Inspection on 24/06/10 for St Marks Care Home Limited

This is the latest available inspection report for this service, carried out on 24th June 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Marks Care Home Limited 17/09/08

St Marks Care Home Limited 04/09/07

St Marks Care Home Limited 11/09/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Key inspection report Care homes for older people Name: Address: St Marks Care Home Limited 38-40 Wellesley Road Clacton on Sea Essex CO15 3PW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 2 4 0 6 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Marks Care Home Limited 38-40 Wellesley Road Clacton on Sea Essex CO15 3PW 01255421750 01255435282 sandy@sahadew.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Marks Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 17 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 17 persons) The total number of service users accommodated in the home must not exceed 17 persons Date of last inspection Brief description of the care home St Marks Care Home can provide personal care and dementia care for up to 17 people over the age of 65 years. The home has been converted from two private residences. It is on a residential street in Clacton-on-Sea close to the town centre and sea front. Care Homes for Older People Page 4 of 34 Over 65 17 17 0 0 1 6 0 9 2 0 0 9 Brief description of the care home Accommodation is provided on two floors, with the upper floor being accessed by a passenger lift. Thirteen rooms are single occupancy and two rooms are shared. Residents have a dining area and two sitting rooms available to them. There is a small garden to the rear of the property and limited off road parking in front of the home. The fee range for the service is from £392.00 to £420.00 per week, this excludes newspaper, toilteries, hair dressing and personal items. This information was provided at the this key inspection. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality Commission is based upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 16th September 2009. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Care Homes for Older People Page 6 of 34 Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and the management team. The visit took place between 10:30am and 16:30pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and provider. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: A number of additional requirements have been made following this key inspection. Improvements are required to be made in relation to the environment. This includes the continued internal redecoration to the small lounge where the salt is rising on the wall, replacement of the patio door glass. Hand rails in the garden to support people in moving freely around the out door space whilst enabling them to gain access. A cigarette dispensing unit is required for safety reasons. Improvements are required to the internal quality assurance process in order to ensure that the purpose of the quality assurance highlight the need for a review of management systems and or additional input and guidance. Care planning and assessments are to improve to ensure that the holistic needs of an individual have been highlighted, recorded and implemented in their best interest. The service must review the provision of activities made available at the service and overall recording systems for this. Care Homes for Older People Page 8 of 34 Supervision should be provided for all staff on a periodic basis with suitable training in the Mental Capacity Act and Deprivation of Liberties and Safeguards. The service still does not have a registered manager who is fit to manage the service. This is placing the people using the service at risk as over all management and improvements must continue. 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. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their immediate care and support needs will be assessed and that staff are able to provide the correct basic care and support to them as per the information contained in the assessment. Evidence: Following the last inspection, the service has further adapted and made improvements to the assessment process. All people using the service have received reassessments of need. This is using the format previously used, known as the initial assessment followed by a series of further more detailed and specific assessments. Examples of these were reviewed for two of the people using the service and included assessments exploring communication needs, skin care needs, cognition assessment and falls. In addition to this the service has introduced a day to day assessment of mental capacity for the people using the service. The services assessment format does explore a range of needs for the individual and provides basic tick box information for staff to use to ensure that they meet the needs of the individual. However the service does Care Homes for Older People Page 11 of 34 Evidence: not ensure that the assessment process fully explores the personal and individual preferences of an individual. The assessment describes using the ticks what action is required but does not tell the care worker how this is to be provided. An example of this is surrounding personal choices for colours of clothes, whether the person likes bubbles in their bath and or their shoes or slippers on during the day time. Part of the inspection process involved case tracking two people. Case tracking is a method used to review a persons care package and reviews the person from the assessment stage to the current stage in their lives, including assessments, care planning, risk management and health issues. Where possible the people case tracked are also visited to gain their views directly. Indirect and direct observations also occurred in order to establish if the care being provided was as per the care plan. Two people were case tracked as part of this inspection process. The assessment process sets out each separate area of need and how the service is able to meet the needs of the individual. The service also has internal documents in place to ensure that each of the records are completed to a standardised approach, ensuring that the full needs of the person are accurately recorded. Examples of areas that had not been completed include a dietary preference form for the individual and the personal appearance chart had not been completed since the 28th April 2010. The remainder of the assessment format allows the assessor to tick which area of need applies most to the person using the the service. For example the section on