We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Stapely Residential and Nursing Home North Mossley Hill Road, Mossley Hill, Liverpool, L18 8BR Tel: Date of Inspection: 03 April 2014 Date of Publication: April 2014 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Consent to care and treatment Care and welfare of people who use services Safety and suitability of premises Supporting workers Assessing and monitoring the quality of service provision Inspection Report Stapely Residential and Nursing Home April

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Trustees for the time being of Stapely Hospital Mrs Angela Lang Stapely Residential and Nursing Home provides accommodation for adults who require personal or nursing care. The service accommodates up to 60 adults, 30 people on the residential floors and 30 people on the nursing care floor. The home predominantly provides a service to people of the Jewish faith and services and facilities are provided around Jewish religious requirements and way of life. Care home service with nursing Accommodation for persons who require nursing or personal care Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Stapely Residential and Nursing Home April

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Consent to care and treatment 8 Care and welfare of people who use services 9 Safety and suitability of premises 11 Supporting workers 13 Assessing and monitoring the quality of service provision 14 About CQC Inspections 15 How we define our judgements 16 Glossary of terms we use in this report 18 Contact us 20 Inspection Report Stapely Residential and Nursing Home April

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 3 April 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. What people told us and what we found We considered all of the evidence we have gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Not sure if it really matters but for the sake of consistency across all reports I think we should have them in the order of safe, effective, caring, responsive well led as per the guidance Is the service safe? People were cared for in an environment that was safe. The nursing care situated on the ground floor required the domestic team to ensure lower level and above eye level cleaning was carried out. The rest of the home including the residential floors was clean and hygienic. Equipment at the home was well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was always available on call in case of emergencies. Staff personnel records we looked at for training, supervision and appraisal CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had been made by the home, proper policies and procedures were in place. Staff were trained to understand when an application should be made, and how to submit one. Is the service effective? People told us that they were happy with the care and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. One person told us. "I have all of my needs met wonderfully by the staff here. I could not be happier". Staff had received Inspection Report Stapely Residential and Nursing Home April

5 training to meet the needs of the people living at the home. Is the service caring? We spent time in all areas of Stapley where we observed staff to be kind and patient to the people who lived there. Care staff and nursing staff were patient with people, asking them what they wanted and not telling them, but encouraging them in the right direction. One person told us "It's a fantastic caring place and I wouldn't want to be anywhere else". A relative told us "The staff are very caring, I go home knowing my husband is so well cared for. It gives me a lot of comfort knowing this". Is the service responsive? People's needs were assessed before they moved into the home. People told us that all staff were very attentive and understood what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs were recorded and care and support provided in accordance with people's wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives. Is the service well led? Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they had completed a customer satisfaction survey, and if they were unhappy with anything staff would always listen. Staff told us they were clear about their roles and responsibilities. They said the management team and trustees always consulted with them before implementing changes to the management of the home and their views were taken into consideration. One member of staff said "We work as a team so all of the people living here have a good quality of life; we provide good care and would not tolerate bad practice". You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Stapely Residential and Nursing Home April

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Reasons for our judgement Stapley Residential and Nursing Home is predominately a Jewish home, the staff and people living there observe all of the Jewish cultural and religious requirements. People that are not Jewish are admitted into the home but are requested to respect the Jewish laws and culture. Other religious practices were encouraged and staff assisted people with their religious practices and beliefs. We were told that priests were contacted and services held in a person's room if they were unable to attend their chosen church. The food served at the home was strictly Kosher and prepared under strict regulations. All of the people who have chosen to live at Stapley are informed about the food and are informed that no other foods can be taken into the home. People we spoke to respected the providers wishes and told us the food provided was good. People who lived at the home understood the care and treatment choices available to them. We observed staff throughout the day treating all people with respect. Personal care was done in private ensuring the dignity of all of the people assisted and supported. There were male and female carers working at the home. Records were in place to inform what the individual's choices were when requesting male/female staff to support them with their personal care. We looked at six care plans that indicated people and their families/advocates were involved in their care planning. The person centred care plans were developed with the individual/families/advocates and reviewed every four weeks or more frequently if required. We spent time with the managers, nurses and care staff on all floors looking at the care plans and discussing how they recorded information on a daily basis. People who were unable to make decisions and lacked capacity had been clinically assessed and records were in place as to who their next of kin or legally responsible person was. We discussed end of life care with the manager who told us that they liaised with multidisciplinary health teams including GP's and palliative nurses. The registered manager told us that it was extremely important for the people living at the home that if they wished to Inspection Report Stapely Residential and Nursing Home April

7 and they could support them, that the person could spend their last days in their room being provided with the clinical care and social care support that would ensure their privacy, dignity and comfort. The manager told us that usually people would chose to move into one of the local hospices. One person we spent time talking with told us that their relative was looked after in a dignified way, they said "Staff are excellent they always sit and chat to them even though they can no longer communicate verbally. They do look happy which makes me happy". Inspection Report Stapely Residential and Nursing Home April

