Inspection on 14/02/07 for St George`s Court Care Centre

This inspection was carried out on 14th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St George`s Court Care Centre 01/09/08

St George`s Court Care Centre 10/04/06

St George`s Court Care Centre 25/10/05

St George`s Court Care Centre 27/01/05

St George`s Court Care Centre 22/06/04

St George`s Court Care Centre 06/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St George`s Court Care Centre Russell Street Cambridge Cambridgeshire CB2 1HT Lead Inspector Nicky Hone Key Unannounced Inspection 14th February 2007 10:55 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 St George`s Court Care Centre DS0000015238.V329613.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. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Court Care Centre Address Russell Street Cambridge Cambridgeshire CB2 1HT 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) 01223 712135 01223 712138 St George`s Court Healthcare Ltd Mrs Jaqueline Christine Wicks Care Home 76 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (56) of places St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who require nursing care is 29 Date of last inspection 10th April 2006 Brief Description of the Service: St George’s Court Care Centre is a care home for up to seventy-six older people. The home is built on three floors, and each floor offers a home to a different resident group. The majority of residents on the top floor need nursing care: there is at least one registered nurse working on this floor at all times of the day and night. The middle floor is divided into two separate units: one offers care to twenty people with dementia; and one has twelve places for older people who need assistance because of physical frailty. There are six permanent places on the ground floor, and ten places which are used for interim care (people waiting for places elsewhere). Half of St George’s Court was built in 2005/6 as an extension to the original 1970s building, which was fully refurbished at the same time. Each of the four units has its own lounge and dining areas with a small kitchenette, a number of single bedrooms, and bathroom and toilet facilities. All of the new bedrooms have an ensuite shower room with toilet and washbasin. Some of the bedrooms in the original building have ensuite facilities, and the seventeen other bedrooms have a washbasin. There are two passenger lifts and staircases for access to the upper floors. On the ground floor there is a large kitchen where all the meals are prepared; a small rehabilitation kitchen; a laundry which serves the whole home; and offices. There are staff facilities on each floor and a central courtyard garden. St George’s Court is in a residential area close to the centre of the city of Cambridge. There are local shops, churches, pubs, restaurants, banks and a post office within a few minutes walk; the city centre is a short bus ride away; and the main-line station with direct links to London and the North is in walking distance. The majority of places at St George’s Court are ‘block-booked’ by Cambridgeshire Social Services. From information provided by the home’s administrator on 27/04/06, the fees are £361 for frail elderly; £445 for dementia care; and £530 for nursing. Fees for the privately funded places are £410, £495 and £580. Copies of the CSCI’s inspection reports are available in the entrance foyer of the home. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of a key inspection of St George’s Court Care Centre which we undertook on 14th February 2007. We have carried out a considerable amount of regulatory activity involving this home since the last key inspection in April 2006. A summary of all the activity is given here: reports written following the random inspections have not been published but are available from the CSCI office. 10th and 26th April 2006: we carried out a key unannounced inspection. This resulted in sixteen requirements being made, three of which were carried forward from the previous inspection. The report of this inspection was published. 25th and 26th May 2006: we carried out a random unannounced inspection because a relative rang us and said she was worried about the way her relative was being cared for. We found evidence during the inspection to show that she was right to be worried: the care was not good enough. We checked one of the requirements from the previous inspection, and found it had not been met: there were still not enough staff on duty to meet the needs of the residents. We also made a further seven requirements, making a total of twenty-three requirements to be assessed at the next inspection. 31st May 2006: A Statutory Enforcement Notice was served about the number of staff working in the home. 21st June 2006: we carried out a random unannounced inspection to check compliance with the Notice served on 31st May. The number of staff on duty on the top floor had been increased, and the acting manager had worked hard to improve the way the staff were working. We considered that the home had complied with the Notice. 5th and 9th September 2006: we carried out a random unannounced inspection to check whether the home had met all the twenty-three requirements we had made at the inspections in April and May. Generally we felt that overall there had been some improvement and we were pleased to find that nine of the twenty-three requirements had been met, and another six had been partly or almost met. The eight remaining requirements had not been met when we visited on 5th September, but the acting manager made sure that five of these had been met by the 9th September. Although we felt this was commendable, we were worried that it takes an inspection for these matters to be dealt with, and that we have to make requirements before action is taken. