Inspection on 03/09/09 for St Kilda Community Support Centre

This is the latest available inspection report for this service, carried out on 3rd September 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE St Kilda Community Support Centre 15 Drew Street Brixham Devon TQ5 9JU Lead Inspector Rachel Proctor Key Unannounced Inspection 3rd September 2009 09:30 DS0000071973.V377603.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Kilda Community Support Centre Address 15 Drew Street Brixham Devon TQ5 9JU 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) 01803 853158 01803 859898 The Sandwell Community Caring Trust Mrs Susan Helen Cohen Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: 2. Old age, not falling within any other category (Code OP) The maximum number of service users to be accommodated is 36. Date of last inspection 17th September 2008 Brief Description of the Service: St Kilda is a residential home that provides 24-hour care for up to 36 service users that are in the category of old age, not falling within any other category. The home offers respite, intermediate and long term care. Other services are also provided from the same building but this report concerns the residential service, which is kept quite separate and has its own dedicated staff team. The home has all single bedrooms that are found over three floors. In addition to this a seven-bed intermediate care unit, which is sited in a wing of the home quite separate from the long-term area. Each floor has its own communal lounge and separate dining area. A vertical lift is available and appropriate bathing and toileting aids for persons that have mobility issues, good access is provided throughout the home. Attractive gardens are found on two sides of the home, which are equipped with tables and seating areas. A hard standing off road car park is available at the home but this has many demands made on it and parking can be very difficult. The home is located in Brixham within walking distance of the community amenities including local shops. The weekly costs of care at the home were following the Care Trusts fee banding on 03.09.09 from £364.68 to £ 405.41. The statement of purpose was provided on each floor where people live and was available from the office of the home. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection, which took place on the 3rd September 2009 between 9:30 am and 4:30 pm. Two inspectors carried out the inspection. The second specialist Pharmacist inspector inspected the medication practise at St Kilda’s between 9:30 and 12:30. Besides the information gathered from the visit to the home information obtained since the last inspection of St Kilda’s in September 2008 has been included in this report. Selected people had their care followed, this included looking at the way their plan of care was recorded and speaking to them about the service they were receiving. The manager provided information for the inspection prior to the visit to the home. This provided information about how the manager of St Kilda’s believed they were meeting the Care Standards. People living at St Kilda’s, their relatives and staff working at home were spoken with as part of this inspection. A tour of the home was completed and some records were inspected. What the service does well: It was clear from observations undertaken that care was delivered in a sensitive way and people were treated with respect. People are consulted about what their interests are and what was important to them. It was clear that staff use this information to ensure people have access to the things they enjoy. And care was provided in a way the people need and expect. St Kilda’s has a core staff team that are experienced and committed to providing a high standard of care for the people who live there. They have access to training that improves their knowledge and skills to care for people. The intermediate care unit provides a service for people admitted for reenablement. People have access to the multi disciplinary team to assess and promote their abilities. Care being provided was goal orientated and agreed with the person receiving care. One person receiving intermediate care said, “Staff had been very caring as they helped them improve their self care ability. They helped with the things they were unable to do themselves and encouraged them to do the things that they could.” One of the health professionals who responded to a survey stated. They take care of the elderly. Respect peoples wishes and care very well”. This means people can have confidence in the care provided for them at St Kilda’s. Meals times are a pleasant experience for people living at St Kilda’s. These are varied and well balanced with choice always available. All the people spoken with said that they thought the meals were good. What has improved since the last inspection? St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.2 Page 6 The assessment and care planning systems have been changed since the last inspection. Assessments for people are followed up with a care plan that addresses their assessed needs clearly. Information in the assessments included the persons GP and their preferred name. This means that people can expect to have all their needs met by the staff caring for them and staff are aware of the way the person liked to be addressed. Care plans are now reviewed monthly or when the person’s needs change. This means that staff have access to an up to date plan of care that reflected the person’s current care needs. The manager has ensured that all the care needs of the people living at St Kilda’s are clearly reflected in their plan of care. This means people receive the care they need. Activities were being provided for people and staff were able to report what activities people had taken part in; these had been recorded in the activities book and the persons plan pf care. This means that staff have a record about the activities the people they were caring for had taken part in and enjoyed. This means people are cared for by staff who know what activities they like to take part in and enjoy. Four people spoken with said they knew how to complain but did not have any concerns about their care. The people who responded to the surveys also indicated they knew how to complain. The complaint policy has been