Inspection on 29/01/10 for St Mary`s Nursing Home

This is the latest available inspection report for this service, carried out on 29th January 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Mary`s Nursing Home 12/03/07

St Mary`s Nursing Home 21/01/06

St Mary`s Nursing Home 19/09/05

St Mary`s Nursing Home 20/12/04

St Mary`s Nursing Home 26/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: St Mary`s Nursing Home Montilo Lane Harborough Magna Rugby Warwickshire CV23 0HF     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: Sandra Wade     Date: 2 9 0 1 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 39 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 39 Information about the care home Name of care home: Address: St Mary`s Nursing Home Montilo Lane Harborough Magna Rugby Warwickshire CV23 0HF 01788832589 01788832216 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Simon Northover,Mrs Beatrice Gooch care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Age: Dementia (DE) age 50 years and above. The maximum number of service users who can be accommodated is: 56 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 56 Dementia (DE) 28 Date of last inspection Brief description of the care home St Marys care home is set in its own grounds near to the village of Harborough Magna, five miles from Rugby. The care home has been developed from the old maternity hospital and retains some of its character. The home is registered for the frail elderly as well as older people with dementia. The home is divided into two floors with the Care Homes for Older People Page 4 of 39 Over 65 0 56 28 0 Brief description of the care home Elderly Frail unit on the first floor and Dementia unit on the ground floor. Exit doors are operated by the use of coded key pads. Each unit has 28 beds. All rooms are single and have en-suite facilities. There is a shaft lift to the first floor and adequate assisted bathing facilities. Care is provided by qualified nurses and care staff. The home has extensive grounds with secure gardens for people to enjoy. Many of the rooms share views of the open countryside. Due to the rural situation the nearest village is approximately 1 mile away. Public transport to the home is limited. There is ample parking to available at the home for visitors. Fees range from £486 up to £800 per week and extra charges apply for services such as private chiropody and hairdressing. These fees are subject to review and contact with the service should be made to confirm current fees. Care Homes for Older People Page 5 of 39 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 inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 12 March 2007. This inspection took place between 7.30am to 6.30pm and was completed by an inspector and local area manager for the service. We received comment cards from seven people who live in the home and eight relatives. Some people were assisted to complete their comment cards by staff in the home as opposed to an independent advocate. Comments are reflected throughout this report where appropriate. Three people who were staying at the home were case tracked but specific care issues relating to other people were also reviewed. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where Care Homes for Older People Page 6 of 39 possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Records examined or requested during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, health & safety records, financial records, complaint records, quality monitoring records and medication records. People were observed in the lounge and dining areas to ascertain what daily life in the home may be like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 39 A review of social activities and mental stimulation is required to ensure people are able to pursue their hobbies and interests where possible to help maintain their health and wellbeing. Care records need to clearly demonstrate the staff actions carried out to meet peoples needs. This includes for example how continence care and pressures sores are being managed so that it is clear peoples needs are being met. Care records for people with dementia need to clearly show how this presents itself and how staff are to manage any challenging behaviours so that there is a consistent approach by staff in meeting the persons needs. Records relating to the management of medication need to show that people are receiving their medicines in the way they have been prescribed to maintain their health. A clear system for recording complaints must be developed to show these are being actioned appropriately to safeguard people. The service need to demonstrate there are sufficient staff supporting people in the home by ensuring all shifts and hours worked by staff are recorded on duty rotas. All accidents and incidents which impact on the wellbeing of people need to be reported to us. This includes incidents of challenging behaviour and instances where medical intervention is sought. This is so it is clear the service is taking appropriate action to safeguard people. Safe systems for keeping bedrooms doors open need to be explored so that people are not placed at risk in the event of a fire. 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 39 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 39 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 can be confident that they will have sufficient information to make an informed decision on whether to stay at the home and that their needs will be assessed prior to them staying at the home to make sure these can be met. Evidence: We asked for a copy of the homes Service User Guide that is made available to people who may be interested in staying at the home. This was viewed and contained detailed information about the staff, facilities, services provided and fees. This document did not contain a copy of our summary inspection report and the manager was made aware that this should be included so that people have all the information they need to make an informed decision to stay at the home. We looked at the care files for three people living in the home to see if an