Inspection on 18/08/08 for St George's Home

This inspection was carried out on 18th 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.

Other inspections for this house

St George's Home 14/08/09

St George's Home 03/05/07

St George's Home 25/04/06

St George's Home 09/01/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE St. George`s Home 116 Marshall Lake Road Shirley Solihull West Midlands B90 4PW Lead Inspector Lesley Beadsworth Key Unannounced Inspection 18th August 2008 10:30 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 Home DS0000064009.V370227.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 Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St. George`s Home Address 116 Marshall Lake Road Shirley Solihull West Midlands B90 4PW 0121 745 4955 F/P 0121 745 4955 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) St George’s Care Limited Mrs Magda Gleeson Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May provide accommodation and personal care for one named service user, as detailed in the variation to registration application received 19.02.03. Under 65 years of age, in the registration category LD. 3rd May 2007 Date of last inspection Brief Description of the Service: St Georges is a purpose built, two-storey residential home providing care for up to 29 older people. The home is close to local amenities, is on a local bus route and the main route through to Solihull and Birmingham. There are 23 single bedrooms and 3 double. Television and telephone points are available in all bedrooms. The home has a large communal area, with a dining area. A quiet area is located on the first floor, with a balcony area to the roof. There is a shaft lift for access to the first floor, providing wheelchair access to all parts of the home. Two of the bathrooms provide assisted bathing facilities. The rear garden is lawned, with some shrubs. Ample parking facilities are available to the front of the property. The manager advised that the fees are £364.00 to £450.00. The Service User Guide states that fees do not include “the cost of private services such as chiropody, dentistry, optician, hairdressing, personal toiletries, newspapers, dry cleaning, clothing or other personal effects.” St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection included a visit to St Georges. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users and four were completed and returned to us, the Commission. Information contained within the AQAA and surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 10:20pm to 10:20pm. What the service does well: Pre-admission assessments are carried out prior to a prospective resident moving into the home to ensure that their needs can be met by the home. These were in sufficient detail to enable this decision to be made. Medical information was well documented. The kitchen and laundry staff are advised on their admission of the relevant needs of new residents in a purpose made form. Residents on going health care needs were being met with care files including information about visits made by the GP, chiropodist, optician, stoma nurse and district nurses. One relative said in a survey completed on behalf of a resident and in response to the question, “Do you receive the medical support you need?” St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 6 “The GP makes routine calls and any symptoms are immediately acted upon” One service user survey answered in response to the question, “Do you receive the medical support you need?” “The GP makes routine calls and any symptoms are immediately acted upon” Residents were care for in a respectful manner in order to maintain their dignity and self esteem. A variety of activities were offered to people living at the home and included outings. Nine residents enjoyed a recent trip to the theatre and an outside entertainer visited the home to sing songs from popular musicals. Residents’ activity preferences were recorded in their care plan. Three people answered “Always” to the question in the surveys, “Are there activities arranged by the home that you can take part in?” One person responded “sometimes” and the following comments were made, “There are activities every day.” “my x’s mental state makes it difficult for x to take part in social activities.” Discussion with people living at the home and observations made showed that they had the opportunity to make choices in their daily lives. Examples of this were when to get up and go to bed, what they had to eat, where to spend the day and whether to join in activities or not. Four residents were asked if they enjoyed the food at the home and all said that they did. Two of the four surveys answered “usually”, one answered “always” and one answered, “sometimes” to the question, “Do you like the meals at the home?” The home has appropriate training, policies and procedures in complaints and in Protection of Vulnerable Adults to safeguard residents. Residents spoken with and surveys completed confirmed that residents and visitors know who to go to if they have any concerns. A relative on behalf of a resident said in a survey, “ I would address any concerns to the manager .. but also I met the owner … who invited me to voice any issues I may have.” Security gates and CCTV cameras provide good security to the home. Residents’ financial interests were safeguarded. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The manager said in the AQAA and in discussion that all residents had a terms and conditions statement (contract) and that a copy was included in the new brochure pack given to all new residents. All four surveys returned to us had the answer, “Always” to the question, “Have you received a contract?” Care plans set out the care required in sufficient detail in order to ensure that all aspects of the health and personal health needs of residents were met. Staff competency in the administration of medication had been carried out, although these need to be done more frequently. All eye drops and ointments were dated when opened to ensure that they were disposed of at the correct time so that unstable medication is not give to residents. The maximum, minimum and current temperatures of the fridge had been taken and recorded in order to monitor that any contents of the fridge were stored safely. The medication trolley was locked when left unattended in order to ensure the security of the contents. Complaints records showed the outcome of any complaint investigation and any necessary action taken. All recruitment practices safeguard residents from the employment of unsuitable people. Some areas of the home had been redecorated, including the first floor corridors and some bedrooms. The communal areas and corridors on the ground floor had been decorated. Grab rails had been replaced in a secure manner to enable residents to use them safely as support when they moved around the home. The manager said in discussion and in the AQAA that new staff were provided with induction training that met the required standard. All staff files looked at provided evidence to confirm this. There were no offensive odours in any of the areas viewed, providing a more pleasant environment for the people living working at and visiting the home. All staff had undertaken mandatory training in order to provide a healthy and safe place to live and work in the best interests of the residents. However there were some concerns about the duration and locality of this training. