes for Older People Page 5 of 13 administer them. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support from them. Good practice guidelines are followed. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines are given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines and well as recording this on the electronic system. The Activity Organisers spend time with residents on a one to one basis, during the early part of the day. They serve morning drinks at a leisurely pace to ensure this is a social time and following this, engage in an activity session. After lunch there is also an organised activity. On the day of the visit some residents were supported with one to one time in their room. One of the residents had flowers they had picked whilst out for a walk to Trinity College with one of the staff members, they told us they had enjoyed their visit. Varied comments were made by people about the food provided at the home, one person told us that their special diet was catered for and that the chef knew their needs well and accommodated them. Another person told us the porridge was runny this morning, and was not nice. Another person said the food is not as good as it used to be, but there is plenty of it. We spoke to the manager about this and discussed the difficulties of varied tastes and preferences. We reviewed the minutes of the last two residents meetings and only favorable comments had been made about the food. The manager told us that this area would be monitored and action taken as appropriate if needed to ensure that people were satisfied in this area. A Hairdresser is available in the home on Thursday of each week and to coincide with this staff offer pampering sessions that include hand massage and nail care. Daily newspapers are delivered to the home. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the Care Quality Commission and Bristol Social Services. A copy is made available to service users and relatives should they request it. The Commission have received no recent complaints about the home. We spoke to people who live at the home and asked them what they would do if they had any problems or complaints. One person told us; I have never had cause to make a complaint, the staff are wonderful. If I had a problem I would speak to the manager and I am confident that it would be dealt with efficiently. The home has in place a complaints logbook in place. This is in place in order to record what complaints are recieved and to evidence how issues of concern have been responded to. We reviewed the information contained within this and saw that issues had been responded to in a professional and timely manner. We walked around the inside and outside of the home and viewed some of the bedrooms and the communal areas including the dining room, conservatory and lounge. Room sizes are fairly spacious for their stated purpose. All areas of the home were decorated to peoples taste, clean and well maintained. We did note that one bedroom had a worn carpet and was a potential tripping hazard, this must be replaced to ensure that an Care Homes for Older People Page 6 of 13 accident does not occur and to demonstrate a well maintained environment for the people who live at Stokeleigh. Staff records were examined for two newly recruited staff members. Both of the files we reviewed contained comprehensive documentary evidence including full employment details, two written references ((including one from the most recent employer) and evidence of identity along with ISA (Independent Safeguarding Authority) and CRB (Criminal Records Bureau) checks. The manager ensures that staffing levels are indicative of the needs and levels of care required and confirmed that levels of staff rise should dependency levels increase. We spoke with the manager about the importance of monitoring staffing levels. We did this because whilst we were at the home staff had changed their shifts to accommodate staff members sickness absence. We are aware that the manager addresses performance issues that may affect the service provided to those who live at the home. It is important that staffing levels are monitored, this is to ensure that the needs of those who live at the home are met by staff . The staff consulted as part of the inspection were positive about the work they were taken on to do and welcomed the opportunity to take on alternative duties. Those staff we spoke with demonstrated a pride in their work and a commitment to the work of the home. Whilst at the home we observed staff and they were seen to be supportive to people who live at the home. It was noted that staff were very patient and asked people who live in the home questions and encouraged them to make decisions, rather that deciding for them and encouraged individuals to make choices. We spent some time throughout the day talking to staff and observing them carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humored and sensitive towards the residents within a relaxed, calm environment. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people living at Stokeleigh. All staff receive training and development to ensure that the staff fulfill the aims and objectives of the home and reflects changing needs of the residents. We saw records that demonstrated that staff had completed training in fire awareness, moving and handling and adult abuse. In addition staff have also attended sessions concerned with infection control, first aid and the manager is booked to complete training in respect of the changes to the law relating to Mental Capacity/Deprivation of Liberty Safeguards, it is recommended that staff at the home also complete training in this area in order that they are aware of their role and responsibility in these areas. Some of the training is carried out by senior staff from the home or alternatively by visiting training providers and the local Council. The manager informed us that a member of staff had been delegated as the homes dementia champion and that they would be attending a training session within the next month in order to raise their awareness of dementia, there are some staff who have recieved training in dementia, however, it is recommended that other staff also undertake training in this area in order that all have an understanding and awareness of this illness. Ms Bird was