assessment of their needs had been carried out prior to them coming to the home. This information assists staff to develop suitable care plans to ensure they receive the support they require to meet their needs. Two files contained a pre-admission assessment indicating each persons Care Homes for Older People Page 11 of 39 Evidence: needs and abilities and it was evident from the records in place that they had been visited prior to their admission to obtain these details. Both initial care needs assessments held sufficient information to form the basis of a care plan and for the service to know whether they would be able to meet the persons needs. We were told that the third person came to the home as an emergency placement so in this case a pre-admission assessment was not completed. The family of one of these people stated that their relative had come to the home following a short stay with another care provider. The family and social worker had identified St Marys care home as their preference and their relative had agreed to the move to St Marys with their recommendation. They confirmed that information about the service was provided to them before their relative moved into the home as was an assessment of their needs. They also confirmed that someone from the home visited their relative while in hospital to assess their needs and a Social Worker had also carried out an assessment of their needs which they understood had been copied to the home. Care Homes for Older People Page 12 of 39 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. Peoples care needs are not always set out in sufficiently detailed care plans to ensure staff have the information they need to meet their needs effectively. Some people do not receive their medicines as prescribed to ensure the effective treatment of their health care needs. Evidence: Care plans and daily records were available for each person but we found that information recorded on the nursing unit was more detailed and informative than information found in care files on the dementia unit. People on the nursing unit looked well cared for in that their hair was combed, they looked clean and were wearing appropriate clothing for the time of year. People on the dementia unit also looked clean and were suitably dressed. We found a number of people on the dementia unit stayed in bed until late morning and those observed in the lounge or communal areas were seated in chairs with little social interaction between themselves or staff. We found that staff were very much task orientated, particularly on the dementia care unit, with little time to spend with people on a one to one basis. Care Homes for Older People Page 13 of 39 Evidence: We looked at the care files for three people who had been identified for case tracking. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The records viewed for one person on the nursing floor showed they had made a significant improvement since their admission to the home. Pre-admission records showed they needed help with meals, were unable to weight bare, had a catheter and needed full support to meet their care needs. Current care records showed they had improved and were able to manage their food themselves, they no longer had a catheter, they were able to walk unaided and had become more independent. A member of staff said x was really poorly when they came in and has made significant progress, staff are out doing assessments all the time, staff had to use the hoist to help x to transfer, they are now independent. Staff were recording weekly baths/showers and some weights for people on a list held separately to care plan files. We found that there was nothing recorded in this file for two people during January which could mean peoples hygiene needs are not being met or the records are not being kept updated. The care records for a person with dementia showed that they were incontinent and therefore were on a toileting chart. A short term care plan had been developed instructing staff to offer three hourly toileting and to monitor bowel and bladder output. The examination of daily monitoring records did not include a toileting chart and there was also no details of any dietary and fluid intake monitoring to make sure this person was eating and drinking sufficiently to support their health. A member of staff spoken to about this person was unable to say what their care needs were. They stated they had not looked at the care plan and had not received a handover (were information is shared about people) when they came on duty at 08.30am. They were unable to say whether there was a fluid and dietary monitoring chart in place or whether the person had been supported to go to the toilet every 3hrs as agreed in the care plan. Another member of staff was able to confirm that the person could eat independently but they were not aware of the persons background or the need for three hour toileting. Discussions with staff confirmed that some are not always using care plans when caring for people and sufficiently detailed handovers do not take place. This could prevent staff from being fully up-to-date with care needs and could lead to an oversight in care. Care Homes for Older People Page 14 of 39 Evidence: The care records for a second person with dementia contained a Getting to Know You form which we were told had been given to the persons family to complete. This gave some helpful information to staff on family contacts, food preferences and the persons previous employment. The form was not dated so it was not clear when this information had been obtained. We were told that this person had a pressure sore and on viewing care records found that a short term care plan had been devised stating this. The care plan contained limited information in that there was no indication of what size this was, if any dressings were to be applied and what was expected of staff in terms of monitoring this. A second short term care plan for pressure sores was found. This stated dress according to wound chart, monitor and record progress on wound chart. On examining the care records no wound chart was located. The manager confirmed that there was