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 8 Accidents were recorded in detail including any action required. Staff meetings now take place giving staff the opportunity to make their views known and to have an affect on the way the service is provided. What they could do better: Care plans had only been reviewed between three and six monthly. There is a risk of care plans not being updated if they are not reviewed at a minimum of monthly intervals, or sooner if circumstances change. Staff competency audits need to be carried out more frequently in order to minimise the discrepancies in records and medication balances and thereby safeguarding the health and well being of the people living at the home. There were some minor discrepancies in the Service User Guide and inaccuracies in the Statement of Purpose. These should be addressed in the new versions of these documents. There was evidence of the home’s practices being task orientated rather than person centred. For example the routine for continence management did not consider individual needs; care staff routinely vacuumed the carpets and mopped the whole of the dining room floor after each meal whether this was necessary or not. There were concerns related to medication. Several errors in the Medication Administration Record Sheets and controlled drugs register in relation to the actual medication in stock were found; a controlled drug was not accurately recorded following being administered; the security of controlled drugs was inadequate; the storage of medication required to be kept in the fridge was not safe. Staff competency audits, that are unannounced and that includes the monitoring of controlled drugs, needs to be carried out regularly and more frequently. Effort needs to be made to provide special diet meals that resemble the main meal as much as possible, within the constraints of the dietary needs, by using, for example sweeteners and sugar free alternative ingredients for diabetic diets. This will help to prevent the person feeling different or discriminated against. The mealtime should be relaxed and a social event. Residents should not feel that they are being rushed by the way the meals are served and tables cleared. Delay in receiving planning permission had caused delays to the improvements in the environment of the home and as a result some areas are not as comfortable for residents as others. For example some bedrooms on the first floor had shabby décor, furniture and fittings. Steps should be taken to improve these areas as much as possible. For example the furniture in these St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 9 bedrooms could be replaced without being affected by any building work in the future. The armchairs in the sitting areas are looking shabby and need replacing or reconditioning. The floor tiles in the part of the lounge previously designated for smokers should be replaced with more suitable carpet. Light fittings in the communal areas should be replaced, as they are dirty, broken and therefore unsightly. Laundry facilities were inadequate with only domestic appliances and very little space, whilst awaiting planning permission to improve these facilities. Consideration should be given to making the communal areas into more homely proportions, for quiet areas to be provided and for different groups of people being able to watch different TV programmes or pursue other interests without affecting the large group. The home would benefit from having a separate room where staff could take their breaks; the manager could meet with families and others in private and where training could take place without impacting on the residents. Concerns regarding infection control raised by the Health Protection Unit and identified in this inspection need to be addressed and actioned in order to maintain infection control. These included • The dirty bath hoist frames • The lack of towel rails, particularly in shared rooms. • The incorrect storage of mops and mop buckets. • The risk of shared toiletries in shared rooms as items not labelled. • Dirty wheelchairs. • Stained/dirty vinyl on armchairs in the lounge. • The lack of individual alcohol hand gel provided by the home for staff use or the provision of liquid hand wash at residents’ washbasins. There are insufficient ancillary staff to prevent care staff from having to regularly carry out domestic tasks that take them away from the care of the residents. Staff training should be undertaken outside of duty hours so that numbers of care staff on duty are not reduced. Efforts should be made to look at temporary solutions being found to improve the senior staff situation until permanent staff can be appointed. 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 St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 10 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 11 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 Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed but with some discrepancies. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had updated the Service User Guide and this document was now presented in an attractive folder, along with a copy of the contract and a business card with details of the home. However there were further updates necessary in this document; the number of inspections undertaken by us, the Commission, now varies depending on the rating of the home rather than the “minimum of twice a year” as stated in the Service User Guide; our change of address. The Statement of Purpose was made available. Some minor discrepancies were noted, for example, the document discusses the facilities for residents who smoke although the manager advised that the home was now a no smoking home and the previously designated smoking area was now no longer St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 13 necessary; in the section related to laundry facilities the author states, “We have a large laundry room which is equipped with high specification industrial washing machines.” Whilst there are plans for this to be the case the present laundry is very small and there are only domestic appliances in use. The AQAA and discussion with the manager showed that all residents now had a terms and conditions statement (contract), a copy seen to be included in the Service User Guide folder. This was further evidenced in responses in the completed surveys with four surveys returned to us having the answer, “Always” to the question, “Have you received a contract?” Three care files were looked at as part of the case tracking process. Preadmission assessments were carried out using a format that included all the necessary headings and included sufficient detail to decide if the home could meet the person’s needs or not. On admission a completed form is forwarded to the kitchen staff to inform them of the person’s dietary needs and to the laundry staff to inform them of any specific laundry requirements. Medical information was particularly well documented. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 14 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. There are minor shortfalls in care plans. Care is not always person centred. Residents have access to health care professionals and are cared for in a respectful manner. There are concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the care files looked at included a care plan that had been devised from the pre admission assessment and any other information collected about the resident on admission. Care plans are set out the care required in sufficient up to date detail to ensure that all aspects of the health and personal health needs of residents are met. The assessments and care plans were also summarised on a ‘Daily Needs Sheet’ so that new or temporary staff were able to easily access the information they needed to provide the care required. However not all information recorded in the reviews was updated on the main care plan. This meant that care staff needed to read the reviews as well as the care plan to be sure that they had the latest information. For example the review of one care St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 15 plan showed that a person had developed “mild confusion” but this was not added to the care plans. The manager and staff spoken with said that the handover of information practice at the beginning/end of shifts was detailed but relying on verbal communication and memory can lead to needs not being met. Staff spoken to were aware of individual needs. The care plans viewed referred to the residents preferred pastimes and one indicated that the person’s decision not to join in communal activities was respected. Care plans had only been reviewed between three and six monthly. There is a risk of care plans not being updated if they are not reviewed at a minimum of monthly intervals, or sooner if circumstances change. Daily records were completed three times during a 24-hour period with specific pre printed headings of diet, visitors and well-being. These headings could be limiting and prevent some information falling under these headings from being recorded. Significant events or concerns were recorded again in a concerns log, which would be used at handover and record any action taken or that had to be taken in relation to the entry. Further to the care plans and daily records there were separate records kept regarding continence management. These charts were for the majority of the take themselves to the toilet every two hours. Discussion showed that this happened even if the person had taken themselves or been taken to the toilet in between. This regimented routine does not indicate a person centred approach to care and it was unlikely to meet the needs of all people under this regime. Separate records were also maintained for the personal care provided to each resident in the form of a tick checklist, showing if the person had a bath, wash, foot care, nail care, shave, oral care, hair care, glasses and hearing aid and clothes change. Charts were also used for all residents for food and drinks taken. These recordings could be included in the daily records rather than on separate sheets. These records further illustrated the task-orientated routines in the home and other examples were observed on several occasions throughout the day when staff routinely vacuumed carpets in the lounges and corridors and mopped the dining room floor after meals. These tasks take care staff away from time with residents and are not person centred. The manager said that the carpets were vacuumed and mopped because there were food droppings on the floor after each meal. Very few crumbs were seen on the carpet after tea but the floors were still thoroughly cleaned. For this amount of cleaning to be carried out three times a day could be considered excessive, created disturbance for the people in the areas cleaned and used time that could be more usefully spent with residents. For the amount of debris on the floor a hand brush or carpet sweeper could have been used, which would have St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 16 been much quicker, less obtrusive and quieter. Residents spoken with about the vacuum cleaning disturbance said that they had got used to it. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, stoma nurse, optician including diabetic related eye tests and chiropodist being identified in the care files looked at. Residents spoken with confirmed that they could see the doctor if they wished and that they had visits from the chiropodist, optician, district nurses and so on when necessary. One relative had completed a service user survey on behalf of a resident and in response to the question, “Do you receive the medical support you need?” had made the following comment, “The GP makes routine calls and any symptoms are immediately acted upon” A resident made the following comment to the same question, “There is a GP who visits on a weekly basis routine.” Records for falls, pressure areas and weight were in place within the files looked at. Preventative measures such as pressure relieving mattresses and cushions were in use. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place so that risk was minimised. Three of the four surveys completed ad returned to us answered “Always” to the question “Do you receive all the care and support you need”. One person answered “Usually”. The medication system was assessed. The administration procedure was observed and was satisfactory with the person responsible not signing the Medication Administration Record Sheets (MARS) until the medication had been given. A lockable medication trolley was used to transport medication around the home and at no time was this left unlocked when unattended. Medication is dispensed by the pharmacist in multi-dose system (MDS) blister packs. Some medication, and all liquids, cannot be dispensed in this way and were delivered in their original packaging. A random selection of MARS was looked at. There were no unexplained gaps or inappropriate use of the codes used to explain why medicine was not given. It was clear what had been given on specific dates, such as when the dose stated ‘one or two’ tablets to be given. However there was no protocol for staff to be able to give ‘as required’ medication safely. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 17 Medication received in to the home was recorded on the MARS and any medication discharged from the home was recorded in a returned medication register and signed for by the pharmacist. All MARS and MDS blister packs tallied. A random audit was carried out on tablets and capsules dispensed in their original packaging. There were several errors found. • Warfarin 3mg and 1mg tablets were prescribed for a person requiring 4mg each day. 28 x 3mg tablets had been received, 4 signatures were on the MARS but 27 tablets remained. 28 x 1mg tablets had been received, 4 signatures were on the MARS and the correct number of tablets remained. This would indicate that on three days only 1mg tablets had been given. • Gelametine tablets had the correct balance of tables but this was difficult to assess because the number of tablets remaining at the end of the last cycle had not been carried over. The medication requiring refrigeration was stored in a domestic fridge that could not be locked. The fridge was kept in the office and this was not locked when unoccupied. A dedicated lockable medication fridge should be purchased and the manager said that this would not a problem. The maximum, minimum and current temperatures of the fridge had been taken and recorded in order to monitor that any contents of the fridge were stored safely. Controlled drugs were inappropriately stored due to the keys for the controlled drug cupboard having been lost several months ago. A cupboard that complies with the misuse of drugs regulations 1973 must be provided so the controlled drugs can be stored safely. The controlled drugs and the controlled drug register were checked and several errors were identified. 11 Diazepam tablets could not be accounted for. Whilst the manager said that it was likely that these had been returned to the pharmacist there was no record to show that this was case. • Fentanyl patches for one resident were not entered in the controlled drug register although were on the MARS. • The staff had used a new page in the register for every new monthly cycle leaving part completed pages. This could create the risk of records being completed in retrospect. • Staff who had undertaken training were responsible for medication. The manager had carried out staff competence audits in November, April and November for some staff. Considering the errors found this needs to be carried out more frequently, unannounced and needs to include the monitoring and auditing of controlled drugs. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 18 A copy of the medication policy was kept with the MARS. Terms of preferred address were on the residents care plan and heard to be used by staff. Residents were cared for in a respectful manner, ensuring that their dignity and self-esteem were maintained. Four residents spoken with confirmed that this was usual. A payphone is available for the residents’ use but there is also a telephone point in each bedroom so that they can have their own phone, at their own expense, if they wish. Shared rooms had appropriate screening to ensure privacy when personal care was being carried out. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 19 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 good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Most of the residents enjoyed meals provided but there were shortfalls in the mealtime period. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a designated activity organiser. The activity programme, which is displayed on the notice board to inform residents of forthcoming events, included progressive mobility, ‘Ladies Hour’ (manicure and make-up sessions), walks to the local shops, visits by volunteers from the local church for craft making and other recreational activities. Nine residents had enjoyed a recent trip to the theatre and in April all residents had the opportunity to listen to a visiting singer who performed songs from popular musicals. The AQAA describes that the activities that residents want to experience are included in the care plan and this was seen in the care plans viewed. Activities offered and/or taken part in were recorded in the resident’s daily records. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 20 Three people answered “Always” to the question in the surveys, “Are there activities arranged by the home that you can take part in?” One person responded “sometimes” and the following comments were made, “There are activities every day.” “my x’s mental state makes it difficult for x to take part in social activities.” The AQAA said that there were no restrictions on visiting unless requested by the residents. The Statement of Purpose states that visiting after 10pm would be discouraged, except for very special circumstances but this would be considered to be reasonable. There were no visitors available to speak to but one resident who was spoken with at length said that visitors were made welcome and also that residents were welcome to invite their relative to stay for lunch and tea and that a small fee, to be donated to the Residents’ Entertainment Fund, would be charged for this with tea, coffee and other