8 Consent to care and treatment Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Reasons for our judgement We looked at six care plans. Care plans included people's choices and wishes in the way that care and support was to be provided. There were areas for people to sign the care plans and staff to tick to show that the person consented to the care plan. People who lacked capacity at the home had records in place to show how the staff were providing care and support that met and respected their best interests. We were informed that advocates were available to support people at the home if required. The manager told us that any family, advocates and multi-disciplinary professionals including social services were involved in supporting people with dementia in making best interest decisions at the home. The manager discussed a best interest assessment with us and said there were a lot of meetings for a person who wanted to go out on their own into the local community. The outcome of the best interest meeting was that the person went out alone but staff always made sure there was information about the home with the person so that they would be assisted home if necessary. All staff spoken with had been provided with Mental Capacity Act training and were aware of the importance of providing care in a dignified respectful way. We were told that there were no DoLS assessments being implemented at the home at this time. The manager told us that staff work closely with social services and they would liaise if they deemed it necessary. Inspection Report Stapely Residential and Nursing Home April

9 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement People who lived at the home were known by staff and we observed some positive interactions between people and staff. We observed that people received appropriate and safe care. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We read six care plans including risk assessments. All six care plans were up to date and relevant for what care and support was being provided. There were care plan review records completed in all six files, and amendments made were relevant and informed what the changes in the care plans for the individuals were. Staff told us how they constantly assessed the people who lived at the home to ensure their welfare and safety was met. There was evidence that care plans reflected the care needs, preferences and diversity of people. Throughout our inspection we observed staff spending quality time on a one to one basis with people and communicating to all of the people who lived at the home. Staff were seen to take time communicating in different ways to individuals who were unable to verbally communicate. We spent time in the dining room at lunch time and we observed people chatting and enjoying their meals. One person said "We enjoy our meals together it's a social occasion, and we do make an effort". There were 26 people in the dining room, two people required assistance to eat their lunch. Staff were observed talking to people, asking them what they wanted from the menu and supporting those people who required support in a dignified manner. People we spent time talking to told us the food was good and they could have a choice off the menu or anything else they wanted if requested. There was a designated activities coordinator whose role was to provide group and one to one activities. In discussion with the manager and deputy managers we were told that all staff were responsible for providing activities and stimulation for people who lived at the home.. Group activities were provided in the lounges on the ground floor and on the first floor which had lift access for people if required. Activities that had taken place recently were singing and dancing, art, beautician, hair, nails and makeup. People were escorted into the community. This including attending day centres, shopping, going out to local Inspection Report Stapely Residential and Nursing Home April

10 restaurants and eateries if they chose to go out. There was a mini bus available to provide transport at all times. There were notice boards that displayed photographs of past activities that people had participated in such as birthday celebrations. Activities were taking place for a few people on the day of our visit that included reading the daily newspaper and a couple of people were doing a jig saw puzzle, staff were seen dancing and singing with people who looked like they were really enjoying the interaction. Talking to people about activities, their comments ranged from "I like talking to my friends", another said "I like reading, I have a lot of books and they will get me books from our library". We looked at the health plans for six people. All medical information that focused on their physical health and mental health was up to date and reviewed on a monthly basis or before if medical intervention had taken place. The home had 13 GP's who visited the people there. The manager told us that people chose to keep the GP they were registered with before moving into the home. We were told that GP's visited when requested. Other multi-disciplinary staff visited people including physiotherapists, speech and language therapists and other clinical professionals. We spent time talking to 15 people who were very positive about life at the home. Comments ranged from "Couldn't be in a better home" "It's a wonderful home, I am very happy with everyone" and "Marvellous place as I cannot live on my own anymore, staff are so caring". Staff spoken with told us that they recorded in the daily records what each staff member provided to each person. We looked at the daily records on all floors that had entries completed at different times of the day. The provider may find it useful to note that 2 daily monitoring charts out of 10 looked had not been fully completed on the nursing floor. All nursing staff had been trained to deal with emergency situations and had received annual updated CPR training. Training records and talking to staff confirmed that they were aware of the emergency procedure and what to do should an emergency arise. There was a call bell system in place for people who use the service to contact staff from. We observed staff responding to call bells appropriately throughout the day. Inspection Report Stapely Residential and Nursing Home April

