Inspection on 25/04/06 for St George's Home

This inspection was carried out on 25th April 2006.

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 Home 14/08/09

St George's Home 18/08/08

St George's Home 03/05/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St. George`s Home 116 Marshall Lake Road Shirley Solihull West Midlands B90 4PW Lead Inspector Mary Hall Unannounced Inspection 25 April 2006 – 19 June 2006 07:30 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.V288166.R01.S.doc Version 5.1 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.V288166.R01.S.doc Version 5.1 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.V288166.R01.S.doc Version 5.1 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 February 2003. Under 65 years of age, in the registration category LD. 9th January 2006 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 and is on a local bus route. 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 nice 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. Parking facilities are available to the front of the property. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of St Georges spanned a six-week period. This included two fieldwork visits, questionnaires sent to relatives’ service users and staff. Relatives contacted via the telephone. A review of all information that the commission held since the previous inspection. What the service does well: St Georges home is a long-standing residential care home for older Persons. The current Manager has been in post for a number of years. The home has changed ownership in the last 12 months. The current owners are committed to working with the Commission to ensure deficits identified are addressed and a number of environmental improvements are planned. A significant number of staff have also worked at St Georges for a long time and know many of the service users well. Service users spoken to and relatives were very complimentary of the staff and services St Georges has to offer. A number of service users said that they enjoyed living here and the food that they received was just the same as home-cooked and there was plenty of it. There are good links with the community and other healthcare professionals. The views of the services provided at St Georges were requested prior to the completion of this report from Solihull Commissioners however, to date this has not been received. The service was able to demonstrate a reasonable awareness and understanding of equality and diversity. The service recognises the importance of promoting equality and diversity for service users and staff. The provider would benefit from gaining a greater awareness of new legislation, guidance on best practice, and provide staff with the necessary information in this area. Staff were keen to co-operate with the inspection process and seemed committed to improve the quality of care received at St Georges. Staff spoke highly of the manager and the new owner and felt both were approachable and listened to their concerns. Service users and relatives interviewed or spoken to were very complimentary of the staff and management of St Georges. Many felt staff went above the call of duty to ensure the needs of the service users were met. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: It has been a difficult time at the home in the last 12 months with change of ownership and long-term sickness of the Manager. This has led to a decline in some practices and record-keeping. In particular: Care Planning Improved systems need to be developed and implemented to ensure when needs are highlighted appropriate action is taken. Risks identified on preassessments or through accidents etc must be incorporated into the care plan and a risk assessment. Updated information from care plans reviews must be incorporated into the current service users care plan. Care plans must be detailed and address the full needs of the service users and include information on preferences for social activities and daily routines Quality Assurance/complaints Conversations with service users and/or their representatives or relatives must be recorded into their care notes. Regular staff and service user and relative meetings must be undertaken to ensure the views on the service are received and acted upon. Any concerns identified must be dealt with appropriately in line with the organisations policies and procedures. Care Practices At all times the service must be conducted as to make proper provision for the health and welfare of service users. Staff must be aware of their responsibilities, by training or other measures such deployment to ensure service users are not left unsupervised. Staff must be made aware they are St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 7 equally liable if they do not speak up and raise issues of poor practice. All recruitment practices must be in line with National Minimum Standards and relevant legislation. Management All the required checks must be undertaken prior to employment and records kept. Staff training and induction must be identified and where required undertaken appropriate to the role they are expected to perform. Staff must receive regular documented supervision. Where monitoring of the service users health or well-being is required detailed records must be kept. Appropriate infection control procedures must be implemented. A programme of refurbishment and redecoration must be developed and implemented. Risk assessment must accurately reflect the risk posed and the measures put in place to minimise the risk. The Commission must be informed of events which occur in the home within 24 hours as required under regulation 37. The Registered Provider must ensure they undertake regular documented monthly visits. 