beverages supplied to visitors free of charge. Observations made and discussion with residents showed that people living and staying at the home had the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. The home continued to have two sittings for meals in order to give more attention to residents needing assistance and to provide less crowded conditions during the meals. The dining room décor and furniture were satisfactory apart from a stained and damaged ceiling tile where there had been a water leak, which looked unsightly. The dining chairs were without back cushions and tended to be uncomfortable as noted at the previous inspection. A large aquarium partly separates the dining area from the sitting areas and created some interest. A meal was taken with the residents at midday. The choice of meals according to the menu was beef casserole with an alternative of egg and chips. However the choices available were beef casserole or chicken nuggets. Residents spoken with said that they were not aware of the alternative to the casserole being available although records showed residents were asked each day what their choices for the day were. The meal was plated in the kitchen, stored in a heated cupboard and then brought to residents, several plates at a time. There did not appear to be any choice of what food was on the plate and we were not asked what potatoes or vegetables were wanted. The meal was reasonably tasty, presented and was nutritious. One resident was given an entirely different dessert from everyone else on the table, that is a small serving of ice cream rather than strawberry flan. When they expressed their displeasure about this they were told indiscreetly that this was because they had diabetes. No alternative was offered, even though the person sat unhappily grumbling about the ice cream until it melted and then reluctantly ate it. The resident has St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 21 a ‘normal’ dessert three times a week as instructed by the GP. Effort needs to be made to provide special diet meals that resemble the main meal as much as possible, within the constraints of the dietary needs, by using, for example sweeteners and sugar free alternative ingredients for diabetic diets. A simple sugar free jelly with strawberries, for example, may have felt less discriminating to the person with diabetes. Although the residents were not openly being rushed, plates were removed quickly when the course was finished and desserts were brought to some residents before they had finished the main course. This gave the feeling of needing to hurry and the mealtime did not feel relaxed or a social event although staff were observed interacting with residents while they served meals or assisted them to eat. Although there was also a cook employed, the head chef, who worked four days a week, prepared and cooked the main courses on the days he worked and fast-chilled it before putting it in the fridge. This was then re-heated by the cook on duty who also cooked the rest of the meal and prepared the evening meal. The manager advised that Environmental Health had previously been satisfied about these arrangements, as the meals were fast-chilled. There was a cook on duty after 3pm for only two days a week and therefore it was likely that care staff are involved with cooking finishing off the meal for teatime, which would take them away from time with residents. The menus were looked at and consisted of a 4-week cycle. Except for Sunday when a cooked breakfast was provided breakfast consisted of cereals and toast with preserves. The main meal of the day was provided at lunchtime. A roast dinner was provided twice a week. The other main choices generally reflected the practice of cooking in advance, consisting mostly of stews, casseroles or pies. A second choice was offered each day and included, faggots, chicken nuggets, sausage and chips, egg and chips or shepherds pie. Four residents were asked if they enjoyed the food at the home and all said that they did. Two of the four surveys answered “usually”, one answered “always” and one answered, “sometimes” to the question, “Do you like the meals at the home?” The kitchen was visited and was clean and well managed. Food items were stored appropriately. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 22 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. The home has appropriate training, policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is displayed in order to inform residents and visitors what to do if they have any concerns. This is also included in the Service User Guide. A resident asked if they knew where to go if they had any concerns said that they would go to the manager to the person in charge and three of the four surveys returned answered “always” to the question, “Do you know who to speak to if you are not happy?” One person answered, “usually”. A relative on behalf of a resident made the following comment, “ I would address any concerns to the manager .. but also I met the owner … who invited me to voice any issues I may have.” Complaints records were maintained and the outcome and any necessary action was recorded. Three complaints had been made, two were related to residents’ behaviour and the third was related to medication being removed from a bedroom for safety reasons but to the occupant’s displeasure. The records indicated that complaints were taken seriously and that people could be confident that they would be listened to. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 23 The appropriate policies and procedures were in place related to Protection of Vulnerable Adults (safeguarding). The large majority of the staff had attended recent training related to this subject and those spoken with knew what abuse is and what to do if the suspected abuse had occurred. All recruitment practices safeguard residents from the employment of unsuitable people. Residents’ financial interests were safeguarded. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 24 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): 19,21,24,26 Quality in this outcome area is adequate. The home offers the people living there comfortable surroundings, free of offensive odour and generally safe and well maintained but with some shortfalls in the cleanliness and hygiene in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was established in 1986 and is located on the main route to Solihull town centre and to Birmingham. There are shops located within a few yards and a local retail park is within walking distance for the able bodied. It is also conveniently located for public transport. Accommodation is provided on two floors, with bedrooms on both floors and communal space on the ground floor. In the AQAA and in discussion the registered manager said that there had been barriers to improvements in the environment due to delays in getting planning permission for redevelopment of the home. This had affected replacement of St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 25 some carpets, improving laundry and kitchen facilities, and further refurbishment in the home. Electronic gates with associated CCTV cameras and an intercom to allow suitable access maintained security. The CCTV cameras were restricted in use to the outside of the premises and therefore did not impose on the residents’ privacy. The front door was also locked at all times. The reception area leads on from the porch where there was a faint malodour. This was not present anywhere else visited in the home. The manager’s office was adjacent to the reception area and this gave her view of the entrance. This office is extremely small, dark and unsuitable for the manager to meet with residents, staff, visitors or other agencies. Currently staff meetings, training and other meetings have to be held in the dining room. The open plan set up of this means that residents are in sight and sound of whatever is going on. They are disturbed and there is no possibility of confidential discussion or comments being made. The communal areas were located to one side of the reception area and consisted of a large open plan area, partly separated by the way armchairs and other furniture were arranged into three sitting areas and the dining area. The large space detracted from a homely atmosphere and presented an institutional appearance with little opportunity for a quiet or peaceful space. This area and the corridors had been recently provided with a new attractive carpet. There were three televisions on in the three sitting areas, one being a large plasma screened set. However this television had a very poor reception/ picture. At the time all televisions were showing the same programme although one of them had the volume turned down. This was being listened to with the use of headphones by one resident sitting in this area and who was visually impaired. The manager and staff were unable to say what happened if the people in the other two areas wanted to watch a different programme. A resident who needed the volume very high controlled one of the televisions and this distressed other residents causing arguments amongst them. The manager had suggested several ways of managing this but without success. A space behind this television and between the two sitting areas was filled with wheelchairs, walking frames and activity equipment and would be safer, look more comfortable and be more useful if it was made into an enclosed storage area. This could also create more homely areas. Grab rails had been securely replaced so that residents were able to use them safely as support when they moved around the home. A smaller area, previously used as a designated smoking area but no longer used for this, retained the original floor tiles for the purposes of the smokers. These should now be covered with more appropriate floor covering for the comfort of the people using this area. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 26 The manager said that ceiling tiles in the communal areas were about to be replaced. The current ones were industrial/institutional in appearance. The wall décor was in satisfactory condition although uninteresting and not stimulating. Lighting in these areas were domestic in appearance but were very dusty and several were broken or with bulbs not working. The manager advised that these were being replaced eventually. Several armchairs had been replaced with new reclining armchairs, which were attractive and enjoyed by the people using them. Most of the remaining armchairs were worn and unsightly. The manager said that the stains on some of them could not be removed. These need to be replaced or refurbished to improve the comfort of the residents. There were three toilets on the ground floor. Whilst each had grab rails and a raised toilet seat one of them would be too small for care staff to appropriately assist anyone to transfer to or from it. There are also two assisted baths and a shower room on the ground floor. There was a separate staff toilet although staff do not have a staffroom and breaks were taken in the residents’ dining room. This is not ideal as it is residents’ space but also as the areas are open plan does not give the staff time away from the workplace. The first floor houses two bathrooms with hoists and a separate toilet. The bedroom looked at on the ground floor was a shared room and was adequately decorated and furnished. This had been personalised by the residents having many of their own possessions around them. This is encouraged by the home and is included in the Statement of Purpose and Service User Guide. The screening between beds was sufficient to enable personal care to take place in private. There was no towel rails were fitted in any of the bedrooms viewed. Towels were stored together on the top of the vanity unit. In a shared room separate storage is particularly as there is a risk of towels being used by both of the residents and therefore increasing the risk of cross infection. Toiletries were also not easily identifiable and this further increases the risk of cross infection. The majority of the curtains in bedrooms had been replaced with new and good quality ones. In the AQAA it was stated that the registered persons would be looking at ensuring that bedrooms occupied by male residents would be decorated and furbished in a more masculine appropriate way. The first floor corridor had been painted and looked brighter and cleaner. The three bedrooms that were viewed on this floor were still in need of decorating and refurbishment, and were looking shabby. The paint on windowsills was peeling. The laminate edging on the three vanity units was worn and created the risk of infection, as the exposed chipboard was not washable. The AQAA said that two vanity units had been replaced but these were not seen. Armchairs in these rooms were old and worn. The manager explained that this St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 27 was because the registered provider