11 Safety and suitability of premises People should be cared for in safe and accessible surroundings that support their health and welfare Our judgement The provider was meeting this standard. Patients, staff and visitors were protected against the risks of unsafe or unsuitable premises. There were areas in the home that required a deep cleaning programme. Reasons for our judgement Stapley Residential and Nursing Home is an old building that is listed in parts so works have to be actioned by the local authority. There was a portable ramp for access for people who used wheelchairs. At the time of the inspection, the environment was adequately maintained with two maintenance men on duty Monday to Saturday and on call evenings and weekends. A compliant fire system had been installed and there was a contract in place for the maintenance of the building's burglar alarm. Electrical equipment was tested annually to ensure it was safe and we saw receipts were kept of all electrical work carried out. Records showed that fire equipment was checked regularly to ensure that it would be fully functional in the event of a fire. In discussion with the head maintenance person we were told that there was a maintenance book that would be completed by staff if a maintenance issue was required to be looked at. This was prioritised and signed off when completed. The records looked at included a recent legionella check on the water tanks that supplied the whole building. The premises had sufficient toilets and bathrooms available. There were some people's rooms that had small ensuite facilities. After having a full tour of the home, we noted there was a need for low level and above eye level surfaces to be cleaned. We observed in the bathrooms and people's rooms on the ground floor that there was dust on the skirting boards and above on picture frames. In one of the toilets we found a commode chair that required a deep clean. In discussion with the manager and the housekeeper we were told that checks on the standard of cleaning would take place more frequently. We were told at the end of the inspection day that a new senior domestic would be starting the following week to ensure cleaning standards were met throughout the home. The provider may find it useful to note that cleaning audits were taking place however they did not contain details of what the housekeeping staff did in each room and general areas. There were areas specifically on the ground floor that required decorating. We were told Inspection Report Stapely Residential and Nursing Home April

12 by the manager and a trustee that they recyclable painting and decorating programme was in progress and the areas the inspector discussed would be completed as part of that programme. This was confirmed by visitors to the home who said "They are decorating a lot of areas throughout the home". All of the people we spent time talking with told us that they were comfortable at the home. The environment was bright, comfortable and warm. Inspection Report Stapely Residential and Nursing Home April

13 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement People who lived at the home interacted with staff well and it was evident that staff were known to them. Comments made by the people "The staff are very good here, always willing to help" "Staff work hard to make sure we are cared for properly" and "The staff are lovely, they support me and my friends here fantastically well". We were told by the manager that all staff were assessed for their training needs including mandatory updates and the manager ensured these were met across the year. Most of the staff training was provided by external organisations. Staff spoken with told us they received appropriate professional development that was arranged to fit in with their working patterns. Mandatory training included mental capacity act, equality and diversity, health and safety, fire safety and dementia awareness. Training records we looked at showed that training was refreshed regularly. Staff had completed relevant qualifications to ensure they were competent in their roles. Staff told us that they were mainly happy with the training they received and could mostly access the training they requested. We looked at the programme of induction and what training new staff completed to ensure they were competent in their roles. All staff spoken with confirmed that they had one to one supervision on a regular basis with a senior member of staff. Staff received annual appraisals, not all staff spoken with had, had theirs to date including the deputy manager and manager. The manager told us that this was an area they wanted to improve on to ensure all staff were confident and competent in their roles. We were told by staff that the managers were good at encouraging staff to complete training and development. The home operated a rota so that staff worked all their shifts on a specific floor ensuring continuity of care and staff for the people who lived at the home. Inspection Report Stapely Residential and Nursing Home April

14 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement The provider had an effective system to regularly assess and monitor the quality of service that people received. People who lived at the home, their families/advocates and staff were asked for their views about their care and treatment and they were acted on. Staff told us that they regularly update information about the quality of the service being provided and discuss ways to improve the service. The home and the local authority carried out a satisfaction survey with people who lived at the home and their family/advocates every year. The results from the last survey showed that the people their families/advocates rated the home as providing good aspects of care. The manager and staff held 'resident and relatives' meetings where they discussed what they wanted to improve and feed this back to staff. However the manager told us that there was very little uptake from residents and relatives at these meetings of late and the last meeting was held in We were told that they had tried different days and times but very few people attended. We were told that visitors were always made welcome at any time and we observed lots of people visiting throughout the day We looked at audits completed that showed regular quality assurance checks took place. Records we looked at showed that staff identified, managed and monitored the risks to people who lived at the home. Senior staff spoken with were fully aware of how to report incidents. Staff told us that were open days for religious gatherings at the service where all people using the service their families/carers and multi-disciplinary professionals were invited. There was a complaints procedure in place that staff were aware of. They told us they would always inform the manager if there were issues brought to their attention. On the day of this inspection a visitor did complain to the inspector and this was dealt with appropriately by the manager. Inspection Report Stapely Residential and Nursing Home April

15 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Stapely Residential and Nursing Home April

16 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Stapely Residential and Nursing Home April

17 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Stapely Residential and Nursing Home April

18 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Stapely Residential and Nursing Home April

19 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Stapely Residential and Nursing Home April

20 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Stapely Residential and Nursing Home April