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 6 24th October 2006: we carried out a random unannounced inspection to check whether the home had met all the fifteen requirements made following the inspection in September. Eight of the requirements had not been met, one was not assessed and one was partly met. Five requirements were not met and a further six requirements were made, so this inspection resulted in thirteen requirements. We also made three recommendations. 30th October 2006: we served Statutory Enforcement Notices on two issues which had been raised at previous inspections and which had still not been addressed by the inspection on 24th October. We had found that parts of the home were not clean, and that some records had not been completed correctly. 20th November 2006: we carried out a random unannounced inspection to check compliance with the Notices served on 30th October. The home had complied with both of the Notices. 15th December 2006: we interviewed Mrs Jacqueline Wicks. Her application to be the registered manager of St George’s Court was successful. ---------------------------------------------------This inspection took place on 14th February 2007. Two inspectors spent 6 hours speaking with residents, staff and the manager, looking round the building and checking records. CSCI sent a questionnaire for residents and relatives to the home in August 2006. We received seven replies. On the whole the people who replied were satisfied with the service they (or their relatives) receive at St George’s Court. We also received copies of two thank you letters which had been sent to the home. Some of the comments from the questionnaires and letters have been included in the summary below and in the body of the report. What the service does well: We received several positive comments from residents and their relatives: “We were very impressed with the overall standard and cleanliness of the facility, and the helpful, friendly and sympathetic approach by you and your staff was exemplary. [The resident] was full of praise for everyone, stating how happy she had been in your care”. “Just a short note of appreciation for the excellent way you have looked after my relative for the past twelve months. It has not always been easy, yet the love and care that has been shown I do not think s/he could have had better attention. S/he seems so happy and contented”. “Generally the staff look after residents very well”. A person who works at the home but is not employed by the home wrote a letter to Excelcare and said “During the past 9 months St George’s Court has, St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 7 in my view, settled down for both residents and staff and is well on course for that which I’m sure your company would expect”. There is good, up to date information available about the home, and full assessments are carried out so that prospective residents know their needs can be met at St George’s Court. Residents and their relatives are made aware of how to complain should they need to, and complaints are dealt with well. Staff have received training in Protection of Vulnerable Adults, and receive regular supervision. The home has a quality assurance system. Most of the home was clean, well-maintained and smelled fresh and there is a pleasant smoking room for residents and their visitors. What has improved since the last inspection? What they could do better: This inspection has resulted in eleven requirements being made. Three of these have been carried forward from the last inspection because they have not been met: three have been carried forward but have been partly met. We were concerned that there were no care plans written for some of the residents so staff had no guidance on the care and support those people St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 8 needed. This also meant that for these people there was no evidence that their healthcare needs were being met. We were also very concerned about all aspects to do with food. The meal provided was dry and unappetising; residents had no choice about what food was put on their plate, nor how much; and the way the food was served was poor. Every part of the kitchen was dirty and there were no menus available. The outside of the building was untidy. Records of one resident’s finances were not accurate, staff rotas did not include surnames of all staff, and the record of food provided could not be found. Staff’s practice in infection control and food safety must be monitored to make sure they do not put residents at risk. Although we received a number of positive comments, one person who had been at the home for a week told us “I don’t know who to complain to: I’d go home this minute if I could”. We also had some negative comments about the food. 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. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 10 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): 1, 3, 6 Quality in this outcome area is good. There is information available about the home so that people are able to make an informed choice, and full assessments are carried out so that people know this home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a lot of information available in the entrance hall at St George’s Court, for people who live at the home, and any visitors to the home, to read. The home’s statement of purpose and service user guide are part of this information. We saw that they were nicely presented, contained all the necessary information and were up to date. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 11 We checked the files of several residents, including people on respite stays, and found that full assessments had been carried out before the person was admitted. One person had gone into hospital and a further assessment had been carried out before she returned. An Intermediate Care service is no longer provided at St George’s Court. There are ten bedrooms on the ground floor which are used by people who have been discharged from hospital and are waiting either to go home, or for a place in another care home. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 12 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, 10 Quality in this outcome area is adequate. The information in care plans is improving but more work still needs to be done to make sure staff know how to fully meet everyone’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at several care plans, some from each floor, and found a wide range of quality. We saw four care plans that contained full, detailed information about the care each person needs. One of these was for a person on a respite stay: a shortened version of a care plan was being used which gave enough information for staff to be able to meet this person’s needs. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 13 Two of the care plans we looked at were very detailed, reviewed and updated regularly, cross-referenced to other parts of the care plan, and there was evidence that either the person themselves, or their relatives, had been involved in writing the care plan. There were a number of risk assessments included in these care plans, for example nutrition, pressure sores, keys, medication, the use of bed-rails, falls and continence. Daily notes were full and gave a good summary of how the person had spent their day. There was evidence on some of the care plans we looked at that the home involves other professionals, such as the tissue viability nurse, and the dietician, when the plan of a person’s care is drawn up. We also saw care plans that detail how other healthcare needs are met, such as visits to the optician, dentist and chiropodist. On most of these plans we noted that people are weighed regularly and the weights recorded. On the top floor and middle floor we looked at the files for three people who were at St George’s Court for a respite stay and found that no care plans had been written, so there was no guidance for staff on how to meet each person’s needs. One daily record stated that the person had refused to go to bed: there was nothing to show that this problem had been investigated in any way, and there were no guidelines for staff on what to do. No risk assessments had been carried out, including for a person who had made a recent attempt to take their own life, and the daily notes that were available (which had not been made every day) were very basic. The notes available for another person said that her husband was in hospital, but the unit manager said he had died. We checked the records of the administration of medication on two floors and found these had been completed well. There were no gaps in recording, including for medication not required. It was also clear how much medicine had been given when a variable dose was prescribed (for example, 5-10mls: recorded that 10mls given). It was not made clear which eye an eye ointment was for. One person on a respite stay was administering their own insulin, but another person told us that when she is at home she looks after her own medicines but the staff give it to her here. Several people had been prescribed fortified drinks: in two bedrooms we noted that these were being stored on the floor. Generally we observed staff treating residents with respect, except for the issues that we raised around meals and mealtimes (see the Daily Life and Social Activities section of this report). Two relatives who responded to our questionnaire commented on the difficulties for residents who find it hard to communicate with some of the staff whose first language is not English (see the Staffing section of this report). St George`s Court Care Centre DS0000015238.V329613.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, 15 Quality in this outcome area is poor. Meals are not provided and served in a way that ensures residents have a wholesome, balanced diet which they enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that staff are thinking much more about activities than they used to and are trying to find ways to improve the range and number of activities they do with the residents. She is pleased that staff are spending time talking to residents more. An activities coordinator works on the middle floor, and the home has a vacancy for another. We noted that generally the atmosphere in the home was very calm and pleasant. When we visited the middle floor there was music playing and people seemed quite content. The shape of the lounge on this floor (long and narrow) does not encourage a homely atmosphere, and the television is in a St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 15 position where only about three people can see the screen. The sensory room on this floor was not used by residents so is now a staff area. The activities coordinator based in the dementia unit said something happens every day, such as music or a quiz, and she is visiting other homes to get ideas. Individual residents go out