was still waiting for planning permission to extend the home and this area would be part of the building work. One room had a non-carpet, non-slip floor to meet the continence management of the occupant, although this is unattractive. There are more domestic looking, washable and non-slip flooring now available. All three rooms were personalised with the residents’ belonging such as ornaments, pictures and photographs. The home does not have sufficient storage and items continue to be stored on the corridors. This included a medicine trolley that is unlikely to be used again as it would not accommodate the MDS system now used. The kitchen and laundry were sited on the ground floor. The first impressions were that the home was clean and hygienic. The following comments were made in answer to “is the home fresh and clean?” in a survey returned to us, “Cleaning standards are high. Accidents are bound to occur occasionally but are dealt with promptly.” “The home is always spotless.” However on closer viewing some wheelchairs and the hoist frames in the bathrooms and other bathroom equipment were very dirty. Skirting boards in communal and private accommodation were dirty and on an area of the dining room wall, behind a chair, there were traces of faeces. The armchairs in the lounge were marked with what looked like spillages. The laundry is very small and impossible to effectively separate dirty and clean laundry in a way that maintains infection control. The manager advised that the registered provider is still awaiting planning permission to extend the home, which includes the laundry but in the meantime there is only room for domestic appliances, making laundering difficult, in particular in relation to the amount of washing carried out and the sluicing of soiled laundry. The two washing machines have programmes that can wash at 60°C and 90°C and therefore enabling the disinfection of laundry. The Statement of Purpose needs amending to correctly describe the current laundry facilities rather than what is planned. Outside of the rear exit of the laundry a mop was stored in a bucket of water and other buckets were outside also containing water. These shortfalls in cleanliness and hygiene are a possible source of infection and do not safeguard the health and welfare of the people living at the home. Following the tour of the home the manager made available the report provided following the Birmingham and Solihull Health Protection Unit (HPU) St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 28 visiting the home in April 2008. The majority of the above shortfalls were included in this report and had still not been addressed. Hand washing facilities were satisfactory with disposable towels and soap dispensers available in all communal hand washing areas. This had been addressed following the HPU report. The report also advised that liquid soap should also be supplied in all bedrooms or that staff should be provided with individual alcohol hand gel. The registered provider had not provided these and staff had purchased their own alcohol gel. This is the responsibility of the registered provider. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 29 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 adequate. There are sufficient care staff available to meet the needs of the residents but the low numbers of ancillary staff may have an impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised but there are some concerns about the training process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the visit there were four care assistants on duty plus the manager. Three weeks of rotas were looked and these showed that this was currently the usual staffing situation throughout the day. Discussion with the manager confirmed this. There was a senior care vacancy and the other senior care assistant was on annual leave. The home had a deputy manager vacancy. There is a domestic assistant working from 8am to 1pm or 1.30pm each day and a further member of staff who worked a 9am to 1pm shift, as domestic assistant at the beginning of the morning shift and then washed and changed to out care assistant duties. The rota did not show the actual hours worked in either role. The catering staff consisted of a part time chef who had City and Guilds catering qualifications, and a newly appointed cook who worked four to six hours for six days a week, starting at 7am. The chef worked 2pm to 6pm on two days a week and 5am to 1.30am two days a week when the following day’s meals are cooked, chilled and refrigerated. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 30 The rotas indicated that there were adequate staff available to meet the needs of the residents. However the low number of ancillary staff and the long gaps in the day when there are only care staff available indicated that staff were carrying out domestic tasks as previously discussed in the Health and Personal Care section. The dirty areas noted further indicated that there is insufficient domestic staff on duty. The need to pre-cook and then re-heat meals suggests that catering staff are not available at the appropriate times in sufficient numbers. The following responses were made to the relevant questions in the surveys returned to us. • “Do the staff listen and act on what you say?” Three people answered ‘Yes’; 1 person made the comment ‘usually’. The following comment was made, “I find that all staff are attentive and feel able to discuss any matters affecting my (relative).” • “Are the staff available when you need them?” Three people answered ‘Always’ and one person answered ‘Usually’. The person answering ‘usually’ also made the comment, “Except when they are short staffed.” Nine of the sixteen care staff (56 ) have achieved National Vocational Qualification (NVQ) Level 2 in Care. This qualification shows that the person has been assessed as competent in their job. Three staff files, two of which were the most recently recruited employees, were looked at. All the information and Criminal Records Bureau and Protection of Vulnerable Adults checks were included in the file. All recruitment practices safeguard residents from the employment of unsuitable people. Further training undertaken by staff since the last inspection included induction training for new staff, all mandatory training related to health and safety issues, Abuse Awareness, Infection Control, nutrition and Basic Stoma Care. Training related to dementia management was planned for the near