no additional records held elsewhere. We later established from a member of staff that wound charts were available but were being held separately to the care files, these showed the wound was being regularly dressed. The personal care records did not make it clear how staff were to manage any baths or showers while this person had dressings on their skin. Care records stated that the person had a rash but there was no indication whether the doctor had stated what this was. The GP visit record did not indicate the rash had been seen by the GP. We were told that cream has been prescribed for this before the person came into the home and were being applied. A short term care plan was seen for itchy areas to the body stating that a cream was to be applied twice daily. A chart for cream application was located separately to the Medication Administration Records (MARs) and this indicated the cream was not being applied twice daily as stated in the care plan. A Continence care plan did not state how often pads were to be changed or what size the person usually would wear to assist staff in supporting this care need. A care plan for behaviour stated monitor and record in the ABC form any behaviour problems X presents. There were no indications within this care plan what the persons normal patterns of behaviour were or what symptoms this persons dementia specifically presented. There was also limited information about any difficulties this presented to the person or staff. This meant it was not possible to gain a picture of what this person was like to make sure staff could appropriately support them. A senior member of staff spoken to was able to give a detailed account of this persons behaviour and how they needed to be supported. The persons family confirmed that they had no complaints about the home and were satisfied with the care being provided. Care Homes for Older People Page 15 of 39 Evidence: Comment cards received from seven people living in the home showed varying responses in regards to people receiving the care and support they need. Two people responded they always do, three people responded they usually do and two people responded they sometimes do. Comments included: Care is good here and Lovely food and good care. Relative comment cards showed that four people felt the service always met the needs of their relative/friend. One person did not respond and three people stated they usually did. Comments included: Very pleased with the care my mother is getting. keep my wife comfortable, well fed and cared for. People living in the home are registered with a local GP who provides an excellent service to the home visiting on Mondays and Fridays each week. He was seen and spoken to during the inspection and confirmed behaviours of people with dementia were being managed successfully and staff were very knowledgeable and skilful. We looked at the way the home manages peoples medication, medicine trolleys are now held on both units and we therefore reviewed medicine management on both units. Since the last inspection efforts had been made to ensure Medication Adminstration Records (MARs) were typed as opposed to hand written so that medicine managment could more easily be audited. We found a number of cases where there were less or more tablets/capsules than there should be in relation to those received, given and remaining. This could mean that people had not received their medicine as prescribed. It was not clear if all the medicines left over from the previous cycle had been carried over to the current cycle. If records are not clear it makes it difficult for staff to audit medicines to make sure they are being given correctly. We found that one medicine has been signed for as given on the day of inspection but had not been given. Staff said they would organise for this to be given as soon as possible. A spray which staff confirmed was for angina symptoms did not contain any label to show it had been prescribed for the person by a GP. A code being used on the MAR had not been defined so it was not clear if the person had received their medicine or not. Care Homes for Older People Page 16 of 39 Evidence: In some cases the MARs did not make it clear what the daily dosages should be meaning staff would have to check each bottle or medicine container each time to check this. All MARs should clearly show the medicine dosages and directions as indicated on the containers to help prevent staff error in their administration. We found that there were creams in peoples rooms being used by staff which were not indicated on the MAR charts. Records of all medicines prescribed and being administered should be clearly indicated on the MAR charts to prevent any oversight in care. Generally we found that the privacy and dignity of people was being respected in that staff managed personal care in the privacy of peoples rooms. Staff were busy during the morning assisting people to get up and we did find one person looking for a member of staff in their night clothes who wanted to get dressed. They were very keen to be assisted and came out of their room asking for help. Although help was provided there was some delay in this due to staff being busy with other people. Care Homes for Older People Page 17 of 39 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 experience minimal social activity and mental stimulation to satisfy their social, cultural, recreational interests and needs. Evidence: The service employ two people to arrange social activities for people but neither were on duty on the day of our visit. The manager told us one activity worker was sick and one was on holiday. Over the last two inspections the service have been advised to improve social activity provision for people. Although efforts have been made, we could not evidence that any significant improvements have been made for the benefit of people who live in the home. We did find that since the last inspection the home have secured monthly visits from a Church of England Minister for those people who wish to participate in religious services. During the early morning one person who was assisted into the lounge was asked if they would