recently interviewed by us (The Care Quality Commission) and was deemed Care Homes for Older People Page 7 of 13 fit to manage a residential care home. We found that she has the appropriate experience, qualifications and skills as required for this position. During our visit Ms Bird demonstrated a commitment to the provision of good quality individualised care packages in the home. Mrs Bird is well known to her staff team and has a high visibility in the home and gives strong leadership and direction. The home have a number of methods in which to monitor and review the quality of service provided at the home and to also establish the levels of satisfaction for the people who live at the home, these include residents and staff meetings, care planning reviews, staff supervision and training. Policies and procedures are in place at the home and all are of the standard expected. We saw that staff are familiarised with these as part of their induction programme with a more in depth approach to such policies as the whistle blowing procedure and adult protection. The standard of recording keeping is very good. Files examined at the inspection were well-presented and easy to follow and written in appropriate language. When we reviewed the information contained within the homes fire logbook, we saw that the home is completing all of the daily, weekly and monthly tests as required. Records of fire drills and staff training were clear and well recorded. What the care home does well: The manager and staff of Stokeleigh have a strong commitment and drive in wishing to provide a good service at the home. The home has a number of methods to ensure that peoples needs and wishes are known, recorded and responded to in a person centred way. This is undertaken through such methods an an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care, residents, staff and team meetings to ensure that all are consulted. There are clear lines of accountability within the home. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of needs were undertaken. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individuals needs and the service is tailored accordingly. Those living at the home said: I am very happy living here, Staff here are very kind. Staff have developed sound relationships with those who live at the home and have a Care Homes for Older People Page 8 of 13 clear understanding of the individual needs, wishes and aspirations of those who live at the home. The home are currently piloting a new electronic, hand held computer system for the monitoring, recording and administration of medication. This was seen by us to be an excellent use of technology to ensure that medicines are given in a safe manner, therefore, protecting those who live at the home. The home is comfortable, homely and well maintained. The house is well furnished and those living at the home have personalised their rooms and showed a sense of pride when showing us their room. Throughout our visit the manager demonstrated good, effective leadership skills that relate to the aims and purposes of the home. It was evident the management and staff are a stable team that supports a commitment to providing quality of care for the benefit of the people living in the home. As well as being organised and skilled in aspects of running the home, the registered manager, actively seeks and value the opinions of staff, residents, relatives and visiting professionals. The manager works closely with staff to establish, maintain and seek to improve communication/relationships and to develop skills, thus supporting the staff group in working together as a cohesive, caring team. What they could do better: There had been no previous requirements or recommendations at our last visit to the home. We recommend that the home incorporate an assessment of peoples ability to make decisions in line with their mental capacity, this should be part of the pre-admission process and also be incorporated within peoples plan of care. At this visit we found that one bedroom had a worn carpet and was a potential tripping hazard, this must be replaced to ensure that an accident does not occur and to demonstrate a well maintained environment for the people who live at Stokeleigh. We recommend that staff compete training in both mental capacity awareness and dementia care. It is also important that staff levels and the needs of those who live at the home are closely monitored and kept under review. This is to ensure that their are appropriate numbers of skilled staff to meet the varied and changing needs of those who live at the home. In line with the Care Quality Commissions currently methodology this random visit was completed instead of a full key inspection. A key inspection reviews all of the Key National Minimum Standards. A random inspection is a more focused, targeted visit and no rating of a service is given. The previous rating for this service as recorded at our visit in 2007 was one of good. It should also be noted that if this visit had been a full key inspection it is anticipated by us that the rating would continue and would have been denoted as one that provided good quality outcomes for those who use the service. Care Homes for Older People Page 9 of 13 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 2. Care Homes for Older People Page 10 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 13 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, 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 19 16 The registered person must ensure that floor coverings are suitable for the needs of residents. The carpet in the identified bedroom must be replaced. This is to ensure that it is not a trip hazard for people. 01/08/2010 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 8 The registered manager should incorporate an assessment of peoples mental capacity upon initial assesment into the home, furthermore, this information should be incorporated into indivudals care plan. The registered manager must monitor staffing levels to ensure that they are sufficient to support the needs of the people who live at the home. Staff at the home should complete training in Dementia awareness and the Mental Capacity Act 2008. 2 27 3 30 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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