up dated since our last inspections and was easily available for people living at St Kilda’s and their representatives. This means that people have been provided with sufficient information to enable them to express their concerns and wishes clearly. What they could do better: We found that when people have medicines prescribed with a variable dose that the actual dose administered to them is not recorded. This means that it is not always possible to feedback to the prescriber on the effectiveness of the prescribed medicine. For the person receiving the medicine this means they may not always have their medicines reviewed appropriately. The redecoration and refurbishment of the environment has continued. However comments received in a survey form indicated the following; “Spend more and decor and furnishings. The size of the bedrooms could be bigger with en suite for more privacy. Although fire safety checks were being carried out the way they were recorded in three separate areas made it difficult to follow. This could mean that some fire safety checks could be missed if the person who was normally responsible for these checks was not available. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 8 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 St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given sufficient information about St Kilda’s prior to their admission to make an informed choice about whether the home can meet their needs. The assessment process adopted by the manager has improved since our last inspection. The assessment documentation prompts staff to look at the holistic needs of the person they are assessing. This should mean that people can have confidence that their care needs will be assessed in a way that enables all their care needs to be recognised and met. The home has a dedicated intermediate care unit where people are helped to achieve their full potential supported by care, nursing and therapy staff. People’s care and rehabilitation needs are identified and realistic goals are set with them. People can have confidence that their changing health and personal care needs will be met. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 10 EVIDENCE: The manager advised that the statement of purpose and service users guide had been up dated since our last inspection. This included the results of the quality audit carried out and provided clear information about the home and its services for people. A copy of this was forwarded for the Commission. A statement of purpose and service users guide was available in each of the lounge areas visited during the inspection. A copy was also available in the office of the home. These gave people information about the home and its services. People asked said they were given information about St Kilda’s which helped them decide. Two people spoken with said they had had the opportunity to visit the home prior to their admission. The three people who had their care followed during the inspection had clear assessments of their care needs completed. The manager has adopted different assessment and care plan process for people who stay long term, Short stay and for intermediate care. One person from each of these areas had their care followed. All the assessments cover the same core elements, which enable the holistic care needs of the individual to be fully assessed. One person whose care was followed said staff had spoken to them about their care needs and what was important to them. They also said they could not fault the care they were receiving at St Kilda’s. One person receiving intermediate care had their care followed. Their assessment clearly stated their assessed need and what the goals of the rehabilitation were. The person had signed their assessment and care plan. When this person was spoken with they said staff had discussed what they hope to achieve during their stay in the rehabilitation unit. The goals they indicated they wanted to achieve were recorded in the care plan. The person said that staff were helping them to achieve their goal of returning home. One staff member spoken with who was working in intermediate care unit advised that the multidisciplinary team assesses and manages people’s care. The multidisciplinary team included district nurses, physiotherapists, occupational therapists and the care staff working on the unit. They also commented that the staff on the intermediate care unit work with the professionals and encourage people they care for to achieve the goals the professionals have set with them such as completing exercises to build up their strength. People receiving intermediate care are cared for in a unit dedicated to intermediate care. They have access to a kitchen area where staff can assess their ability and what aids would be needed when they return home. Physiotherapists have access to a treatment area where they can assess the individual and provide treatment. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way care plan information was recorded for individual people living at St Kilda’s should ensure they receive the health and personal care they need. Staff understand the needs of the people they care for. We found that people are supported with their medicines by people who have received training and assessed as competent. However it is not always clear what dose of medicines prescribed with a variable dose that they have received. People living at St Kilda’s are treated with respected by the staff team who care for them. The things that are important to them are taken into account when their care is planned. EVIDENCE: St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 12 Three people had their care followed as part of this inspection. One person from each of the following areas; intermediate care unit, long stay and respite unit. The people in the long stay and respite units had a care plan completed from their assessment. The way care plans are recorded has changed since our last inspection. The manager provided a list of the areas assessed when a person was admitted to the home. The care plans provides information for staff relating to the persons health and social care needs as well as emotional and recreational needs. The care plans were being stored in a locked cupboard in each unit where people were living. Each unit has