like the television on. This was then put on by the member of staff but the person was not asked which television channel they would like to watch. It was only later when a senior member of staff came into the lounge and asked them that the Care Homes for Older People Page 18 of 39 Evidence: television channel was changed to something of the persons choosing. One person was observed on a number of occasions throughout the day walking about in the lounge corridor. No interactions were observed between them and staff and there was no social stimulation observed for the person. Observations in the lounge on the ground floor showed four people were sitting in armchairs. The television was on but the sound turned down as there was music playing on the stereo. No one was watching the television, three of the four people were sitting with their eyes closed and the fourth person was continually shouting and it was difficult to know what they were saying. One person appeared to like the music and was smiling while walking around the room. There are Getting to know you forms held on files recording some life history for people but we found this information to be limited. There was no evidence to suggest this information was being used to identify specific activities for people or for reminiscence therapy. Two staff spoken with did not know what information was held in the Getting to know you records. There was no evidence of person centred activities particularly for those people on the dementia care unit. There was no specific schedule showing when activities take place, staff confirmed that any organised events are recorded in the evaluation notes recorded in the care records for each person. We were also told that since the last inspection an activity book has been introduced for each floor whereby staff record what social activities have taken place each day. Activity records for December 09 showed that there had been a fish and chip supper (collected from a local fish and chip shop), music afternoon, Christmas party, carol singing by pupils from a local school and entertainment from an accordion player. We were told that people can access a hairdresser once a week or when requested where this is possible. Comment cards received from seven people living in the home (some who were assisted to complete by staff), showed that four people felt there were always social activities they could participate in. One felt there usually were and two stated dont know. A relative has commented X is not a very sociable person, staff at St Marys respect this and do not pressurize X to join in with activities or mix with others if X doesnt wish to. Care Homes for Older People Page 19 of 39 Evidence: One person spoken to said that they had been to a concert since being at the home and there was sometimes entertainment, dinners and they had regular visitors. Another person spoken to said nothing to do and I get fed up. We observed people having breakfast in their rooms and there was a calm atmosphere throughout the home. Breakfast for some consisted of bacon, egg, toast and a cup of tea and this looked attractive and appetising for people. Breakfasts delivered to rooms were kept covered and were on trays. We were told that people can choose what they would like to eat and where they would like to eat their meals. At lunchtime the meal was faggots, chips and mushy peas and rice pudding. Alternative choices were available. We were told that since the last inspection the kitchen staff hours have been increased so that someone is available from 7am until 7pm and people can have more flexible eating times. The kitchen was well organised and the cook was aware of those people who were on special diets such as soft diets or needing alternative puddings due to diabetes. The cook explained that they had changed the way they present soft meals by liquising meat and vegetables and piping potato on the top so that meals looked appetising. We were told that the home had achieved the Gold Standard Award for their environmental health which includes maintaining good standards of food management and standards of cleanliness in the kitchen. In one dining room there was regular interaction between staff and the people who use the service. People were not hurried and were able to eat their meal at a pace conducive to their needs. Dining tables had cloths and napkins but there was no salt and pepper and cold drinks were served in plastic beakers. Staff were tentative and people sitting at the tables did not require support to eat their food. Meals were plated up in the kitchen. In the second dining room people were seated at wooden type tables with napkins but no table clothes. Some people were wearing bibs to protect their clothes. One person waited longer than the rest to have their meal and when this arrived staff asked if they wanted salt and vinegar and put it on for them. People sat in silence with little interaction between themselves or staff. One ate very little of their meal . Spoons were available to assist people to eat and staff were on hand to assist with feeding those who needed support. One person got up from their chair and started to walk out of the dining room. Staff attempted to encourage them to come back by offering them some juice and pudding but they still wandered out of the dining room. One person picked up a piece of lemon on their plate and put this in their mouth, they reacted by Care Homes for Older People Page 20 of 39 Evidence: saying oooh that was horrible and placed in on the table. We were told by a member of staff that on a typical day staff would assist people with personal care and ask them what they would like for breakfast (which included showing pictures of food to help people choose what they would like to eat). Staff said that If the person was unable to choose from the pictures they would show them the meal. We found that a high number of people needed support to eat their food and have a drink. We saw people being shown pictures of what was being made available to them. Observations in the kitchen at lunchtime showed some people had eaten very little food as large amounts of food was being