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. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Planned improvements in pre-assessments and an updated Service Users Guide and Statement of Purpose will help to ensure service users and their relatives have the information they need to make an informed choice prior to admission and that the home can meet their needs. EVIDENCE: It is the homes practice that only privately funded service users are issued with contracts. Of the social services contracted service users in the home whom were case tracked none were issued with terms of residency agreement. Currently it is the Manager or Deputy Manager who undertakes preassessments, risk assessment and care planning. Training records evidenced on file for the deputy Manager indicated that risk assessment training had been undertaken November 2005. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 10 The Manager confirmed that the Statement of Purpose and Service Users Guide are currently under review and all service users and relatives will receive a copy when completed. In addition the provider has now developed an admission checklist, which lists all information supplied to service users and relatives at the point of admission. This is to be signed by a member of staff, service users and/or relatives. This document needs to include reference to the Service Users Guide. The Manager confirmed Inspection reports are not routinely copied and placed on the board for relatives of all service users to read. Some relatives were aware that the Commission for Social Care and Inspection undertook inspection visits. Relatives spoken to either during the visit or by phone were unaware of inspection reports being available. This has been discussed and agreed that all future reports will be available on the notice board. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Whilst care plans have outcomes for service users. There is a lack of detailed information which would enable staff on a daily basis to ensure these were achieved. Whilst there has been some remedial improvement not all service users health care needs are fully met even when identified. Overall service users privacy and dignity are maintained within the home, however more diligence is required to ensure privacy and dignity in the toilet area is maintained at all times. EVIDENCE: Four current service users files were case tracked and one whom had left the home. All had detailed pre-assessment. The care plans seen however, only had global outcomes for the service users. For example, maintain independence, and, provide a safe and warm environment, provide assistance with personal hygiene, provide assistance and supervision when mobilising etc. Issues identified on pre-assessments are not always translated into the care plan. Information is not linked in together for example care planning, risk St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 12 assessment and reviews. For example, there were clear action points to be included in the care plan. There was no evidence that these had been included into the care plan and daily records did not contain any evidence that these action points had been implemented. One area of concern was that when a daily record entry indicated a need for a urine test. The urine was not tested for 19 days where an infection was noted. The GP was contacted and prescribed antibiotics for the infection. It should be noted however, that in between fieldwork visits the home has introduced a resident concern book. This identifies any concerned staff have, and names and individual to be responsible for ensuring the action has been taken. Staff and management felt this book works well. There was no systematic monitoring of the service users dietary and nutritional intake, or monitoring weight. One service user had not had a review, there were no key worker records and no risk / manual handling assessments. Undertaken. Staff often know the best way to address service user needs however, this is not shared and documented. For example, a service user was having her prescribed Fortisip which was at the table in the box with a straw. Eventually the cook mentioned that if she put it in a cup the service user would drink it without any difficulty. This good practice had not been passed to other staff or recorded in the care plan. Another pre-assessment/care plan mentions will occasionally need assistance with feeding due to poor eyesight. This was not identified or any systematic action plan in place. Subsequent reviews have not addressed this issue. One risk assessment indicated possible obesity. The service users weight was not checked for three months despite the service users last weight check indicated a significant weight gain. The risk assessment did not identify either of these issues. Looking at the handover records it was evident that three days prior to our visit a service user had been identified as requiring a urine test. This had been passed over on day one to the day staff but no other entries related to this. When the staff were asked whether the test had been undertaken they were unaware. The handover from night to day staff was observed. All day staff attended and one night staff stayed on the floor. It is unclear if this resulted from prompting by the inspector. Several service users were mentioned and how they had been through the night. One mention was in relation to service users who needed to see the district nurse in relation to a potential pressure sore. In this instance the district nurse visited that day. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 13 Some relatives stated they were involved in care planning reviews. All relatives were positive about the care received at St Georges for their relative and that staff were friendly and caring. Reviews on service users who were case tracked were brief and information was not translated into actions for staff to enable them to achieve the stated outcomes. In addition, there was no regular pattern for reviewing individual service users. There was a record of professional input in the files of service users case tracked; professional visits recording sheets and daily records that identified service users have regular access to other health professionals. Entries in daily records indicated monitoring was required but this did not translate into practice. For example, paramedics recommended the service users blood sugar level be monitored, plus urine tested for another service users. There was no record indicating a blood sugar levels had been taken or was being monitored and there was a delay in both service users receiving urine tests. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service The home offers daily recreational activities, although these are dependent on inclement weather and staffing levels. Individual preferences identified have not always been included in care plans which means service users dont always find the lifestyle experienced matches their expectations and preferences. EVIDENCE: Some pre-assessment indicated preferences for social activities that service users like to undertake. For instance reading newspapers. The service user who indicated they liked to read daily papers had not purchased them and there were none freely available for her to read. In addition, there were no regular entries which related to them having a glass of sherry as indicated on the pre-assessment. The provider does not have clear plans in place to meet individual preferences that have been identified for social activities. A number of service users whom are able are assisted by relatives/friends to go out from the home. The night staff interviewed indicated that morning routines are by preference of the service users and that at least two service users like to have their St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 15 breakfast in bed. This was not documented on their care plan. A Social Worker held a review meeting and commented It does seem that.... is woken early in the mornings in order to be ready for breakfast. ... does not appear bothered about this but I would ask if this was to meet the homes time scales rather that being flexible to needs. Service users spoken to during the visits stated there were some activities but these appear not to be regulary implemented. One activity the majority of service users enjoyed was progressive mobility. One relative also commented on how their mother seemed to enjoy this. There were no individual activity plans for service users although some social and recreational activities that the service users would like to participate in had been noted in the preassessment/care plan. One service user and one relative did comment that the home did not provide enough stimulation need a bit more entertainment. The activity plan seen indicated a number of activities that could not be undertaken during the winter months or if the weather was poor and some were staff dependent. Activities included on the activity plan all were for a one-hour period and included activities such as cards, bingo, ladies hour, singalong, go to the shops, tea and biscuits, relax in the garden. These activities were to be undertaken between 2 and 3 pm, 3 - 5 pm and 7 - 8 pm. All days had two activities. However, daily records did not always contain any information relating to activities or refusal by the service users to participate. Service users were observed at the dining table at breakfast time. Plastic aprons were used on some service users. On our entry no staff were present to assist those who needed support. Two additional staff arrived to assist with breakfasts at 8 a.m. Four service users were observed to be sitting and eating their breakfast in a wheelchair at the table. Whilst observing support given at breakfast time there were at least two occasions when the staff member assisting the service users left them and returned some five minutes later to continue with assistance. When assistance was being given it was positive to note the interaction between the member of staff and service user. On one occasion a service users was observed having assistance in the toilet and the door been left wide open. This issue has been previously raised in minutes of the staff meeting seen. One relative stated that missing laundry and wearing other peoples clothes whilst improved, can still be problematic. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 The quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Service users and their relatives/friends can not be confident that their complaints will be listened to, taken seriously and acted upon at all times. In order to ensure that service users are protected from abuse their needs to be better recording and acting on complaints, reporting all concerns to the Commission. In addition there needs to be improved recruitment practices, relevant legislative checks undertaken and more frequent staff supervision to ensure service users are safeguarded. The long-term absence of the Manager has clearly impacted on ensuring the staff team have the direction, guidance and support necessary to ensure the home meets the needs of it’s service users. EVIDENCE: The Commission for Social Care Inspection received two complaints since the last inspection. The Commission investigated these concerns. Visits were made to St. Georges, to investigate these and the outcomes summarised as follows: Complaint one summary The complainant was concerned as to the accuracy of information given, regarding accidents within the home. These concerns were found to be upheld. Records were not consistently or accurately maintained, this led to misleading information being given as to the cause of falls. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 17 There was a failure to ensure that where the needs of a service user had changed significantly, a full and proper assessment was carried out prior to being readmitted to the home on discharge from hospital. This led to a catalogue of events that were poorly managed and could have been avoided. Care plans and risk assessments failed to provide sufficient detail as to how to meet the needs of an individual. Staff had consequently, little direction as to how this care was to be carried out. Direction to staff was global and not specific in its detail, as a result where incontinence became an issue this was not actioned into a consistent continence management programme. Ensuring food intake was monitored was inconsistent. There was a lack of delegation as to who was overseeing the care delivered to the service user, and picking up on poor practices. The administration of prescribed food supplements was not recorded, and inconsistent. Where concerns were brought to the attention of the staff or Manager these were not recorded in the complaints log or followed up. Conversations with relatives, were not recorded in care notes to demonstrate their views about the care, consequently these went unresolved. Concerns were expressed about the poor management and care given to service users clothing. There was an element of carelessness on behalf of staff. Complaint records available for inspection demonstrated that only formal complaints were logged and the records of any investigation in the outcome were poor and not in line with the policies and procedures. Complaint two summary A complaint was received by the Commission for Social Care Inspection during 2006. The complainant raised several areas of concern regarding the care of a service user. The Commission investigated these concerns. One visit was made to St. Georges and the provider asked to provide a written response to certain areas of the complaint. Issues were raised in relation to lack of information, poor recording, assessment and reviews, the impact of staffing levels, care practices, communication and standard of décor. Some areas of the complaint were irresolvable. There is a need to improve recording and ensure assessment and review information is updated as required on care plans and risk assessments. Staffing levels have been problematic, however, this appears to have been resolved at the time of this investigation and inspection. Issues relating to décor are being addressed through this inspection. At the time of writing this inspection report the Manager has failed to send in an action plan to address the requirements arising from the recent complaint investigation. Combined complaint investigations and requirements set, has enabled action to be taken in order to address some of the communication difficulties. The Registered Provider is arranging monthly meetings with relatives. To date, only one has St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 18 taken place with two relatives. However relatives spoken to during the fieldwork visits were not all aware that these meetings were to be undertaken. In order to encourage and promote compliments and complaints the provider has put a box up on the wall. It is hoped that this will encourage relatives to let the staff know of their concerns and also inform them when good practice has taken place. The areas of concern identified during the course of these investigations have led to a number of requirements being placed upon the home. Alongside this the provider will continue to be monitored closely by the Commission to ensure the requirements are adhered to. These must be addressed with urgency in order to provide the required safeguards for service users. The Registered Manager has failed on the number of occasions to notify the commission as required under regulation 37. In addition the Manager was unclear when asked, as to what disciplinary records should be kept. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 26 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. There have been some noted improvements in the environment. For the provider to fully ensure that service users live in a safe, well-maintained the gate installation needs to be completed and a rolling programme of internal redecoration and refurbishment developed and implemented. EVIDENCE: The bedrooms of service users case tracked were inspected. All were found to be clean, warm but minimally personalised. As the service was registered prior to National Minimum Standards for care homes not all rooms meet the required size or contain the minimum required furniture, fixture and fittings. However, the service users were very happy in the rooms. One room in particular, was felt not to be gender appropriate in respect of its soft furnishings and décor. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 20 The Manager stated there is currently no program for redecoration or refurbishment of the home internally. Communal areas were found to be clean and warm. The provider has purchased since last inspection a large plasma television and some new dining-room furniture. External improvements include the driveway and in the near future completion of gates at the entrance. The rear garden offers a lawned area with some patio furniture. Garden furniture appeared well worn and in need of replacing. However, due to building work service users would not be able to access this area unsupervised as there is garden refuse and uneven surfaces. Until the gates are finished this area is not secured. A tour of the premises was undertaken and noted the following issues:no hand or grab rails on the first floor, a toilet seat was broken, not all bins were covered. In addition, the bathing areas need to be reviewed. Long-term plans for the home must include assisted bathing facilities to ensure staff are able to assist service users appropriately with bathing. Infection control procedures are not always followed for example, there was liquid soap in a number of communal toilets and a number of bins did not have a lid. One member of staff was asked to demonstrate the use of the hoist however the hoist was broken. Although it is not in current use it needs to be either repaired/all replaced to ensure it is in safe working order should the need to use it arise. The Registered Provider has some long-term plans to improve facilities for example, the laundry and staffing areas. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. There has been some improvement in staffing levels, staff have some skills to meet service users needs. However, some mandatory and specialist training is required. Service users would be better supported and protected if the home was to implement its recruitment policy and practices and ensure these are in line with legislative requirements. EVIDENCE: Four staff files will looked at. Apart from one all of these were selected on the basis of that theyd recently been made up to senior carers. Identification was available in all files. Of the staff files looked at all had incomplete work histories, there was evidence of an interview however without clear records the inspectors were unable to establish how the decision was made to employ or not employ the member of staff. Staff files showed a one-day induction had been undertaken and all staff files contained copies of training. However, it was noted that some training was out of date and some, but not all, had undertaken relevant statutory training in manual handling, first aid, fire safety, infection control and health and safety. The pre-inspection questionnaire submitted as part of the inspection process indicated that 84 of care staff have achieved NVQ level 2 or above. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 22 One-newly appointed senior carer who has responsibility for administering medication had not had relevant updated accredited training. The Deputy Manager has not had any recent training in medication management and has not undertaken any training in first aid and adult protection. It was positive to note that the provider does offer some specialist training courses for example dementia care, diabetes awareness, recording and record management, nutritional care and learning disability. However, it is of some concern that these areas of training have not all been embedded into current care practice. On the training records available it is evident that a number of training areas for the four senior carers and the deputy Manager needs to be undertaken. On the main office wall there is a training matrix which identifies staff and training undertaken. The Manager informed us that some training is currently been arranged. Discussions with the Manager and Deputy Manager and evidence of training certificates confirmed that training is provided by an external trainer and the majority if not all is accredited training. Supervision records indicate that supervision has been very spasmodic. In addition, there is no clear inductions into the role of senior carer of those newly appointed. It was also observed that the medication trolley was left unattended in the lounge whilst medication was being administered. Given that some service users are confused better arrangement should be in place to ensure the medication trolley is supervised/ or locked at all times. There were other members of staff in the vicinity at this time . The Manager stated that this member of staff was down for medication training for which a date is yet to be set Staff have recently received training in equality and diversity and reporting and recording. This was not verified by an audit of all staff training files. Staff meetings are undertaken but these are not on a regular cycle. The last of minutes were dated 29 March 2006. A number of issues were identified, laundry-still an issue, and complaints-staff advised they must log all complaints, staff being over friendly dietary advice and training requirementsfall awareness first aid and incontinence. Also references the need for activities to be more varied. Another staff meeting had been undertaken on 18 May 2006, again issues were highlighted and there was no available record of follow-up action. For example, medication errors. It was a concern that on this and previous inspection visits when asked staff were unsure and gave different answers to the number of current service St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 23 users. To date the home does not keep