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Inspection on 19/08/08 for Maris Stella Wing

Also see our care home review for Maris Stella Wing for more information

This inspection was carried out on 19th August 2008.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This was a friendly home. Staff knew about individual resident`s needs. We saw a number of good care practices. For example, a member of staff sitting beside a resident who was upset and talking to them in a sensitive way. We saw residents being given choice at mealtimes. Tables in the dining areas were attractively laid. This provided residents with a nice environment in which they could enjoy their meals. The hygiene standard within the kitchen area(s) won the home a `5 star award` following the last inspection by Southend Borough Council. The range of activities, pastimes and social events provided by the home was excellent. Information and detail to support this are referenced within this report. The Facilitator Co-ordinator ensures that staff recruitment and training records together with other administration documents are current and well maintained. There were established systems within the home by way of meetings and consultations that enable residents to contribute to the day-to-day management of the home.

What has improved since the last inspection?

The activities and social events programme has greatly improved. This means that residents have a wide choice of what they might want to do or be involved in. The menus have improved following consultation with residents. The manager has completed their Registered Manager` s Award and the NVQ level 4 training. We now regularly receive appropriate Regulation 37 notifications. This tells us about incidents or matters that we need to know about. For example, when a resident has had an accident and requires medical treatment or when a resident has died.

What the care home could do better:

The manager has not obtained sufficient and adequate information about residents admitted on a holiday or respite basis to assess if the home can meet their care needs. Residents admitted on this basis do not have care plans in place. This means that staff do not know what their care needs are or how to meet them. Therefore residents admitted on a holiday/short stay/respite basis are at potential risk. Residents who did have care plans and risk assessments in place are also at potential risk. This is because documentation did not indicate whether the manager had assessed every area of care. There was not always an adequate risk assessment in place, or the known and identified care needs had not been recorded. Details are within the report. Current practice means that residents are at potential risk because care staff do not have documentation to clearlyshow what the care needs are, how to meet the needs and how to manage risk. The home should also put in place a system to demonstrate that staffing levels at night have been assessed to ensure that sufficient will be on duty to meet the needs of 36 residents. There was no evidence to support that two staff on duty at night are not sufficient to meet the needs of the 25 residents currently accommodated. There was a requirement at the last inspection to increase the levels of staffing at night. There was no evidence at this inspection to support that a review had taken place.

CARE HOMES FOR OLDER PEOPLE Maris Stella Wing Nazareth House 111 London Road Southend On Sea Essex SS1 1PP Lead Inspector Ann Davey Unannounced Inspection 19th August 2008 9am X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maris Stella Wing Address Nazareth House 111 London Road Southend On Sea Essex SS1 1PP 01702 345627 01702 430352 philroseman@tiscali.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Congregation of the Sisters of Nazareth Mrs Christine McCarthy Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2006 Brief Description of the Service: Maris Stella is registered to provide personal care and accommodation for 36 older people. It is one of two separately registered care facilities sited at Nazareth House. The home is near the Southend town centre, the railway station, bus routes and all local amenities. The grounds include wellmaintained gardens and ample car parking facilities. The premises are older in style and retain many of the characteristics including a large main hall, which is used for activities and entertainment. The home also has its own beach hut at Shoeburyness that residents can use. Accommodation is sited on three floors and there are two shaft lifts. Most bedrooms are single and a limited number have ensuite facilities. There are three lounges, which retain a family home-style environment. Additional seating areas are available around the home. Kitchenettes are available on each floor where residents and visitors can make drinks and snacks. There is a Statement of Purpose and Service User’s Guide available. A copy of the last inspection report is available upon request from the home. The weekly charges range from £410.00 - £490.00. The exact fee depends on the type of accommodation available/requested, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced site visit that took place over one day. The visit started at 9am and finished at 5pm. The last key inspection took place on 19th September 2007. An Annual Service Review took place on 19th November 2007 We were assisted throughout the inspection by the registered manager, the named representative for the registered owner (referred to as Sister for the purposes of this report) and the