returned to the kitchen. Staff told us there is lots of wasted food. Despite this, we did not see any regular snacks being offered to people during the day. This could mean people may not be receiving sufficient dietary intake. The absence of dietary monitoring records place meant we could not review this and some people could therefore be at risk of not having their nutritional needs met. Menus were not seen on display and did not include all food, snacks and drinks that are made available to people so that people know what is available to them. A relative told us food good Brilliant at Christmas, we both had a Christmas dinner and presents. They stated that their relative was free to choose when to go to bed and when to get up in the morning. They were not aware of any social activities or religious services but said they could visit at any time. Comments from other relatives included The food is very high quality. We were very pleased at Christmas time to be invited to share both a Christmas tea and lunch with X One person spoken to said Food very good, have choices, carers nice they also said that sometimes they chose to stay in bed and confirmed that staff respected this choice. Staff told us there are No snacks in the home, some are purchased by relatives but they do have fresh fruit and sometimes have cake a choice of hot or cold tea and hot drinks and biscuits or cake are served around 8 pm. Comment cards from people living in the home showed that two people always like the meals in the home, four people usually do and one person sometimes does. Care Homes for Older People Page 21 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for managing concerns and complaints are in place but these are not sufficiently robust to enable people to feel confident their concerns will be managed and resolved to their satisfaction. Evidence: Since the last inspection we have received two concerns relating to allegations made about people not receiving appropriate support and care. At the time of this inspection these were being followed up and investigated by the Local Authority as safeguarding referrals. The home had correspondence showing that they had received four complaints including the two concerns received by us. A written record of complaints was not available showing when complaints had been received, investigated and responsed to and to show if these had been upheld, there was only correspondence relating to them available. The manager advised that responses to complaints were in the process of being done. We have subsequently been made aware that one family who made a complaint were not happy with how this had been managed and have therefore chosen to move their relative to another home. This could mean the home are not resolving concerns to the satisfaction of some people. The Service User Guide contained a copy of the homes complaint procedure giving people clear direction to first approach the nurse in charge of the unit. This procedure Care Homes for Older People Page 22 of 39 Evidence: did not detail the name of the manager, provider or Local Authority should the person making the complaint wish to pursue their concerns with them directly. People spoken to said they would make a complaint if they were not happy. One relative stated staff are always kind, no complaints. Another stated It is always possible to improve but I must say that St Marys is really on the ball and they are always on the lookout to improve their service. Comment cards received from eight relatives showed that seven out of eight knew how to make a complaint about the care provided. Staff spoken to were aware of how to recognise abuse and their reponsibilities to report this. Training schedules seen showed that some staff had attended training on types of abuse and the prevention of this and some staff were still to complete this training. Care Homes for Older People Page 23 of 39 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained environment but some attention to hygiene practices is required to ensure the home continues to be a pleasant place for them to live. Evidence: Communal areas on both floors of the home were seen in addition to a sample of bedrooms. There were handrails in all corridor areas, toilets and bathrooms had assisted bathing facilities to help those who are less mobile to access the bath. We observed other equipment in the home to assist staff in moving people safely. The lounges had a variety of comfortable chairs, small televisions and music equipment which were used during the day. Areas observed were decorated to a good standard and bedrooms seen were well furnished with personal items reflecting the interests and identity of the person. Since the last inspection some of the bedrooms had been redecorated. We were told that bedroom audits were completed on a monthly basis to ensure the home remains clean, tidy and pleasant for people to live in. The quality survey carried out by the home showed positive responses in relation to the question asked about how people rate their bedrooms and cleanliness of the home. One comment card received by us stated: The room and ensuite are not always as clean as they should be. Care Homes for Older People Page 24 of 39 Evidence: To appeal to the sensory needs of people with dementia there were some textured pictures on the walls in the dementia unit for people to touch and we were told there was also a rummage box of toys and items brought in by staff that was being kept in the lounge. The rummage box was not easily visible to people and staff were not seen to direct people to where this was being kept. The home has two dining areas, one on each floor which are small but bright and have good views of the surrounding countryside. There is an attractive and safe garden area, which people can use during the summer months. Staff were observed to wear protective clothing when carrying out personal care tasks and when serving meals to maintain good hygiene practices. A person who was carrying out the cleaning for the home confirmed they always wore gloves when cleaning. Observations in toilets located on the ground floor showed in one toilet there