any register of service users and therefore staff could not be certain who was in the home at any time. On day two of the fieldwork the provider has now introduced the service users register, which is completed at varying points in the day. It was positive to note that unlike previous visits there was a full complement of staff on duty as per rota. A number of significant improvements had been noted on day two of the fieldwork. For example, the staffing complement has been improved to ensure service users receive appropriate support at mealtimes, staff member is now deployed in the lounge, and there are two sittings at lunchtime allowing staff time to support those service users who need assistance. A number of staff was spoken to and interviewed during the fieldwork visits and it was positive to note that many have detailed knowledge of individual service users. Staff confirmed they are key workers to individual service users. Staff also commented on the improvement in staffing levels and how this has helped them deliver a better service. Staff were keen to co-operate with the inspection process and seemed committed to improve the quality of care received at St Georges. Staff spoke highly of the Manager and the new owner and felt both were approachable and listened to their concerns. Service users and relatives interviewed or spoken to were very complimentary to the staff and management of St Georges. Many felt staff went above the call of duty to ensure the needs of the service users were met. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. This outcome area initially was poor however, improved record keeping, improved systems, the return full-time of the Registered Manager and the commissioning of contractors has enabled improvements to be made during this inspection. EVIDENCE: In the previous 12 months the Registered Manager has been absent on longterm sick. The Mnager is currently back full-time. The provider failed to notify the Commission of the Managers absence and of what management arrangements were in place. During this period there have been noticeable lack of management oversight of the running of the home and staff shortages. The Deputy Manager has achieved her NVQ 3. Under nutrition and nutritional support training was undertaken May 2005 by a number of staff. It is of some St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 25 concern that this training has not been fully translated into practice. Due to illhealth the Registered Manager has not undertaken her Registered Managers Award. Since a meeting with the Registered Provider there have been some noted improvement in the management structure. A number of care staff have been promoted to senior care status. Whilst the majority have their NVQ level 3 there is still a need for an induction into their new roles and responsibilities, a training needs analysis to identify training requirements and regular supervision. The accident records were viewed and these showed that there had been fourteen accidents in the four-month period since the last inspection. Lack of managment oversight was evident for some of this period. None of these had been reported to the Commission as required under Regulation 37. It is very concerning to note that events that affect the welfare and protection of service users, are not reported to the Commission, and potentially place service users at further risk. Failure to report under the Regulation 37 has been identified in previous inspections and complaint reports. The staff files inspected and discussions with care staff it was evidened that supervision had not been undertaken regularly as required by the National Minimum Standards. A number of issues have been raised informally by service users/relatives and in daily records, handovers and staff meetings which have not been actioned. Whilst there is some noted improvement in assigning tasks as evidenced observing handover, and discussions with staff, through direct observations it was clear that no member of staff had been specifically deployed to monitor the lounge area. When one staff was in the lounge they were often distracted by attending to the needs of a particular service user. On day two of the fieldwork this issue has now been addressed and one member of staff is deployed to the main lounge. In addition, an additional staff member comes on duty at 7.30 am to support residents. Whilst the Registered provider visits the home the required regulation 26 visit documentation is not being completed. The Responsible Individual has acknowledged a number of deficits and has taken steps to address this. They have enlisted the services of a consultancy firm to deal with the number of documents, systems and to support the Manager to ensure requirements arising from this inspection will be actioned within the timescales set. There is no detailed quality assurance program in place to ensure the views of service users, relatives and staff are used to inform and improved service delivery. St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 26 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 2 2 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 3 3 2 2 1 St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 27 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 OP2 Regulation 5(b) Requirement The Registered Person must ensure that all service users are issued with the terms and conditions of residency. The Registered Person must ensure that when risks have been identified for example, accidents, pre-assessments, updated reviews these must clearly be incorporated into a risk