Inspection on 18/03/09 for St George`s Care Centre

This inspection was carried out on 18th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St George`s Care Centre 06/12/06

St George`s Care Centre 07/11/05

St George`s Care Centre 04/07/05

St George`s Care Centre 23/09/04

St George`s Care Centre 22/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St George`s Care Centre Ratcliffe Road Leicester LE2 3TE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Debbie Williams     Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: St George`s Care Centre Ratcliffe Road Leicester LE2 3TE 01162745115 01162702318 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prime Life Ltd Name of registered manager (if applicable) Ms Rachael Collins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Date of last inspection Brief description of the care home St Georges is a home for up to thirty six older people and is registered to accomodate people who have dementia. The home is a pleasantly furnished and decorated two-storey building and is situated in a quiet residential area of Stoneygate, Leicester. It is set in extensive grounds, surrounded by lawns and mature trees. Information about the home and the weekly fees is available at the home as is the Care Homes for Older People Page 4 of 28 care home 36 Over 65 0 36 Brief description of the care home previous inspection report. Care Homes for Older People Page 5 of 28 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: two star good 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: This key inspection included a visit to the service. We visited the service on the 18th of March 2009. The main method of inspection used was case tracking which meant selecting three people and tracking the quality of their care by checking records, discussion with them and with staff. We also looked at the providers own assessment of the services they provide, which they sent to us, this is called the annual quality assurance assessment or AQAA. We checked all the standards which the Care Quality Commission have decided are key Care Homes for Older People Page 6 of 28 standards during this inspection. In some sections we have also checked additional standards, these will be detailed in the main report. We spoke with people living at the home, with staff and observed care practice. We also used a type of inspection specifically designed for use with people who have dementia. This type of inspection is a short observational inspection (SOFI). This involved observing three residents in the communal areas for two hours and observing their state of being and the level and quality of staff interaction. We looked at records required for the efficient and safe running of the home and spoke with the registered manager about policy and procedure at the service. We also considered information we received from social services about a safeguarding adults investigation they undertook at the service. The providers have responded to this investigation in a helpful and professional manner and have agreed that staff will undertake further training in this area which is provided by the local authority. What the care home does well: What has improved since the last inspection? What they could do better: Staffing levels and skill mix must be sufficient to meet the assessed needs of people living at the home at all times. There are no separate catering staff employed at the home or separate staff responsible for the provision of activities, therefore consideration should be given to the time staff have to attend to peoples needs at all times of the day. St Georges is registered to accommodate people with dementia and therefore care staff must receive the training they require to meet the specific needs of people with dementia, this includes the management of challenging behaviour and the provision of meaningful activities. Care plans and care records should be up to date and record the changing needs of people living at the home, this is to ensure that changes are communicated to care staff and current needs can be met. People should also be given the opportunity to be involved in the care planning process. All areas of the home should be kept clean and hygienic in order to provide a comfortable and pleasant environment for people living at the home. Care Homes for Older People Page 8 of 28 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 set out 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 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Georges have had their needs properly assessed before moving into the home and are provided with the information they need to make an informed choice before moving in. Evidence: An information guide is provided to all prospective residents and or their families and this provides information about the service provided and the aims and objectives of the service. This information can be provided in different languages or in larger print if requested. Before moving into the home a needs assessment is carried out by a senior member of the team in order to ensure the service can meet the persons needs, where applicable, social services care needs assessments are included within the assessment process. Whenever possible, people are encouraged to visit the home before moving in. A six Care Homes for Older People Page 11 of 28 Evidence: week trial period is offered to all residents, at the end of this time a review is held to ascertain whether the placement is satisfactory or suitable before being made permanent. Care and assessment records were seen for three people who were case tracked as part of this inspection. A thorough and comprehensive needs assessment was carried out and this included appropriate risk assessments. This ensures that staff have the information they require to meet peoples needs and to minimize