was no wastebin in which to place disposable hand towels and in a second toilet there was a white plastic jug on the floor which was being used for the disposal of paper hand towels. Plastic aprons and disposable gloves were located in toilets for staff to use. We viewed the laundry this had a sluice facility for managing any infected or heavily soiled laundry items. There was no soap, liquid handwash, paper towels or hand drying facilities in the laundry necessary for staff to maintain good hygiene. Records were being kept of which member of staff had washed peoples clothes (this enables staff to be held responsible and accountable for the laundry in their charge). On arrival at the home there was quite a strong smell of urine on the ground floor. This became less obvious as the day progressed but there was still a smell of urine present when our visit concluded. Care Homes for Older People Page 25 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be supported by friendly and approachable staff who are subject to ongoing training to ensure they care for people safely and effectively. Staff are subject to recruitment checks to ensure they are deemed safe and suitable to work with vulnerable people. Evidence: The home has two units on separate floors and each cater for 28 people. Each unit is separately staffed and run. On the day of our visit there were 54 people accommodated in the home. We were told that the usual staffing arrangements for the home include five care assistants plus one nurse during the day from 8am to 4.30pm and four care assistants and one nurse from 4.30 to 9.30pm. At night there are two care assistants and two qualified nurses. The manager confirmed that she and the deputy manager both work in a supernumerary capacity to supervise and support care staff as required. The service also have their own dedicated catering, cleaning and laundry staff who we were told work seven days per week. Duty rotas seen showed that there were two nursing staff on duty during the day and night and five carers on each unit during the morning and four in the evening as confirmed by the manager. Care Homes for Older People Page 26 of 39 Evidence: We found that the duty rotas did not contain full information about staff working in the home. For example some of the staff were listed using first names only as opposed to initials and surnames. This can make it difficult to identify an audit trail of staff who have worked in the home when viewing duty rotas retrospectively. We also found that the activity organisers, ancillary staff and maintenance staff were not listed. This means it was not possible to confirm there were sufficient staff available to provide these services to people on an ongoing basis. The manager and deputy manager shifts worked were also not on the duty rota to confirm sufficient management support was being provided on an ongoing basis. Duty rotas showed that some staff were working a mixture of days and nights within the same week and some staff were working a late shift from 4.30pm to 9.30pm followed by a night shift. This means that staff will not have a sufficient break between shifts which could impact on their effectiveness when working with vulnerable people. Working these long hours can also contravene the Working Time Directive. The night shift hours were not indicated on the duty rotas so it was clear these were sufficient. Those staff working nights were indicated by an N. We observed that staff were busy throughout the day attending to people and their roles were very task orientated with little time for interaction with people. Some staff were still getting people up at 12 noon. Comments made by staff included Staffing levels are not good. Between 3.00pm and 4.30pm is the only time to talk to people, not enough staff. Very good care here. Yes enough staff. Our role becomes more task orientated as opposed to person centred. Comment cards received from seven people showed that one person felt there were always staff available when they needed them and six felt there usually was. One person spoken to said Staff look after most of them alright. Relative comments included The staff at St Marys are well qualified to meet the needs of X, I find them very committed to their work, Friendly efficient staff throughout the nursing home Staff generally seem caring but little details sometimes spoil what they provide for example I often have to tidy X clothes The personal files were viewed for four staff working in the home. These confirmed that satisfactory pre-employment checks had been carried out including a Criminal Record Bureau (CRB) check and satisfactory references. New staff confirmed they had completed induction training which included moving and Care Homes for Older People Page 27 of 39 Evidence: handling, infection control and fire. Induction packs were available but we did not see a completed induction pack and it was not clear that induction training was based on the Skills for Care Common Induction Standards. This training is normally provided over several weeks to allow staff to build up their competencies. Staff competencies also need to be demonstrated so that it is clear staff are safe to care for people. We were told that there are 24 staff working in the home and of these fourteen have achieved a National Vocational Qualification (NVQ) II or III in Care and three are in the process of completing their NVQ II. This training helps staff to develop skills in identifying and responding appropriately to peoples needs. A training schedule was in place but it was not clear that all staff had completed statutory training such as Moving and Handling. The deputy manager advised that this training was ongoing and this was something she was hoping to address soon. Care Homes for Older People Page 28 of 39 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. The service aims to ensure the home is run in the best interests of people but further actions are required to involve people to demonstrate this. Health and safety is addressed on an ongoing basis although there remains areas needing attention to ensure people can be confident they are safe at all times. Evidence: On the day of our visit the manager, deputy manager and Director were all present. The manager told us that she has continued to keep her skills updated by attending further training including Nutrition, Recruitment and Selection, Alzhiemers and Challenging Behaviour. All staff were open and helpful and made a valuable contribution to the inspection process. Two Senior Nurses were on duty and provided considerable information throughout the day. A formal quality assurance system was in place which included the completion of Care Homes for Older People Page 29 of 39 Evidence: questionnaires by the relatives of people who live in the home. The outcome results seen showed positive responses to the questions asked which included questions such as Do you feel able to express your opinions freely, Do you feel all aspects of care are adequately met, Do you feel that the meals provided are adequate. Comments had been collated and these identified problems with:- visitors not being able to access the home at the weekends, garden facilities not being adequate (in that more benches and chairs were needed) and the need for some bedrooms to be decorated. The service had responded by fitting a keypad lock system to an external door for so that regular visitors could easily access the home, putting chairs and tables out into the garden and making a commitment to look at additional garden facilities next Summer and confirming that bedrooms were being decorated in rotation. It was not evident that the outcome of these surveys had been made available to relatives so that they could see the areas identified for improvement and the proposed actions in relation to these. This issue was raised at the last inspection to the home. The service needs to address this. We were told that no surveys had been undertaken with people living in the home and no meetings took place with them. In addition to quality surveys the home also have various auditing processes in place such as medication audits to check these are being managed appropriately and bedroom audits to check these are clean and tidy. Comments received by us on the quality of the service provided were mostly positive and are reflected where appropriate throughout this report. Additional comments included:I have had experience of three homes and none have come up to the standard of St Marys. I do wish facilities could be provided for visitors to make their own drinks. Should I have any problems they would be dealt with at once. Comment cards received from seven people showed that one person felt staff always listen and act on what they say, two people felt they usually do three people felt they sometimes do and one person felt they never do. We looked at how peoples money is managed in the home. The registered provider told us that a private chiropodist usually visits every six to eight weeks and provides one collective invoice which is paid by the home and is then charged to people as appropriate. Each person is given a receipt to confirm payment. Care Homes for Older People Page 30 of 39 Evidence: We were told that those people who do hold their own money are usually supported by a relative, independent advocate or legal adviser. People are also invoiced each month for hairdressing and any other sundry items purchased on their behalf. We found that individual receipts were not obtained from the hairdresser for each person. This should be done so that there is a clear audit trail and any request for access to records can be facilitated in accordance with data protection. The registered provider demonstrated a commitment to discuss this with the hairdresser with a view to securing individual receipts as suggested. Accident and incident records showed that there had been some aggressive incidents between people which had not been reported to us as required. We also found that some people had been taken or admitted to hospital that we also had not been informed of. The service must ensure that any accidents or incidents which impact on the wellbeing of people or involve medical intervention are reported to us so we are aware the service have taken appropriate action to address these. A review of health and safety records was undertaken to confirm that equipment was subject to regular servicing and appropriate health and safety checks were being carried out. Records confirmed that the Lift, bath hoists and scales had been serviced and also the five year electrical check and electrical portable appliance testing had been carried out. We saw that an engineer report had been completed for the gas on 26.1.2010 and we were told they were awaiting Landlords Gas Safety Certificate to confirm the gas safety of the home. Weekly fire alarm tests were being carried out but it was not evident that all staff had been involved in the practicing fire drills. We observed that door wedges remain in use within the home despite this being highlighted at the last inspection as a concern. If bedroom doors are wedged open this means they will not automatically close in the event of fire which could place people at risk. If people wish to have their doors open the service should ensure this can be done safely by the use of self closing devices which comply with the fire precautions. Care Homes for Older People Page 31 of 39 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 32 of 39 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 12 Care records must demonstrate that instructions in care plans such as three hour toileting have been carried out. This is so that is is clear the care needs of the person are being met. 31/03/2010 2 8 12 Where people have 31/03/2010 symptoms of dementia. Care records must be developed showing how this presents itself including any behaviours or triggers to inappropriate behaviour and records must detail how staff are to monitor and record this. This is so that staff adopt a consistent approach in supporting the person to maintain their health and wellbeing. Care Homes for Older People Page 33 of 39 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 3 8 12 Clear care plans must be developed regarding the prevention, incidence, treatment and outcome of any pressure sores. This is so it is clear that people with pressure sores are receiving appropriate support to promote the prevention and healing of these to maintain their health. 