senior carers who take responsibility for ensuring peoples care plans are up to date and information needed was recorded. The person whose care was followed on the long stay unit had a clear plan of care that identified how staff should meet their care needs. The person had difficulty eating some foods. This was recorded in their care plan advising staff which food they were able to eat. Risk assessments were an integral part of this person’s plan of care. Manual handling assessments showed their ability had changed. A new stand aid had been provided by the health professional that assessed them. The person’s problems with swallowing were clearly identified in a risk assessment. This as well as the persons care plan guided staff what actions to take to reduce risk. People’s personal choices and their self care ability were being recorded as part of their care plan. This enabled staff to know what the person could do themselves and what they needed help with. One person spoken with during the inspection staff help them with the things they were unable to do and encourage them to do the things they can. Each element of the care plan for this person had been reviewed monthly or sooner if their care needs changed. The staff on duty were clear about the person’s needs. The senior in charge of the unit advised that each shift hand over comments are recorded about the persons care. The person whose care was followed had three entries a day; morning, afternoon and night time. The senior advised that this enables care to be handed over each shift change and ensured continuity of care for the person. The involvement of other health professional in the person’s care was being recorded separately. These included the persons GP, therapists, chiropodist, dental appointments and district nurses. Specialist pressure relief equipment and manual handling aids had been provided by the health team for one person whose care was followed. This shows that people have access to health care professionals who influence the way care was provided for them. The person whose care was followed who had accessed short stay had a plan of care that followed the same thirty two elements as the long stay person. The care plan did not contain as much detail but did have sufficient information for staff to understand what care the person needed. The person ability for self care and the reasons for the short stay were clearly recoded. The person had St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 13 signed their plan of care. Reviews of the plan of care were recorded separately from the daily information staff recorded three times a day. Information from the hospital unit the person had stayed in prior to their admission was also provided. We found that appropriate secure medication storage was available in the home, although some of the cupboards were not fitted in accordance with current legislation. Arrangements were made whilst we were present for these to be fitted correctly and we have since received confirmation that this has been done within the agreed timescale. This means that people can be assured that the risk of inappropriate diversion of their medicines is reduced. We found that some of the Medication Administration Record (MAR) charts were written in the home. When this happens the charts were not always fully completed and did not specify the dates covered. Also there was not always a record to indicate who had written the chart or any evidence that the entries had been checked. This means that it is not always possible to identify when medicines have been administered. Also if the person making an entry were to make a transcription error there is no process in place to check this before administrations are made. We found that people administering the medicines had received appropriate training and had been assessed as competent to carry out the task. Records also indicated when they were next to be assessed and when further training would be planned. This means people can be confident that they will receive their medicines from appropriately trained people. Staff observed caring for people during the inspection were respectful and supportive towards the people they were caring for. Staff were explaining what they were doing before they did it keeping the person informed of any care tasks. Staff were involving people in discussion and treating them respectfully. Six people spoken with living at the home said staff were always friendly and helpful towards them. Comments’ included; “Staff understand what I need and help me to do the things I am unable to do myself.” “The girls are all very good”. Other comments from the survey forms included; “Staff very friendly” “It feels like home. Cared for very well” “It’s like a family. The staff are very good. When family members visit they are welcomed and made to feel welcome” “Take care of the elderly. Respects peoples wishes and care very well for client’s and tries to meet their needs”. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are provided for people who live at St Kildas, however these may not always meet peoples expectations. People are encouraged to exercise choice and control over their daily lives by the staff team who care for them. Mealtimes are a pleasant experience for people who live at St Kildas. EVIDENCE: The staff on each unit take responsibility for the activities and entertainment people on the unit take part in. A record of activities each day was being kept. These included quizzes, card games and listening to music. During the inspection one unit was playing cards with an individual. Another unit was conducting a quiz for people. The senior in charge of the unit advised that some day’s staff complete one to one activities with people other days they organise group activities. People spoken with were generally satisfied with the level of activities and entertainment provided for them. However some comments suggest that people would welcome being able to go out more and St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 15 see more visiting entertainers. One person commented that they had really enjoyed listening to a musician who had come to the day centre. They said they would like to be able to do this more often. The senior in charge of the unit told us that the day centre staff at St