with staff but the home does not have a mini-bus so no “general outings” can take place. The unit manager on the middle floor said she is contacting the Alzheimer’s Disease Society for ideas about activities for people with dementia. One resident, at St George’s Court for a respite stay, told us that the “music man” entertained at the home the day before the inspection, and there was a church service the previous Sunday. Visitors are made welcome at all times. One visitor we spoke with spends every day at the home and has a meal with his relative. There is a church service fortnightly, but there is little other opportunity for residents to participate in the life of the local community. We were very disappointed about all aspects to do with meals. The chef told us that no cooked breakfasts are served other than to one resident who has an egg. This person told us that on the morning of the inspection she asked for an egg for breakfast and eventually it was “plonked in front of me – just an egg. I asked where bread and butter was - I never got it”. Porridge and cereal, as well as bread (for toast if required), jams, marmalade, tea and coffee are available in the unit kitchens. The chef said he does not start work early enough, or have the equipment, to provide cooked breakfasts. We saw menu boards in each dining area: two of the boards were displaying the meal that was for lunch that day, the other (in the dementia unit) showed the previous day’s menu until the lunch arrived and then it was altered. We had a range of comments from residents about the meals: - “I am vegetarian and would like more fish. Staff usually ask me what I want. The food is awful, never hot. I’m given sweetcorn when I don’t want it. I would like some parsnips”. - “I have been here for a week. The meals are dry – no gravy. There are a lot of crisps. No condiments on the tables and when I asked, they couldn’t find any salt.” - “I am here for a short stay. The food is good – a nice choice every day” There is a choice of main course for lunch and residents are asked the previous day what they would like. The list (which has room numbers and not names) is taken to the kitchen and sent back to the unit with the meal so that staff know who has asked for which meal. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 16 Meals are cooked in the main kitchen and put in heated trolleys, one for each unit. We observed lunch being served in two units. The meal looked boring and unappetizing: it was dry and colourless, and there was no gravy. It was identical to the meal we had seen at a previous inspection when we made the same comments. In both units, staff stood at the trolley and served all the food on to the plate and gave it to each person in turn. This meant that residents had no choice about which food items they would like, or about how much. On one unit, the person who told us she does not like sweetcorn was given sweetcorn as it was the only ‘vegetable’ available: the staff said “just leave it”. Another resident was nearly in tears because a huge plate of food was put in front of her: she said it really put her off to see so much food. The staff said “just eat what you want”. Eventually, when the person became increasingly distressed, they took some of the food away. In the dementia unit there was a complete lack of organisation in the way the food was served. One member of staff stood at the trolley and was trying to check the list to see who wanted what, and serve all the food items while several staff just stood round waiting. The trolley was kept in the kitchen area of the unit so some residents in the separate dining area did not know what was going on. There are three tables in this dining area. Instead of serving each table and then moving on to the next, some people at each table were given a plate of food. This meant that the residents without food thought that they had been forgotten and were calling out. They were virtually ignored by the staff. Again, residents were not given any choice of what they wanted on their plates, nor how much. There were no condiments on the tables, and none were offered. There were plastic coloured beakers for squash on each table, and cups on the tables but no saucers. A “soft diet” was provided for residents who need it. This consisted of bowls of pureed food: there was no record, either on the units, or in the main kitchen, to say what was in the pureed food. When we spoke to the chef he could not find the record of food provided. He showed us some menus, but the dates on the menus did not make sense. He said there was no menu available for the current week: he was deciding daily what to provide and using food up out of the freezer. Lots of correcting fluid had been used to make numerous alterations to the menus we saw. We would not have been able to work out what food had been served on which day. It was evident that a very limited variety of vegetables was being served. We were very concerned about the lack of cleanliness in the main kitchen (see the Environment section of this report). St George`s Court Care Centre DS0000015238.V329613.