risk. A getting to know you form is also used and this provides staff with information about peoples individual preferences, interests and cultural needs. This information is vital for staff to meet peoples needs as many of the residents accommodated may experience difficulty communicating their needs and preferences. A short observational focused inspection (sofi) was undertaken as part of this inspection and this was to look at whether the needs of people with dementia were being met. During the sofi, staff were responsive to residents who were being observed and interacted frequently and positively with them. However, later in the day some residents observed in the lounge and dining room appeared somewhat anxious and aimless, it was unclear if this was due to staffing levels or to the training needs of staff employed regarding specific dementia care needs and provision of meaningful activity. Some staff had received training in caring for people with dementia and challenging behaviour but a requirement was made that all staff receive training in these areas. Care Homes for Older People Page 12 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are met but could be improved further by better care planning and recording. Evidence: We looked at care plans for three people who were case tracked during this inspection. Care plans were comprehensive and appeared to meet all assessed needs. For one person care plans had not been reviewed since December 2008 and were not reflective of current needs, however, care practices observed confirmed that staff were providing the care required to meet current needs, the acting manager said that the majority of care records were reviewed on at least a monthly basis. We also looked at daily records and found that statements were often vague and did not provide an account of events of the day or of the wellbeing or otherwise of the person living at the home, a recommendation was made regarding this. Forms were seen within care records for consultation with people living in the home or Care Homes for Older People Page 13 of 28 Evidence: their representative regarding the care planning process, these had not been completed for two of the people case tracked. A recommendation was made that people living in the home or their representatives should be involved in the care planning and review process. Evidence was seen of staff consulting with health-care professionals such as GPs or community nurses where required. One person who had been identified as at risk of malnutrition had been referred to the GP but a not to a dietitian, a recommendation was made that this be followed up again with the GP and a dietitian referral requested. Community nurses are consulted when people are identified as at risk of developing pressure sores. We spent two hours observing staff interaction with people living in the home in the lounge and dining room. We observed that people are treated with respect and their right to privacy was respected. Medication is managed by staff who have received training in this area and was being managed safely and effectively. Care Homes for Older People Page 14 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Georges are able to make choices and are given opportunities for to take part in activities and have a relaxed lifestyle. Evidence: We spent two hours observing care practice in the lounge and dining room. It was evident that people were offered choices and that routines of daily living were made flexible to meet peoples needs. People living at the home were free to move around all the communal areas in the home and people were observed doing this during the inspection. During the morning, staff were observed engaging with residents in the lounge. People were offered to participate in a balancing game with plastic rings, a few residents chose to participate and others declined and their wishes were respected. One staff member invited residents to sing their favourite song, two residents appeared to respond well to and enjoy this activity. Later in the afternoon residents were observed in the lounge and dining room, some people appeared anxious and aimless and there was less staff supervision or structured activity at this time. Care Homes for Older People Page 15 of 28 Evidence: Two residents chose to have their lunch time meal in the lounge rather than in the dining room and one person chose to have their meal later in the day, staff respond well to these requests and demonstrated a flexible approach. The dining room was congenial and the atmosphere calm and relaxed. Staff were seen assisting residents in a sensitive manner. A choice of meal was offered and one staff member took the two plated up choices to the residents and this enabled them to make a their choice. One resident enjoyed helping staff at meal times and with other daily tasks such as dusting and watering plants. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Georges can be confident their complaints will be listened to and taken seriously. Evidence: The complaints procedure is included within the information guide that is given to people before moving in to the home. The manager holds a surgery once a month for residents or their representatives. A recent social services safeguarding adults investigation recommended that staff undertake the local authority safeguarding adults training and the acting manager said that this was taking place. The acting manager was able to demonstrate a good awareness of safeguarding adults polices and procedures. Staff are instructed about what to do in the event of suspected abuse as part of their induction training and provided with a training pack to work through when they first commence employment. The service is registered to accommodate people with dementia or mental health needs. Not all care staff had received training in this area or regarding the safe Care Homes for Older People Page 17 of 28 Evidence: management of challenging behaviour. A requirement was made regarding this. Recruitment practices at the home were robust and ensured that the relevant checks and references were obtained before staff commenced employment, this minimizes risk for people living in the home. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at St Georges are mostly provided with a safe and comfortable environment which is accessible and meets their needs. Evidence: There was an unpleasant odour in the reception area, the manager said this had been a problem for some time and was going to ask the maintenance team to address it. All other areas of the home seen were clean and well maintained. The furnishings in the communal area are homely, and people are encouraged to bring their personal possessions and have them in their bedrooms. We saw staff using specialist equipment to help people move around the home, and we saw staff being gentle when moving people with a hoist. Records show that the home is well maintained. There was a separate laundry area and staff have received training in infection control. Pictures were used along with words for signs to communal bathrooms and toilets in order to support people with dementia. As well as the main lounge and dining room there were smaller quieter communal Care Homes for Older People Page 19 of 28 Evidence: lounges and people had access to all move around all communal areas. Care Homes for Older People Page 20 of 28 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 living at St Georges mostly have their needs met by the numbers and skill mix of staff. People are protected by the homes recruitment procedures. Evidence: At the time of this inspection staffing levels did not always meet the needs of people accommodated. There were no separate catering or activities staff employed and this meant that care staff also had to undertake these tasks. While during the morning staff were in attendance for people in the lounge and dining areas, in the afternoon there were fewer staff in these areas and residents were less engaged. Feedback form the community nursing team also said that it was sometimes hard to find staff. A requirement was made that staffing levels must always be sufficient to meet peoples needs. Recruitment procedures at the home were robust, all relevant checks and references were obtained for new staff before they commenced working at the home, this minimizes risk from harm for people living at the home. All new staff complete a period of induction training and records were seen of this. Training records were seen, staff were provided with the necessary mandatory training Care Homes for Older People Page 21 of 28 Evidence: such as induction, moving and handling and fire. Not all staff had received training about caring for people with dementia or challenging behaviour, a requirement was made about this. A programme of National Vocational Qualification in care training was in progress and the majority of staff had either achieved or were working towards this qualification. Care Homes for Older People Page 22 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run in the best interests of people living at the home. The health, safety and welfare of people living at the home is promoted. Evidence: The registered manager had recently been registered with the Care Quality Commission and passed the fit person application and interview. People living in the home and staff spoken with felt the manager was approachable and would listen to their concerns and suggestions. The registered manager demonstrated she had a good rapport with people living at the home and a good understanding of their needs. Systems were in place to assess quality assurance and these included regular audits carried out by a senior manager. Care Homes for Older People Page 23 of 28 Evidence: Policies and procedures were in place regarding peoples personal money and this minimized the risk of financial abuse. Staff had received all mandatory health and safety training. Information provided confirmed that all routine maintenance and safety checks had been carried out. Care Homes for Older People Page 24 of 28 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 25 of 28 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 4 18 All care staff must receive 30/06/2009 training which enables them to meet the specific needs of people with dementia. This is to ensure that people living at the home have their needs met. 2 7 14 Care plans must be reviewed 30/05/2009 on at least a monthly basis. So that peoples changing needs are reflected and communicated within care records. 3 18 13 All staff should receive 26/06/2009 training in the care of people with dementia and the safe management of challenging behaviour. To safeguard people living at the home from poor and abusive practice. 4 19 23 The unpleasant odor in the reception area must be eradicated. 23/05/2009 Care Homes for Older People Page 26 of 28 All areas of the home must be pleasant and comfortable for people living at 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 2 7 7 People living in the home and or their families should be involved in the care planning and review process. Daily records should be more descriptive of events of the day and peoples wellbeing or otherwise in order to ensure information is communicated effectively to staff and changing needs responded to appropriately. People should be given the opportunity to participate in meaningful activity that meets their individual needs and preferences. Where risk of malnutrition is identified, advice should be sought from an appropriate health care professional. 3 12 4 15 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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