washing, needs assistance is ticked. Other examples of tick assessment completed include sleep assessment, foot assessment, mobility assessment and sociability assessment. The pre admission assessment does explore some areas off difference and diversity and identifies the persons preferred name, religion, age and wishes in the event of death or a terminal illness. The format does explore marital status but does not prompt or identify civil ceremony and partnerships. The service consults the assessment information to see if they can meet the prospective individual needs before they make the decision to accept the application for admission and offer a place. For both of the assessments reviewed as part of case tracking it was directly observed that the service was in receipt of one of the assessment carried out by social services. Individuals are provided with a statement of terms and conditions or a contract before admission to the service. It gives basic information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy. The contract is normally reviewed when the persons circumstances change. One person file contained the contract and the other persons file did not. This Care Homes for Older People Page 12 of 34 Evidence: was discussed with the manager at the time of the inspection and the contract could not be found on site. The manager was asked to forward the contract to us, however this was not completed. The service has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service users guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. These documents, were on display within the service. The AQAA tells us that we ensure that all residents are assessed prior to admission and they are given the right to choose and make the final decision. The home does not provide intermediate care at present. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that the staff are suitably experienced to meet their needs and ensure that they are supported to access health care services as required. Evidence: The care plans of two people living at the service were read to determine how the service supports the needs identified in the persons initial assessments. The care planning format followed the information obtained during the assessment process. Each area of need was identified in a separate care planning tool and covered items such as, eating and drinking, personal hygiene, elimination, dressing, communication, mobility, sociability, oral / mouth care and foot care. Each of the care plans detail the identified need for the individual person followed by the individuals need and outcomes for delivery of the care and support. Each of the care plans seen, followed a similar format. It was established that the assessments for each area of need then contained a care plan. One person using the service commented Its OK here. in addition to this one person put their thumb up when asked if they liked living here. Care Homes for Older People Page 14 of 34 Evidence: The AQAA tells us that residents privacy, dignity are maintained at all times. A comprehensive individual centred care plan is drawn prior to provide care. All residents have their own GP. dentist, chiropodist, and optician when required. Details of health care professional visits were observed in the care plan folder. Care plans observed had been reviewed. The care practices observed throughout the day were respectful and dignifying at all times. One care worker was directly observed supporting some one with their lunch and afternoon tea and biscuits. This was achieved in a calm, unhurried manner. In addition to this people were observed to be treated with total respect and staff were observed listening to the needs of the person and communicating with them in their preferred methods. Overall the plans do give instruction to staff in meeting the majority of peoples needs, and from observation and discussions with people living at the home and the staff group there was evidence of knowledge of the individuals and their needs. However if the information in care plans was more detailed and responded to all the information staff demonstrated that they knew about the person, it would provide an increased level of consistency in the delivery of the staff support and improve the outcomes of people living at the service. The AQAA contains minimal information from the service regarding how the service evidences it meets the national minimum standards. It states, (in relation to evidence to show that we do it well), that a record is kept in the residents folder. This information remains unchanged from the last key inspection completed in September 2009. The files seen contained assessments relating to nutritional screening, skin and a moving and handling plan, outlining the needs of person living at the service. These gave an indication of the persons strengths and weaknesses that affect the outcome of their movements. The service completes a general risk assessment. This is a formated document completed for all people using the service. These had recently been reviewed. The risk assessment tool explored medication issues, finance, diet and food, infection control, falls, dementia and access to bedrooms. The service maintains records that monitor peoples health and wellbeing such as regular checks on their weight and fluid intake. This provides tools that give indications of changes in the persons wellbeing which may require action by the service. The service uses a number of recognised tools to identifying deterioration in a person specific health area, which in turn alerts the service to other possible health issues associated with the deterioration. Care Homes for Older People Page 15 of 34 Evidence: Visits made by medical professionals such as GPs or District Nurses were maintained on peoples files, and included the reason and outcome of the visit. The management of medication administration was reviewed as part of this inspection visit. This included the indirect observation of staff administering the lunchtime round and discussions with staff. The service had recently experienced and issue with regards to the management of controlled drugs. Following this the service has reviewed the policy, retrained the staff and implemented an audit system to check medication systems and management. This was reviewed a part of the inspection. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have access to some activities, however the provision of these activities could be improved to ensure that they are meeting individual preferences and wishes. Evidence: People using the service are given the opportunity to take part in a selection of activities within the service. Due to the number of people residing at the service, the frequency of community base trips is minimal. There is no formalised activity planner in place. The service has a large white board on display, this shows what may be available for people to engage in. On the day of the inspection the board stated what staff were on duty and that a sing along would occur. The service has an activity person who works one hour per week on a Wednesday. Following discussions with the provider of the service, it was felt that this was adequate, as people cant concentrate for longer periods of time. Our concern was expressed in relation to the provision of activities at the service and the general lack of information and or knowledge about what the provision of activities could improve upon. The provider did not have information from the National Provision of Activities for Older Pople (NAPA), neither were they registered with this organisation. Care Homes for Older People Page 17 of 34 Evidence: A person using the service commented I like the ice cream. In relation to what the service does well, the AQAA tells us that providing social activities as per residents preference and abilities. Encourage relatives to visit regularly and also residents are encouraged to practice their beliefs freely. The AQAA has also identified that they are planning to improve on the provision of activities, increasing participation and out door activities. The previous AQAA highlighted that the service would make additional improvements and commented that they would increase the amount of activities provided within the next twelve months. During the inspection it was evident that care staff were offering some activity, this included sitting in the garden having ice cream, chatting and listening to music. Towards the end of the inspection several people were observed playing dominos in the main lounge. It was evident also that the needs of the people using the service were at times high and thus the availability of care staff to continue to complete activities as well as providing care may be compromised. Feedback was provided to the provider in order to review this situation. The service has a basic understanding of human rights and how this impacts on people using the service. There is little documentary evidence to support this approach, but staff were directly observed to be respecting and dignifying personal choices and opinions. The service completes a tick box sociality assessment and in addition to this also completes an activities interest form. It was not apparent that the activity schedule had been completed with the specific interest of the people using the service at all times. There were care plans relating to the social needs of people there were not specific details of how the assessed needs and abilities of people shaped their choices and how staff should support these. Records were maintained by staff with reference to the activities that people had been offered and or engaged in. Records showed that the one person using the service over a period of one week, listened to music and or joined in a sing along or rested in bed discussions were held with the provider regarding the recording and how accurate the records are being maintained as a true reflection of the provision available. The provider felt that the records were reflective of the activities provided. One person using the service stated we listening to music a lot and chat amongst ourselves. Another person spoke about the choice of meals and felt confident that if they chose something else from the offered menu this would be not be a problem, they said the foods tasty. Another person stated the meat is very chewy. During general observations made over the meal period, a number of people using the service had left the meat. This was fed back to the provider at the end of the inspection. Care Homes for Older People Page 18 of 34 Evidence: Menus showed that two choices were available. Records were also maintained where people had made their choices. The observation of the lunchtime meal indicated that there was generally a congenial atmosphere where people were given time to eat in a relaxed manner. The staff moved around the dining room and lounge serving the meals, encouraging people to eat and offering assistance if required. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that they are listened to and that complaints are acted upon. Evidence: The service has a complaints procedure that meets the NMS and regulations. The procedure is up to date and information regarding the process to complain is located in the entrance foyer of the building. The procedure is not available in alternative formats. Some individuals spoken to as part of the inspection process stated that they know how to make a complaint. One person using the service stated I would always talk to some on in charge. In addition to this another person stated I think I know how to complain. Complaints from individuals were fully recorded. The AQAA tells us that the service has not received any complaints within the last twelve months. The AQAA tells us that the service has identified that they could improve by to continue to provide training and to minimise complaints. There are policies and procedures for safeguarding people who use the service, these are specific to the service and have been reviewed. The service also held a copy of the multi agency approach for Essex. Care Homes for Older People Page 20 of 34 Evidence: Staff spoken to confirmed that they had received training in safeguarding of vulnerable adults. People using the service say that they are satisfied with the care in the service and feel safe. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service reside in a homely environment, however improvements are required in order to ensure that people feel they can access all areas, reside comfortably in their home and enjoy a homely environemtn. Evidence: The service is a homely place to live and the bedrooms and communal rooms meet the National Minimum Standards or are larger. All bedrooms that were seen, were personalised to the individuals own taste. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. One person using the service commented I like my room. In addition to this one person commented I spend time in my room. Most bedroom doors have the name of the person on a plaque, however the service does support a number of people with Dementia. Some improvements have been made in relation to signage being used to display toilets for example. No additional memory aids were being used at the service. This was discussed with the provider during feedback. The lay out of the service attempts to encourage people to socialise and engage in small clusters rather than all in one area. The service has many different seating areas available with books and music available to all. The design of the internal building allows people to move freely throughout with a lift available to move between floors. The environment promotes the privacy, dignity and autonomy of people. This Care Homes for Older People Page 22 of 34 Evidence: was directly observed during the inspection, where people where seen to be supported to their rooms for personal care and support tasks. Staff were also seen to knock an wait on bedroom and bathroom doors. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers and of satisfactory quality. Within the last twelve months redecoration of several bedrooms and replacement of bedroom fire doors has occurred as these were highlighted during the last key inspection. No additional improvements were noted. The management has an infection control policy. They seek advice from external specialists, such as NHS infection control staff, and encourage their own staff to work to the services policy to reduce the risk of infection. Hand sanitiser, aprons and gloves were seen to be used and readily available for all staff. The AQAA tells us that improvements are planned over the next twelve months and include the to build a conservatory to carry out activities. Improvements to the kitchen area have been made which were highlighted at the last inspection. This includes new tiling and flooring. It was observed that the dinning room table coverings were old, dirty and uninviting. two of three tables were covered in old Christmas paper cloths. Later during the inspection these had been removed. The glass in the patio doors was also blown, limiting the view into the garden area. This still had not been replaced. Detailed discussions occurred with the provider who fed back that they had thought that the glass had been broken and upon inspection it was noted not to be broken, therefore they did not feel it was needing to be replaced. The provider agreed during the inspection to replace the panel of glass were vision was effected and not clear. The provider agreed that he was clear about the required action to take. It was also noted in the small lounge area that an area of wall had bubbled. On further discussions with the provider it was established that this was rising salt. The provider stated that they were in discussions with the specialists and this would be rectified. The garden area was small and reasonably maintained. Since the last inspection improvements have been made to the garden area and several surfaces have been concreted to make them level and safer for walking on. There still remains to be limited railings around the garden to support with walking. Outside on one of the Care Homes for Older People Page 23 of 34 Evidence: tables there was an old metal tin filled with cigarette butts. People using the service who did not smoke were in close proximity of this. This was brought to the attention of the manager. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are cared and supported by a dedicated staff team who are kind and respectful in their approach, ensuring that people feel safe in their own home. Evidence: People are generally satisfied that the care they receive to meet their needs. One person using the service stated the staff are lovely. The provider confirmed that there are three care staff working throughout the day with one waking night person and one sleep in person. In addition to this the person in charge is supernumerary. In addition, there are catering, housekeeping on duty in the waking day. The service does not use agency staff or have a relief bank list. The recruitment records of the three staff contained documents that supported the employment of people who were suitable to work with vulnerable adults. This included full application forms, references, proof of their identify and CRB checks. In each case the staff had commenced their employment with a ISA first request while the full CRB report was waited for. A new member of staff was able to confirm that a formal interview had taken place, that references and a CRB had been applied for. The staff member also stated, I have started my induction. In addition to this the member of staff commented, the team works really well here. Since the last inspection a new Care Homes for Older People Page 25 of 34 Evidence: deputy manager has been appointed to further support the provider in the running of the service. The training programme included items such as health and safety, food hygiene, fire safety and manual handling as having being completed so far this year. Staff spoken with said they had enjoyed the training they participated in and felt that there was training on offer. One staff member stated I am hoping to start my NVQ III. The staff have not received any training in the Mental Capacity Act and Deprivation of Liberty and Safeguards. The AQAA tells us that The home has 50 staff with NVQ level 2 training. All new staff receives common induction training within six week of employment. Evidence of the inductions were seen on staff files. All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. During the inspection care staff were directly observed supporting people in a caring respectful manner. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can not be assured that the service is run in their best interests due to not having a registered manager and or a person who is meeting all the required National Minimum Standards. Evidence: Mr Sahadew a director of the company, St Marks Care Ltd who owns the service, has been operating as the person in charge. He is a registered nurse and has worked in the residential care sector for many years. Mr Sahadew is a registered manager for another service inspected by the Care Quality Commission. Mr Sahadew has made an application to become the registered manager for St Marks. Mr Sahadew demonstrated a willingness to learn and improve the quality of the service at St Marks. Progress and complaince has been made with a number of the requirements made at the last inspection, however due to an inconsistent, unregistered manager in post there are areas of the service that are slipping. This is reflective in the over all quality rating of the service and the number of requirements Care Homes for Older People Page 27 of 34 Evidence: that have been made. The proposed registered manager showed