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, 18 Quality in this outcome area is good. Residents know their concerns will be listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the bedrooms in the home have information about how to make compliments, comments or complaints, and the people who returned the questionnaires said they would know how to make a complaint if they need to. We spoke to someone who visits his relative every day. He said his relative is looked after “quite well”. He told us he is happy to speak to the staff or the manager if things are not right, and does not want to keep complaining. One person who had been at the home for a week told us that she did not know who to complain to. Any complaints received are thoroughly investigated and a full response made. Staff have received training in the Protection of Vulnerable Adults (POVA). St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. Generally the home is kept clean and pleasantly decorated so that the residents have a comfortable home to live in. The main kitchen was dirty which could potentially put residents at risk, and the grounds were untidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This is a very large home and staff work hard to keep it clean and smelling fresh. We walked round the whole building but only entered a few bedrooms. Generally the standard of cleaning and maintenance was very high and we only found a few minor defects which we discussed with the manager. For example a ceiling tile in one bedroom was not in place; there was a bad stain around a St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 19 smoke detector; several corridor lights were not working and one was flickering; and a bedroom door was not closing properly. A smoking area is provided on the ground floor. This is a very pleasant room where residents and their visitors can go to smoke if they wish to. We were concerned about the cleanliness of the toilet in one ensuite and asked the manager to check all the toilets. We noticed that a table and chairs had been put in the small kitchen on the ground floor which meant that most of the kitchen was not accessible to anyone in a wheelchair. The manager confirmed that the flooring used in the bedrooms is non-slip, but she felt the tiles in the front hallway could be slippery when wet. She agreed to investigate this and rectify it if a problem was found. We were seriously concerned about the lack of cleanliness in the main kitchen. It was very dirty: floor; work surfaces; walls; and doors of fridges, freezers and so on. In fact, everything in the kitchen was dirty. We were also concerned about the outside of the home. The car park and grounds at the front of the building were littered with rubbish, including cigarette ends and plastic gloves. One relative who responded to the questionnaire commented that the front of the home would look better if the slabs were cleaned. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. Residents benefit from improved numbers of staff on duty who are trained and competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection we spoke to several residents who commented about the staff. For example “staff are very kind”; staff are “very nice, very kind and hard-working, they are there for you”; “you couldn’t get any better staff than here”. One person who responded to the questionnaire wrote “generally the staff look after residents very well”. The numbers of staff on duty have improved. Several shifts were being covered by agency staff as there were still a number of staff vacancies. The home usually manages to get agency staff who have previously covered shifts so that they know the residents. The manager has worked hard to bring staff training, and the training records up to date. We saw that the majority of staff have received all the required St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 21 training. New staff receive a thorough induction. The home has yet to achieve 50 of staff with a recognised qualification, but we were told that this is being addressed. Two people who responded to the CSCI questionnaire commented: “It’s sometimes difficult for residents to understand some of the carers, because of communication problems due to foreign dialects” and “The over-riding problem is the lack of English language skill amongst the staff”. The manager told us that two of the staff have signed up for an English speaking course, and that someone from Cambridge Regional College is coming in to help staff with both spoken and written English. We looked at the personnel records for two members of staff. These were satisfactory except that one person’s registration with the NMC had not been verified, and on the other a possible gap in employment had not been fully explored. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. The management of the home is improving, giving residents a better quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall the management of the home has improved greatly, due for the most part to the efforts of the registered manager, Jackie Wicks. We were still concerned that Mrs Wicks is trying to do everything herself. She feels however St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 23 that the management team is getting stronger and that she is starting to delegate some responsibilities, knowing that the tasks will be carried out well. The senior staff team had been involved in Leadership training for some months. The person leading this training spoke with us and told us how impressed he is with the way the team has developed, although they were all aware there was still some way to go. The manager also said she feels that the whole staff teams on each floor are developing well. The company regularly carries out a survey of residents’ views and the results are published. Part of the home’s quality assurance system includes a number of internal audits. We saw that an audit of care plans had taken place recently. The home looks after personal allowances for three residents. We checked one of these and found the cash did not