Facilitator Co-ordinator, Sister has responsibility for overseeing the business of Maris Stella and also St Joseph’s (a sister home) that is on the same site. The Facilitator Co-ordinator has responsibility for staff recruitment, staff training, contractual and maintenance matters. The home had completed and returned their Annual Quality Assurance Assessment (AQAA) to us prior to the last inspection. We have requested a new AQAA as the last document was completed over a year ago and does not contain current information. This document gives homes the opportunity of recording what they do well, what they could do better, what has improved in the previous twelve months and their future plans for improving the service. Information and detail from the new AQAA will be referred to in the next inspection report. We have sent surveys to the home so that residents, staff, relatives and professional health/social workers have the opportunity to tell us about their views of the home. Any information we receive will be included as part of the next inspection. We spoke with a range of staff and residents and to three visitors. The day in the home was pleasant and all staff were co-operative and helpful. A tour of some areas of the home took place. Throughout the inspection, care practices were observed and a random selection of records viewed. A notice was displayed advising any visitors to the home that an inspection was taking place. One visitor told us that they had been seen the notice. All matters relating to the outcome of the inspection were discussed with the appropriate party (see above). They took notes so that development work could be started immediately where necessary. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The manager has not obtained sufficient and adequate information about residents admitted on a holiday or respite basis to assess if the home can meet their care needs. Residents admitted on this basis do not have care plans in place. This means that staff do not know what their care needs are or how to meet them. Therefore residents admitted on a holiday/short stay/respite basis are at potential risk. Residents who did have care plans and risk assessments in place are also at potential risk. This is because documentation did not indicate whether the manager had assessed every area of care. There was not always an adequate risk assessment in place, or the known and identified care needs had not been recorded. Details are within the report. Current practice means that residents are at potential risk because care staff do not have documentation to clearly Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 7 show what the care needs are, how to meet the needs and how to manage risk. The home should also put in place a system to demonstrate that staffing levels at night have been assessed to ensure that sufficient will be on duty to meet the needs of 36 residents. There was no evidence to support that two staff on duty at night are not sufficient to meet the needs of the 25 residents currently accommodated. There was a requirement at the last inspection to increase the levels of staffing at night. There was no evidence at this inspection to support that a review had taken place. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 was not inspected as intermediate care is not provided). Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents care needs are not fully assessed and recorded before they are admitted. EVIDENCE: The pre-admission documentation of two of the most recently admitted residents was viewed. Both had a pre-admission assessment document in place and there was an interim care plan available. The assessments were basic and both care plans were underdeveloped. The manager told us that work was still in progress. During the morning we met a resident who was on a two week holiday from another registered care home. The manager did not know their surname or their care needs. The resident had been admitted without an assessment of their care need and there was no care plan in place. There was no documentation from the home in which the resident normally lives. The Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 10 manager told us that the home provides care for a large number of residents requiring respite or holiday admissions. The manager commented that because of the high volume of residents accommodated for this type of care, there is never enough time to formulate a care plan. The manager had a folder with some basic information on these residents, but there was no evidence of any full assessments of need and/or interim care plans. We were told that three residents had been accommodated on this basis in July 2008, and so far there had been two more residents admitted since the beginning of August 2008. This practice means that residents are admitted to the home without a full assessment of their care needs. Without an assessment process in place, the manager would be unable to be confident that the home could meet all the care needs of those admitted for holiday or respite care. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive good personal and health care support but may be at risk because the care delivered is not underpinned by a detailed and/or current care plan. EVIDENCE: Four care plans and associated documentation such as risk assessments and accident records were looked at. Within the documentation there was evidence to support that residents are consulted about their personal wishes. Care plans were in place, but they were not detailed and did not always reflect the known current care and health needs of residents. For example, one care plan had the following headings ‘incontinence, washing/dressing and activities’. There was no reference to other care needs such as food or health care needs. One resident was receiving the services of a community nurse but reason for the treatment was not on the care plan. In one care plan it stated that the resident bathes twice a week but was actually being cared for in bed Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 12 permanently, making this task impossible. Another resident was an insulin dependent diabetic but this was not referenced on the care plans available to us. The manager told us that they had seen this particular care plan but could not locate it for us to look at. We noted that at least three residents had bed rails fitted to the beds. The risk assessments seen were not adequate. The assessment documentation stated why the bedrails were in place, but the was no assessment and instruction for staff to follow to minimise the risk of danger to the resident once they were in use. One resident had asked that no bumpers be fitted, there was no risk assessment in place. We looked at some entries in the accident book to make sure that information from any incident had been documented (if appropriate) in the respective care plan. One resident had received treatment following a fall and required observation. This was not on the care plan. Each care plan file had an evaluation document. The manager explained that if there are any changes to residents care, it is the evaluation document that is updated, not the care plan. We could see that evaluations had taken place. We explained to the manager that each resident must have a care plan in place that reflects their current assessed needs, how they are going to be met, who by and when. Current practice in the home means that residents can not be assured that staff providing care will know what their care needs are because their care plans are not detailed or current. Each resident has a key worker. We spoke to three residents about this and each one knew about the system and thought it was good. Residents told us that staff are kind and ‘there’s always somebody around’. A relative told us that the home ‘cares for X with great care and dignity’. Another resident told us ‘I’m looked after so well here, I want for nothing’. We asked other residents if they had choice about food, getting up in the morning and what they do during the day’ Their replies were ‘oh yes, they are always asking me about what I think, they’re considerate’…..’yes, they ask me’….’sometimes they don’t, but I can tell them anyway’. We spoke to various members of staff about care practices in the home. Those spoken with had a good understanding of individual resident’s care needs. We noted that the rapport between residents and staff was warm, natural and supportive. We did see one incident of poor practice. A member of care staff was seen moving a resident out of a chair into a wheelchair by pulling the resident’s right upper arm. This type of movement is dangerous. We asked the member of staff to stop this activity immediately as there was a risk that the resident may be injured. We reported this observation immediately to the manager who dealt with the situation. The manager told us that this member Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 13 of staff had received training and knew about the correct moving and handling techniques. The situation was further discussed with Sister and the Facilitator Co-ordinator who assured us that the matter would be dealt with seriously and in an appropriate manner. We were satisfied with this response. We also saw a number of good care practices during the day. For example, one resident seemed quite distressed in the lounge area and a member of staff went over to them and sensitively spoke with them. We overheard conservation where a resident was being asked if they wanted a window open and explained that if it happened, there might be a draft. The member of staff went to ask the resident if they would prefer to sit somewhere else that may be more comfortable for them. We overheard another conversation where a member of staff was talking to a resident about what they would like to wear for the day. The manager reported that all staff in the home have a good working relationship with all social and health care professionals. We saw entries within the care documentation system demonstrating that appropriate assistance is requested when required. As recorded previously in this section of the report, health care needs are not always being recorded in the care plan. This means that if a member of staff looked in a care plan for instruction on how to meet a resident’s needs, they may not know that there is a health care need to be met. This could leave residents at risk because staff may not have a clear picture of all their needs and how to respond. We looked at medication administration, storage and recording systems and sampled various aspects for compliance. Each resident had a MAR (medication administration record) sheet. There were no unexplained gaps. Routine day-today medicines were neatly stored in a metal trolley. There was no overstocking of medicines. We asked two residents if they were happy for the home to look after their medicines for them. One resident replied ‘oh, it’s best as I don’t have to worry about it’. Controlled drugs are not being stored in a cupboard that meets current regulatory specifications. Advice and guidance was given to the Facilitator Co-ordinator about how to address this. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a good diet provision and an excellent social activity/occupation programme. EVIDENCE: The manager told us that the majority of residents benefit from regular contact with family and friends. We were told that the few residents, who do not have family or friends to visit, have regular contact with a named social worker. During the course of the day, there was a steady stream of visitors to the home. Two visitors told us that they are always made to feel very welcome. One said ‘it’s always a pleasure to come here’. The home provides a daily religious (Roman Catholic) service to which all residents are invited. The home has its own church on site. In addition, representatives from the local Church of England visit the home on a regular basis. From our conversations with residents, all indicated that within reason they are able to exercise choice and control over their personal lives within the home. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 15 One resident acknowledged that there has to be routines, but indicated that these were acceptable. Residents benefit from an excellent activities and occupational programme. The home employs two part time activity co-ordinators. We met with one of the co-ordinators in their own office and were impressed by our findings. The co-ordinator was enthusiastic and totally committed to providing suitable and appropriate activities. Both co-ordinators have received appropriate training in connection with their role and responsibilities. On each floor (there are 3 floors in the home) there was a detailed activities programme for the current week. We established that generally there are at least four structured communal activities a week on offer. Events include both ‘in-house’ activities and activities provided by external entertainers/visitors. We saw documentation to demonstrate that activities such as a puppet show, an afternoon tea with the Carnival Queen, pottery, cooking, carpet bowls and PAT dogs (for therapy) had taken place in recent weeks. We saw evidence to support that one of the co-ordinators spends regular designated quality onetwo-one time with the more frail or dependant residents. For residents who have limited hand mobility, the co-ordinator was able to evidence that such activities as painting classes had been arranged to provide meaningful therapy. On the wall in the main hall where many of the group activities take place, we saw a lovely display of artwork. On the day we were there, a contractor was in the home fitting ‘black out’ curtains so that residents could watch a film in more comfort. Each resident had an activities file. Entries were dated, signed and there was a space for comments. The co-ordinator had recently devised a questionnaire and assessment (for residents to tell the co-ordinator what they like and or not like. This is due to be implemented very soon. The co-ordinator showed us a detailed list of the outside entertainers and contacts used by the home. We asked residents about their views of the activities. All those spoken with were very positive about the opportunities they have. Clearly, the activities on offer are varied, interesting, diverse and pleasing. We also spoke to two residents who prefer to spend time alone in their respective bedrooms. Both reported that they knew about the activities, but preferred to spend their days in the privacy of their own room. Residents have recently been involved in the preparation of new menus. On each floor the menu was displayed. There was also a large print version in the dining area. The dining area was bright and attractive. During the visit we overheard residents being asked about their choice for the following day. For lunch on the day on the day of the visit the following was available; soup, braised steak, an egg dish, creamed croquettes and mixed vegetables. Peaches and ice cream and a hot drink followed the first course. Tables had linen cloths Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 16 and serviettes, a tray with an assortment of condiments a jug of juice and drinking glasses. Each table had a bowl of fresh fruit. Some residents required assistance with eating and staff were carrying out these tasks sensitively. Residents were very positive about the food provided. The kitchen area was clean and tidy. There was a current record of the fridge and freezer temperatures. There was a detailed daily kitchen cleaning schedule. Food in the freezers and fridges was labelled and sealed. The home maintains a daily record of what individual residents eat at every meal. We noted several gaps in the supper records. The manager said that this was a genuine oversight. The kitchen supervisor was efficient and competent when speaking to us about the provision of food. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for in an environment where they are comfortable to raise concerns and know that these would be dealt with appropriately. EVIDENCE: The complaints procedure is displayed on all three floors. We noted that the procedure makes reference to the National Care Standard Commission. The manager will ensure that this is amended to show the Commission’s details. The home has a complaints log. The manager reported that there had been no complaints since May 2008. Residents spoken with said that they knew they had the right to raise any issues of concern and would feel comfortable about approaching Sister (see summary) who they see on a regular basis. There were comments such as ‘I would talk to Sister’….’I suppose Sister would help me’……’my son would talk to Sister’. When we were in the office a relative came and told the manager about a concern they had about their relative’s catheter care. It concerned us that the manager replied ‘we’ll be with you shortly’. Due to the aspect of concern raised by the relative, we suggested to the manager that somebody should deal with the situation in response to the concerns raised as quickly as possible. The manager then asked a senior member of staff to deal with it. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 18 We saw records to demonstrate that training had been provided for staff to ensure residents are protected and the measures they would take if poor practice were suspected. The facilitator Co-ordinator was able to demonstrate that further training has been planned. Care, domestic and kitchen staff spoken with understood that if they suspected any abuse, they should report it to either the manager or Sister. Sister, the manager and a senior member of staff knew that they had to follow the safeguarding adults from harm procedures if a matter was brought to their attention. Two safeguarding adults from harm incidents have been referred to Southend Borough Council (safeguarding team) in recent months. Both were in connection with care practices. The Facilitator Co-ordinator gave us further information by telling us that one related to a poor communication matter and the other was an inadequate management of a concern. Investigations have taken place and we are waiting for the concluding reports. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean and comfortable. EVIDENCE: During the day we saw many aspects of the home. During the afternoon we spoke with some residents in the lounge areas and others in the privacy of their bedrooms. Bedrooms were personalised and comfortable. The lounge areas were homely. One resident said ‘I like to stay here (bedroom), I’ve got everything I need’. Another resident said ‘I like to sit in here (lounge) there’s always something going on’. One relative said ‘it’s always clean here’. There were no unpleasant odours in the home. Bathrooms were functional. The kitchen and laundry area were clean and tidy. The garden areas that surround the home and enjoyed by residents were well maintained. We saw no areas or aspects of the home that caused us concern about the safety of residents. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 20 Some areas of the home are in need of maintenance. For example, areas of paintwork have seen better days and the tiling in one bathroom in particular was in poor condition. Generally all areas of the home were in fair/good condition and well maintained. We spoke to the manager about the apparent high use of hospital style beds within the home. The home is not registered to provide nursing care and should therefore be careful to retain a setting more suitable to assessed care needs. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A team of well recruited and trained staff look after residents. EVIDENCE: A clear staff rota was available. The rota showed us that there was a minimum of six care staff (inc a senior) on duty during the morning, five care staff (inc a senior) in the afternoon and evening. The manager told us that sometimes they are included in these numbers. At night there are two ‘awake’ care staff on duty. The home also employs domestic, cooking, maintenance, administration and activity/recreational staff. At the last inspection a requirement was made to increase the staffing levels to three carers at night. At this inspection we noted that only two are on the rota. The home is registered to provide care for 36 residents and there were 25 accommodated at this inspection. Residents’ bedrooms are on three floors and some residents require two members of staff to move and handle them safely. At this inspection ‘day’ staff told us that there were enough staff on duty to provide good care. We did not speak to ‘night’ staff about this. We have sent surveys to the home asking that staff may like to share their views about this with us. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 22 The manager told us that sickness levels are low and that residents benefit from being cared for by an established group of staff. Records demonstrated that regular senior, care and kitchen/ domestic staff meetings take place. This means that all members of staff are kept up to date with aspects of the home. We saw the records of three staff that have recently been recruited to the home. Records were in good order. We saw that the home has a sound induction and training programme in place. This means that residents are cared for by staff that have been well recruited, inducted and trained. AS referenced earlier in the report, we observed poor manual handing and lifting techniques by a member of staff who had undertaken appropriate training. All staff must be trained and assessed as being competent to care for residents in a safe way. The manager told us that all staff have regular supervision sessions. We did not ask to see the records but two members of staff confirmed that they meet with a senior member of staff. The Facilitator Co-ordinator told us that 60 of the staffing establishment have completed their NVQ level 2 training and three members of staff have completed their NVQ level 3 training. Staff we spoke with knew about the care needs of residents. We saw that the interaction between residents and carers was friendly and supportive. Staff were friendly and knowledgeable about their respective roles and responsibilities. Residents told us ‘yes, staff are ok’….’they’re all right and kind to me’….’they’re always so busy’….I like X she’s lovely’. Two relatives were positive. One said ‘they’re always rushed off their feet, but I have no problems’, the other said ‘in general, they’re a good bunch’. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for in an environment where their care needs and safety are managed by an efficient team. EVIDENCE: Since the last inspection the manager has completed the Registered Manager’s Award and the NVQ level 4 training. Senior care staff support the manager in the day-to-day management of the home. Throughout the inspection, the manager referred a number of aspects raised by us to the senior member of staff on duty for response. Staff told us that they were satisfied about the way in which the home is managed and generally refer management issues to whoever is available. By this we established they meant, Sister, the manager or the senior carer on Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 24 duty. We did not receive any negative comments about the management of the home from either the residents or relatives. The Facilitator Co-ordinator manages the safety and maintenance issues. We sampled a number of safety and maintenance records and noted there were current. Fire and Rescue Service visited the home on 24th September 2007 and provided a satisfactory report. They made a routine visit again in June 2008, but did not supply a report to the home. A Food Hygiene and Food Standards inspection was carried out in November 2007 and the home was given a ‘5 star award’. We noted the following comments in the report ‘kitchen is excellent….hygiene and practices above average’. The home has a generic environment and safe working risk assessment management folder dated February 2008. These records are not kept within the immediate area where staff work. It is important that staff can access these records, as they need to know how to keep themselves safe at work. We saw that the home has a system in place to ensure that fire drills are undertaken on a regular basis. There were records to show that fire alarms and the emergency lighting system had been checked. We saw records to demonstrate that residents’ meetings take place on a fairly regular basis. The manager told us that a meeting had been planned to take place soon. This supports the information given to us by the activities coordinator. We saw the minutes of the last meeting held in the Spring. The issues discussed were resident orientated and covered issues such as food and activities. Residents indicated to us that whenever possible their corporate/ personal views and opinions are considered. This means that residents have an opportunity to influence and contribute to the day-to-day management of the home. We spoke briefly to the Facilitator Co-ordinator about the home’s quality assurance report. We were told that this was in progress. We are kept informed about notifiable matters (for example, falls that require medical attention and deaths) that are required through the Regulation 37 reports. We also saw the records of the Regulation 26 reports undertaken by Sister. Regulation 26 reports are undertaken by a representative of the owner of the home and report on the day-to-day conduct. The home looks after residents’ personal monies if requested. The system for these financial transactions had a good audit trail. Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The service must be clear that it understands the needs of proposed residents prior to their admission by carrying out a needs assessment. This is to ensure that the service can be confident that it can meet assessed and identified needs. This should identify the level of care support they will require and identify the resources required to meet this. 2 OP7 15 All aspects of every resident’s 15/10/08 personal care and healthcare needs must be assessed and documented in the care plan and adequate risk assessments put in place to support the consistent delivery of person centred support to each resident. Information must be current. This is to ensure that staff know what the care needs are and how to meet them. 3 OP8 12 Residents’ health and welfare DS0000015458.V370083.R01.S.doc Timescale for action 15/10/08 15/10/08 Page 27 Maris Stella Wing Version 5.2 must be supported by the documentation of health care advice and/or intervention. The use of monitoring records must be in place to assist staff in supporting identified health care issues. This is to ensure that staff know what the health needs are and who is going to meet them. 4 OP9 13 A metal cupboard of specific 30/11/08 gauge with a specific double locking mechanism must be fixed to a solid wall or a wall that has a steel plate mounted behind it and can be fixed with either rawl or rag bolts put in place to ensure that controlled drugs are stored safely. The timescale for action reflects the period of time needed to purchase and fit such a cupboard. 5 OP30 18 Residents must be supported by staff that are provided with sufficient training to gain appropriate and adequate skills and expertise and are assessed as being competent to meet the assessed needs of the residents they support. This is with particular reference to safe moving and handing techniques. 15/10/08 Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Maris Stella Wing DS0000015458.V370083.R01.S.doc Version 5.2 Page 30 - 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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