little clarity and knowledge of how improvements have been made and or future improvements. We spent significant time talking to Mr Sahadew regarding quality assurance of the service and management systems. Mr Sahadew did not show effective use of skills and or knowledge. Mrs Sahadew was present during the feedback and answered many of the questions in order to establish the right evidence and clarify evidence where non complaince was established. Although the service returned the AQAA when asked to do so there was very limited information about how the home was listening to the people who lived there and was moving towards a greater compliance with the Care Homes Regulations 2001. The primary purpose of the AQAA is to inform the Commission about how the Registered Person and or provider, understood the strengths and weaknesses of the service in meeting its regulatory obligations and how they were seeking to address these. The quality of the information in St Marks AQAA evidenced a lack of clearly defined planned progress towards a quality service provision. It is important that the organisation and manager identify ways in which they can access information and support in respect of good practice in their care sector and consider how they will incorporate this learning into the service development plans. Mr and Mrs Sahadew spoke about commencing a course in business management and stated that their background was in nursing and not social care and business. This was not evidenced within the services AQAA. The AQAA did however hight, the home has well trained deputy manager working under supervision of a suitably qualified owner. A comprehensive service users guide and statement of purpose is in place. A quality assurance is carried out on yearly basis to ensure that the service users are satisfied with the care and services provided to them. The manager is liked and respected by the staff and people living at the home. They said that they were approachable and always responded to what they told her. One staff member stated the management are supportive and approachable. The manager stated that the service had conducted a quality assurance survey since the last inspection. These documents did not set out how many responses had been received in each category but gave an overall summation of their content. The outcomes centred on central issues such as quality of care, meals and decoration. The manager had not produced a published report at the time of the discussion. A letter was sent to us following the inspection where the provider had responded to an individual who had, for example responded to the decoration being fair. The letter informed them that improvements are ingoing and if they were able to suggest any Care Homes for Older People Page 28 of 34 Evidence: further improvements. The stakeholders surveys are an important element of the services quality assurance system. It is important that people who use the service, their supporters and others are asked how their experience of the service meets their expectations. The information gathered from this should be used to inform the services annual development plans and their completion of the AQAA returned to the Commission. The quality of the current format and information gathered by the St Marks surveys and their responses should be considered by the organisation to understand how this affects their overall quality assurance programme and their progress in meeting the National Minimum Standards for Older People 2001. Internal quality assurance systems are in place and following a recent incident in relation to medication a fortnightly audit is now completed. Staff records demonstrated some staff supervision was taking place but that this was not consistently carried out for some staff. The opportunity to give feedback to staff in relation to their performance is an important element of staff development and quality assurance. The records relating to the maintenance of health and safety systems and equipment within the service were reviewed at this visit. The certificates for the maintenance of gas and electricity systems, the passenger lift and hoists and fire safety equipment were all within date. The service has a current liability insurance. These records demonstrated a robust approach to the health and safety of people living at the service. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must state the specific care and support that an individual wishes and requires. In order to ensure that the specific needs of people are met at all times and that they are protected from harm. 30/09/2010 2 19 23 Areas of the garden accessible to people using the service should have suitable railings. To enable people to move freely and safely around the grounds 30/09/2010 3 19 23 The service must be well 31/08/2010 maintained and presented to suit and meet the needs of people using the service. The rising salt on the wall and the glass in the patio door require attention and resolution. Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that individuals reside in a safe, well maintained environemtn at all times. 4 30 18 Staff working at the service must receive training in the Mental Capacity Act and Deprivation of Liberty and Safeguards. To ensure that they have the skills to protect and support the people using the service as required. 5 31 9 The service must have a 30/09/2010 registered manager whom is fit to run the service To ensure that the service is managed by a qualified person fit to manager the establishment. 6 33 24 The service must ensure that an effective quality assurance process is place. To enable continued improvements to be made to the overall running of the service, in the best interest of the people using the service. 30/09/2010 30/09/2010 Care Homes for Older People Page 32 of 34 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 2 3 12 The assessment should explore specific personal preferences and wishes. People using the service should be offered access and encouraged to engage within a variety of activities suitable to their personal preferences and choices. The service should ensure that people are offered the opportunity to engage in community based activities on a regular basis. Additional signage should be incorporated into the service to further support people with dementia. An appropriate cigarette disposal unit should be purchased. Staff should receive suitable and periodic supervision. 3 14 4 5 6 22 22 36 Care Homes for Older People Page 33 of 34 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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