31/03/2010 4 9 13 People must be given their medicines as prescribed. Medication Administration Records must show that the amount of medicines received, given and remaining are correct. This is so it is clear people are receiving the medication they require to promote their health. 31/03/2010 5 9 13 Creams prescribed for people must be applied as instructed. This is to ensure the cream prescribed for the person is fully effective in treating their condition and promoting the healing process. 31/03/2010 6 16 17 A clear record of complaints and concerns received must 31/03/2010 Care Homes for Older People Page 34 of 39 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 be maintained detailing dates, actions taken to resolve these and whether the concern/complaint was upheld. This is so people can be confident complaints are being managed appropriately and to their satisfaction. 7 27 17 The service must demonstrate the hours and shifts worked by the manager and all staff working in the home on the duty rotas. This is so it is clear there is suitable management support being provided as well as sufficient staff to provide effective services to people. 8 37 37 All accidents which require medical intervention and incidents of challenging behaviour which impact on peoples health and wellbeing must be reported to us. This is so we can be sure the service is taking appropriate action to safeguard people. 31/03/2010 30/04/2010 Care Homes for Older People Page 35 of 39 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 9 38 23 Suitable systems for 30/04/2010 retaining bedroom doors open must be in place which meet with fire precautions. This is people are not placed at risk of harm by having their doors open should there be a fire in the home. 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 1 The Service User Guide should contain a copy of the Care Quality Commission summary inspection report to make sure people have all the information they need to make an informed decision to stay. Personal hygiene records need to be completed consistently to show that the personal care needs of people are being appropriately met. Medicines which have been prescribed by the GP need to retain their original prescribing labels so it is clear the medicine being used is for the person it has been prescribed for. Any creams prescribed for people need to be clearly indicated on the MAR charts so that it is clear to staff these have been prescribed and how they are to be used. Codes on Medicine Administration Charts need to be clearly defined so that it is clear whether the person has received their medicine or not. The provision of social activities and mental stimulation needs to be significantly improved to ensure peoples social care needs are met and their health and wellbeing is maintained. Menus should be on display and show all drinks, snacks and 2 7 3 9 4 9 5 9 6 12 7 15 Care Homes for Older People Page 36 of 39 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 meals provided so that people know what is available to them. 8 15 In view of the food wastage seen, peoples food intake should be monitored and their likes and dislikes reviewed to ensure people are receiving meals and snacks of their choice to promote their health and wellbeing. Staff who have not completed training on the recognition and prevention of abuse should complete this to ensure all staff are aware of their responsibilities on how to protect vulnerable adults. Adaptions to the environment to support people with dementia should be considered . This could include the use of signage, reminiscence areas, colour coding, tactile and sensory aids. The unpleasant odour identified should be investigated and removed so that the home remains fresh and pleasant for people to live in. Staff and people who live in the home should have access to soap and hand drying facilities at all times to ensure hygiene can be maintained. It is also recommended that suitable waste paper bins are made available in bathrooms. Staff surnames should be indicated on duty rotas so there is a clear audit trail demonstrating there are sufficient staff to support the needs of people. A review of staffing should be undertaken to ensure this is sufficient and staff are not working excess hours such as 13.5hr shifts as well as both day and night shifts which could impact on staff effectiveness in supporting people as well as contravene the Working Time Directive. Induction training for new staff should be based on the Skills for Care Common Induction Standards. Records should demonstrate staff competencies and dates when these have been achieved so it is clear they are deemed safe to work with vulnerable people. An at-a-glance training schedule should be provided showing dates when staff have completed training and dates when this is due. The service should also demonstrate that training has been arranged for those people where there training is due to ensure they retain the skills required to care for people safely. Page 37 of 39 9 18 10 19 11 26 12 26 13 27 14 27 15 30 16 30 Care Homes for Older People 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 17 33 Systems for monitoring the quality of care and services provided should be further reviewed to include people living in the home and any other interested parties such as GPs and professional visitors. The outcome of these should be published and made available to people. This is so the home can demonstrate the service is being run in the best interests of people who use the service. The service should obtain individual receipts for services or items purchased on behalf of people so there is a clear audit trail of monies spent and people can view their own financial records without concerns around data protection. 18 35 Care Homes for Older People Page 38 of 39 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. 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. 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