future. Discussion with the manager showed that training sessions were generally of only a two-hour duration and therefore several of these subjects may not have been covered in sufficient depth to give staff the knowledge and skills they needed, in particular Moving and Handling. Dementia training planned will also St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 31 be only a two-hour session when there may only be sufficient time to cover very basic information. Training takes place in the open plan dining room and staff on duty also attend, leaving one person ‘on the floor’ to care for residents. If staff are off duty they do not receive any payment for attending training. The manager said that the staff at the course would be called upon to assist with residents’ care as necessary. This raised concerns that residents are not receiving adequate care and all needs are unlikely to be met during the training; there would be no confidentiality due to the open aspect of the communal space; staff would have difficulty concentrating on what was being taught. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 32 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): 31,33,35,38 Quality in this outcome area is good. A person undertaking the appropriate qualification and who has previous management experience manages the home. The monitoring and auditing of the service and practices is carried out to ensure that all services operate in the best interests of residents. The residents’ financial interests are safeguarded. Health and safety practices protect residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been in post for19 years, providing the home with continuity and leadership. She had achieved National Vocational Qualification Level 4 but had not yet completed the Registered Managers Award due to unavoidable circumstances. She has the appropriate experience for her role but should complete the Registered Managers Award as soon as she is able. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 33 All residents spoken with made positive comments about the manager and several positive comments were made in the surveys regarding her approachability, for example, “ I would address any concerns to the manager.” The home currently does not have a deputy manager. Recruiting to the post had been successful, as applicants had not met her criteria. A senior care assistant post was also vacant and the other senior care assistant was on annual leave. This makes managing the home and monitoring the service, and the meeting of residents’ needs, difficult and the registered persons may need to look at temporary solutions until permanent staff can be appointed. A Quality Assurance system was in place, although not all services are yet included, and surveys had been distributed to residents, visitors and staff. A representative of the homeowner visits unannounced each month and provides a report to the manager and a copy for us. These were looked at, were comprehensive, and contained the information we would be asking for. Meetings with residents and their families were held regularly in order to get feedback on their views of the home and to discuss any concerns that they may have. These systems indicate that the home is monitoring the service in order to enable growth and improvement. Money was held on behalf of a number of residents and was kept in a locked place. A random audit of some of these was carried out. There were appropriate records of transactions, and cash that balanced against these records, for any money held on behalf of residents. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. The AQAA also gave us information related to these checks. St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 34 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 3 x x 2 x 2 STAFFING Standard No Score 27 2 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 St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 35 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 OP7 Regulation 13 Requirement Care plans need to be reviewed at a minimum of monthly intervals or if circumstances change. This will ensure that care instructions are up to date. Audits of staff competency in medication administration must be carried out at regular and frequent intervals. This will ensure that residents receive medication as the doctor intended. Medication must be given as instructed. This will safeguard the health and well being of the people living at the home. A cupboard that complies with the misuse of drugs regulations 1973 must be provided so the controlled drugs can be stored safely. Medication requiring refrigerated storage must be stored safely. This will safeguard the health and welfare of the people living at the home. All controlled drugs must be accounted for and accurate records maintained. This will DS0000064009.V370227.R01.S.doc Timescale for action 30/09/08 2. OP9 13(2) 30/09/08 3. OP9 13(2) 30/09/08 4. OP9 13(2) 30/09/08 5. OP9 13(2) 30/09/08 6. OP9 13(2) 30/09/08 St. George`s Home Version 5.2 Page 36 7. OP26 16(2) 8. OP27 18 ensure the safety of the drugs. There must be appropriate 30/09/08 infection control measures in place. This will protect the welfare of residents and staff. There must be sufficient 30/10/08 domestic and catering staff to prevent care staff from having to take time away from residents. This will ensure that the needs of the residents are met. 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. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be amended so that they are accurate and up to date. Care of residents should be person centred rather than task orientated. Special diets should resemble the main meal wherever practicable. Mealtimes should be unhurried and a social event. Age appropriate tableware should be provided. All areas of the home should be decorated and furnished, including light fittings, to a satisfactory standard. Consideration should be given to making the communal areas into more homely proportions. A towel rail should be provided in bedrooms for each resident. Efforts should be made to improve the senior staff situation until permanent staff are appointed. OP8 OP15 OP15 OP15 OP19 OP20 OP26 OP31 St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 37 St. George`s Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Home DS0000064009.V370227.R01.S.doc Version 5.2 Page 39 - 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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