Kilda’s offer places for people living at St Kilda’s when they have room. However this is on a rotational basis to allow every one the opportunity to attend at some point. The day centre manager confirmed that places are made available for residents at St Kilda’s when number allow. Some of the comments received in anonymous surveys are listed below. It would be nice to have regular outings but everyone is very good Good activities, nice friendly happy staff. Good choice of food. Relatives spoken with during the inspection said the staff keep them informed and they were satisfied with the care their relative was receiving. Visitors were coming and going through out the inspection. They were seeing people in the privacy of their own room or in one of the communal areas. The way individual care plans are written show that people’s choice was taken into account when care was planned. This included the time they liked to get up or go to bed, the type of activities they enjoyed and the people who were important to them. One person spoken with said they liked their own company and preferred to watch television rather than take part in activities. They said the staff are always helpful to them and they understand what they like to do. The manager advised that people are encouraged to manage their own financial affairs if they are able. People’s individual rooms entered during the inspection had been personalised with items of their choice. One person said they had kept the little things that reminded them of their home and this had helped them settle in. Meals are prepared in the homes kitchen and distributed to the individual units where people live. The seniors in charge of the units had ensured that people’s personal preference for food or their dietary needs were recorded. People were advised of the main meal each day. Those that were asked said they would be given an alternative if they did not like what was on offer that day. Staff working on the units knew what people liked and tried to ensure they had what they liked to eat. People asked during the inspection said the food was good. However one comment received in an anonymous survey stated that the home could improve by “Greatly improving the very poor menu and quality of food it cooks”. The menu’s seen were varied and nutritiously balanced and no one raised any concerns during he inspection about the food. Another person commented that meals were, “Generous size, plain cooked food, fresh ingredients used. The meal time observed in the intermediate care unit was unhurried with people eating their meals at their own pace. Staff were assisting people discreetly when they needed help. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at St Kilda’s can have confidence that any concerns they raise will be dealt with sensitively by a staff team who understand them and have their best interests at heart. Staff receive training for protection of vulnerable adults. The staff team are aware of how to recognise and respond to any incidents that cause concern, and people are protected. EVIDENCE: The complaint policy and procedure were easily available for people in the home. This was contained in the service user’s guide, which was provided for people. Those spoken with during the inspection said they knew who to speak to if they had any concerns. People who responded to questionnaires mostly said they knew how to raise concerns. All said staff were helpful to them. One concern and one safeguarding referral relating to medication have been received since our last inspection. The home manager has cooperated fully with investigation relating to medication practises in the home. The manager advised that she has changed some medication practice as a result of the referral. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 17 The manager advised that information about protection of vulnerable adults was provided in the office for staff. She also advised that each member of staff was issued with a copy of the homes policies and procedures, which includes vulnerable adults. The manager also stated that staff sign to say when they have read the policies and a copy of this was kept on their individual staff file. The manager confirmed that staff have protection of vulnerable adult training. Four of the staff spoken with confirmed that they had had this training. The training coordinator advised that a record of all the courses staff had completed were recorded. The training matrix was available for inspection. This showed when staff were due to have refresher training for the protection of vulnerable adults. And the date they last completed the training. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team at St Kilda has shown commitment to improving the environment for people living there. This means people who live in St Kilda can have confidence they will have a reasonably well-maintained environment to live in. EVIDENCE: A tour of the home was completed; all the communal areas and disabled access bathrooms were seen. Some peoples rooms on each floor were entered. The long stay and respite unit was arranged as on three separate floors each containing nine or ten bedrooms for people to use. The intermediate care unit contains seven bedrooms for people to use. In addition to the seven bedrooms on the intermediate care unit, a therapy room and an assessment kitchen was available for health professionals to assess peoples ability and progress. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 19 The Commission has been made aware of plans to provide new build accommodation at a different site. Some comments received suggested that the rooms could be bigger and en-suit facilities would be useful and provide more privacy. The staff indicated they would like more office space. The middle floor which was refurbished at our last inspection was in use. Six people were living in this area. The senior in charge advised that the unit was mostly used for people receiving short stay respite care. Other floors had been refurbished and redecorated since our last inspection. The top floor had been redecorated and new furniture provided for some rooms. An office area had been created on this floor for medication storage, care plans and other information staff needed. Staff on this unit commented that it was much easier having people’s care plan information easily available on the unit. The manager advised that each unit has dedicated office space. Senior staff on each unit take responsibility for ensuring the unit runs smoothly and peoples care needs are met. New carpets had been fitted and new furniture purchased. The manager confirmed that the refurbishment would be continuing. Each of the four separate areas had their own kitchen/dining and lounge areas for people to use. People were seen to be using these during the inspection. The people who had chosen to stay in their own rooms said they preferred this and would take part in activities if they were interested in them. Since our last inspection the way cleaning of the individual units was organised has changed. Staff on each unit take responsibility for cleaning the rooms and bathrooms on their unit. Each of the four separate areas were clean and fresh and free from odour. Four staff spoken with during the inspection said they had got used to the routine and worked together to ensure their unit was always clean and fresh for the people there. Although two commented they felt this left them less time for people’s care. The manager commented that since the change the standard of cleanliness of each unit had improved. The laundry area is sited away from people’s individual rooms and the food preparation areas. Staff working on the units take responsibility for ensuring people have their cloths returned to them. The manager has provided an infection control policy for staff and staff have access to infection control training. The pre inspection information indicated that 44 staff had received infection control training. The home employs 41 care staff and 16 staff who are not involved in care. The training matrix completed shows when staff have received this training and when up dates are due. Staff observed were using gloves and aprons when providing care. They had access to hand wash facilities. A yellow bag system was in place for the disposal of clinical waste. The home has hopper style sluice with an adjacent large sink provided on each floor where people live for disposal of waste. Although not all had a designated hand wash sink for staff use. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has ensured a robust recruitment system was used to protect people from unsuitable staff. The management team at St Kilda’s are committed to providing staff with the training they need to do their jobs well. This means that people have access to staff who have the knowledge and skills necessary to provide their care. EVIDENCE: The manager provided a copy of the duty rota for the week. This had been divided up into the four units in the home, top floor, middle floor, lower floor and intermediate care unit. This showed that there were 2 staff on duty each shift for all but the lower ground floor, which had five people living there. In addition to the staff assigned to the different unit’s one member of staff acts as a floater between units five days a week. The staff on the units said they helped each other out. If they had completed their work one of them would help out on another unit. Staff spoken with said the system usually worked well. They also said they covered shifts when a team member was off to enable the people in the unit to have staff who knew them providing their care. The manager advised that giving the seniors on each unit responsibility for their units staff arrangements had been working well. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 21 All the staff spoken to during the inspection said they had sufficient staff on duty to meet the needs of the people they were caring for. In addition to the care staff the home employs a cook, kitchen assistants, maintenance staff and a training coordinator who also maintains staff personnel files. The AQAA (Annual Quality Assurance Assessment) information indicates that the homes management team are committed to ensuring staff achieve an NVQ (National Vocational Qualification) level 2 or above in care. This information indicated that twenty-three of the thirty-eight permanent care staff employed had achieved an NVQ level 2 or above. Four of the staff spoken with during the inspection said they had good access to training. The home has a training coordinator who monitors the training staff receive and the training staff need. She advised that the training matrix set up shows when staff need refresher training or need to complete training. The matrix entries were seen for four staff during the inspection. This shows that the management are committed to training the people who work for them. Six staff files were looked at during the inspection. Each had an application form references and information police checks had been completed prior to the staff member starting work. Contracts of employment, which had been signed by the staff member were also available in their staff file. The information gained interview, which showed how the person had been selected for the role have been kept. The information available shows that staff recruitment was robust and should protect people from unsuitable staff. For staff spoken to during the inspection said they were well supported and had good access to training. One staff member who had recently been promoted to senior said they had good support following their promotion. Staff training list is cast the training coordinator. She provided a training matrix that showed the training staff had completed or had planned. Information relating to 6 staff members training records were viewed. This showed that staff have access to mandatory training that is regularly updated as well as training relevant to the needs of the people they care for. The manager advised that all staff would have a training and development plan as part of their annual appraisal, which would be reviewed at supervision when necessary. The training coordinator takes responsibility for staff files, ensuring they are up-to-date with copies of training certificates for courses staff had completed. Staff files seen contained training and development plans. A record that supervision had taken place had also been recorded. The manager advised that she completes the supervision for senior staff and they complete supervision for of staff they are responsible for. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Kildas manager continues to be committed to ensuring that the home’s run in the best interests of the people who live there. The health and safety management of the home should ensure that peoples health and safety is protected and promoted. EVIDENCE: The registered manager has several years experience working in care. Since the change of ownership the management systems with in the home have changed. The manager advised that the new structure, which had senior carers responsible for each floor where people were living, had been St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 23 introduced. Senior carer’s are responsible for up to ten people in their area. The main home has three floor and three staff teams. The intermediate care team has a separate staff group who care for up to seven people. The staff spoken with during the inspection said the system was mostly working well. However one commented that completing domestic tasks some times meant they had less time to spend with people living in their unit. All the staff spoken with during the inspection said their access to training had improved since the change of ownership. These staff also said they had access to training that helped them to do their jobs. The training information provided during the inspection showed that the management were committed to providing staff with the training they needed to do their jobs well. The manager provided information about the quality assurance that had been completed since our last inspection. The results had been added to the revised statement of purpose, which was easily available for people living in the home. A copy of the revised statement of Purpose was sent to the Commission. The information provided in the AQAA (Annual Quality Assurance Assessment) showed that the policies and procedures had been reviewed in April 2009. The manager advised that staff are given a copy of the organisation policies as part of the up dated staff handbook. She confirmed that the majority of staff had received these handbooks. One of the staff handbooks was seen during the inspection. These were comprehensive and provided the staff with the information they needed. How the money people had given for safe keeping was managed was discussed with the manager. The money held for one person was checked. Copies of receipts of expenditure were also being kept with the records of money held. The manager advised that each person has a separate folder with the money they have given to staff for safekeeping. The manager confirmed that the home does not manage any of the current people’s financial affairs. Care plans indicated who took responsibility for the person’s fiancés if they had been assessed as unable to do this them selves. There was a clear record of supervision for staff. The training coordinator confirmed that although she managed staff files as part of her role, the manager and seniors take responsibility for supervising staff. The manager advised that the new staffing system with senior carers enabled some of the supervision of junior carers to be delegated to them. Staff spoken with said they felt supported to do their work and the management team were approachable. One comment received in an anonymous staff survey stated when asked, “What does the home do well”: - “Good employers who make you feel you have a stake in St Kilda’s and the care you deliver. Employ staff who genuinely care about delivering quality care and are dedicated to improving the persons quality of life. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 24 A written statement of policy, organisation and arrangements for maintaining safe working practices at St Kildas was provided. This was available in the office of the home. The manager has ensured that staff receive mandatory training for health and safety, manual handling and fire safety. The training coordinator was keeping records of the date staff completed any training and the dates when up dates were needed. The computer generated training matrix was viewed for six staff employed at St Kilda’s. This system allows the manager to ensure that staff receive the training they need in a timely way. The manager confirmed that risk assessments had been completed for working practices in the home. This was provided for inspection. The fire risk assessment was also available. However the information that showed fire safety checks had been completed were difficult to follow. The maintenance person who takes responsibility for fire safety checks advised that they had recently introduced a new system of recording and not all the information had been transfer as yet. Records of accidents were being kept and information relating to reportable instances was provided for staff. The manager advised that she regularly reviews accident records to ensure any actions that need to be taken to reduce risk are taken. St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 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. 1 Standard OP9 Regulation 13(2) Requirement The Registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Arrangements must be made to ensure that the actual dose administered is recorded when people are prescribed medicines with a variable dose. This is to ensure that appropriate feedback can be given to the prescriber about the effectiveness of the medicine and also to inform what dose is required at future administrations. Timescale for action 30/11/09 St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 27 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 OP9 Good Practice Recommendations It is recommended that for the safety of people using the service that when Medication Administration Records are hand written that the person writing them signs and dates these and then they are checked and signed by a second person. The redecoration and refurbishment of the environment should continue. The manager should consider keeping the information relating to fire safety checks in one place, rather than the three separate records currently being kept. 2 3 OP19 OP38 St Kilda Community Support Centre DS0000071973.V377603.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Southwest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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