match the record. Residents on respite care are encouraged to put their money in the safe for safe-keeping. The manager stated that staff supervision is up to date: we did not look at the records. Some of the records we checked were not being kept accurately. For example, staff rotas on the top floor did not include full names of all the staff, and the record of food provided could not be found. Records were available to show that tests of systems and equipment are carried out as required, including tests of the fire alarm and emergency lighting systems. Records of staff training showed that the majority of staff have now been trained in all areas relating to health and safety (fire safety; moving and handling; first aid; infection control; and food safety). However, we found a couple of examples where staff were not putting their training into practice. There was soiled linen in the bath in one bathroom on the top floor, and there was a skip full of dirty linen also in bathroom, which does not meet infection control standards. In one of the units we found a slice of cake in the fridge, which had no date on it. When we asked a member of staff about this, we were told it was probably from today. This staff member then put the cake back in the fridge, still with no label, showing a lack of understanding of food safety. As discussed previously, we were very concerned about the cleanliness of the kitchen. The manager said the Environmental Health Officer had visited about eight weeks prior to our inspection. She had been told by the member of staff on duty at the time that the EHO had discussed staff training, storage of food, fridges and freezers, and delivery of food, but not cleanliness. There was no record of this visit available. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 24 The unit manager on the middle floor told us that she is putting forward a proposal to erect a low dividing wall so that the kitchen area in the dementia unit can be separated from the living area in order to keep residents safe. She explained that staff have to constantly watch this area to make sure residents who would be at risk in the kitchen do not harm themselves. We agreed that this would seem to be an improvement which would benefit everyone, providing residents could still access the kitchen safely when they wanted to. One resident we visited in her bedroom was sitting in a chair and the pull cord for the call system was out of reach. She told us she had fallen twice and has had to “shout, shout, shout” before someone has come to help her. St George`s Court Care Centre DS0000015238.V329613.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 2 X 3 X 2 3 2 2 St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 12(1)(a) Requirement The registered person must promote and make proper provision for the health and welfare of service users. Care plans must contain sufficient information to show that service users’ health and welfare needs are met. This requirement is carried forward again: it has been partly met. The amount and range of activities offered to service users must continue to improve. This requirement is carried forward: it has been partly met. Service users must be offered a variety of suitable, wholesome and nutritious meals of their choice. Suitable equipment must be provided so that service users can be offered wholesome and nutritious food. This requirement is carried forward from the inspection on 24/10/06. DS0000015238.V329613.R01.S.doc Timescale for action 31/05/07 2 OP12 16(2)(m) & (n) 31/05/07 3 OP15 16(2)(i) 30/04/07 4 OP15 16(2)(g) & (i) 31/05/07 St George`s Court Care Centre Version 5.2 Page 27 5 6 OP19 OP26 23(2)(o) 23(2)(d) The external grounds must be appropriately maintained. 30/04/07 All parts of the home must be 30/04/07 kept clean and hygienic. The main kitchen must be kept clean. The registered person must ensure that persons employed are fit to work at the care home. Staff’s knowledge and use of the English language must be adequate for them to be able to communicate with services users sufficiently well so that they can meet the needs of the service users, and they must be able to communicate well with other staff. This requirement is carried forward from the inspections on 05/09/06 and 24/10/06: it has been partly met. Service users must be protected from abuse. Any monies held on behalf of service users must be handled correctly. A copy of the duty roster must be kept. This record must be accurate. Staff’s surnames must be included. This requirement is carried forward from the inspection on 24/10/06. A record of food provided must be maintained This requirement has been carried forward from inspections since 25/10/05. Service users must not be placed at risk. Staff’s practice in infection control and food safety must be monitored. DS0000015238.V329613.R01.S.doc 7 OP30 18(1)(c) 31/05/07 8 OP35 13(6) 30/04/07 9 OP37 17(2) and schedule (4)(7) 30/04/07 10 OP37 17(2) and schedule (4)(13) 30/04/07 11 OP38 13(3) and 13(6) 30/04/07 St George`s Court Care Centre 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. 1 Refer to Standard OP38 Good Practice Recommendations The organisation should consider separating the kitchen area from the living space in the dementia unit so that service users are kept safe. St George`s Court Care Centre DS0000015238.V329613.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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 St George`s Court Care Centre DS0000015238.V329613.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. 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