assessment that is reviewed regularly and updated as required. The Registered Person must ensure care plans include updated information from reviews. The Registered Person must ensure that care plans are in sufficient detail to provide clear guidance to staff on the actions to be taken to meet service users health and welfare needs. Specialist needs such as the promotion of continence, and professional advice and any aids or equipment that are to be provided are recorded and St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 28 Timescale for action 07/07/06 2 OP7 13(4)(c) 30/06/06 3 OP7 15(2)(b) 30/06/06 4 OP7 15(1) 5(2)(b) 30/06/06 5 OP7 12(1)(a) 6 OP7 13(4)(c) 7 OP10 12(4)(a) 8 OP16 4(1)(c) 14 Sch1 9. OP18 37(1)(e,f) 10 OP19 23(2)(b) includes. This is a previous requirement. The Registered Person must ensure that risk assessments for service users who are likely to wander, need assistance with feeding and, display challenging behaviour are in place and updated regularly. All staff must be briefed relevant risk assessments. Part of this is a previous requirement. The Registered Person must ensure that a risk assessment outlining how toilet and bathroom areas can be accessed in the event of a service user falling must be devised and made available to all staff. This must be included in the service users care plan. This is a previous requirement. The Registered Person must ensure that the home is conducted in a manner that promotes and protects the privacy and dignity of service users. Toilet doors must be closed when in use. This is a previous requirement. The Registered Person must ensure that all service users and their family, or representative, must be provided with a copy of the complaints procedure. This is a previous requirement. The Registered Person must ensure that any event that affects the wellbeing of a service user, such as short staffing or theft, is reported to the Commission via regulation 37. This is a previous requirement. The Responsible Person must ensure that a proposed plan of action with timescales should be submitted to the Commission. DS0000064009.V288166.R01.S.doc 24/06/06 24/06/06 24/06/06 24/06/06 07/06/06 07/07/06 St. George`s Home Version 5.1 Page 29 11 OP31 17 12 OP20 23(2)(b) 13 OP22 23(2)(n) 14 OP16 17 15 OP27 18(1)(a) 16 OP27 12(1)(a) 13(6) 18(4) This must include information on the two bathrooms, which are currently under utilised, meet the assessed needs of service users. A plan should be submitted to the Commission The Registered Person must ensure that all conversations with service users and or their representatives is recorded on their care notes and kept up to date. This is a previous requirement. The Registered Person must ensure that the Commission is informed of the completion of side gate to the property. The Registered Person must establish a system for reviewing and improving the quality of care within the home. This will include consultation with service users and their representatives to ensure they are happy about the care they receive at the home, to include the staff’s attitude, response to complaints, A record of relatives meeting was seen but no record of follow up action was available. This is a previous requirement. The Registered Person must ensure all expressions of dissatisfaction by service users or their representatives, and the action to be taken in response to this, must be recorded in the complaints log. This is a previous requirement. The Registered Person must duty rotas clearly reflect the hours actually worked. Rotas must be legible. This is a previous requirement. The Registered Person must ensure that the care home is conducted so as to make proper provision for the health and DS0000064009.V288166.R01.S.doc 24/06/06 07/07/06 30/07/06 20/06/06 24/06/06 30/07/06 St. George`s Home Version 5.1 Page 30 17 OP29 19 Sch2 welfare of service users. Staff must be made aware of their responsibilities, by training staff and other measures such as safe deployment, to ensure service users are not left unsupervised. The staff must be made aware that all are equally culpable if they do not speak up and raise issues of poor practices within the home. This is a previous requirement. The Registered Person must ensure all persons employed or volunteers to work in the care home have both a POVA 1st and CRB check undertaken prior to commencing work. A list of all employees and the status of their checks must be submitted to the Commission. This is a previous requirement. The Registered Person must ensure that staff training deficits are identified and met 24/06/06 18 OP30 18(1)(c) 30/07/06 19 OP31 9(2)(b)(i) 10(3) 20 OP30 21 OP32 22 OP36 The Registered Person must forward confirmation of when the registered Manager intends to undertake her required training This is a previous requirement. 12(1)(a,b) The Registered Person must ensure that all staff receive an appropriate induction commensurate with the role they are expected to undertake. 21(1)(2) The Registered Person must ensure that staff have the opportunity to attend regular staff meetings. Issues identified during these meetings must be properly addressed by the management team. 18(2) The Registered Person must ensure that that all staff receive regular documented supervision in line with NMS for Older DS0000064009.V288166.R01.S.doc 30/07/06 30/07/06 30/07/06 20/06/06 St. George`s Home Version 5.1 Page 31 23 OP38 12(1) 24 OP30 18(1)(a) 25 OP14 Newman 50 26 OP30 18(1)(a) 27 OP38 13(1)(3) 28 OP38 13(4)(c) 29 OP26 16(2)(e) 30 OP15 12(1) 31 OP12 16(2)(m) Persons The Registered Person must ensure that ensure that all staff are working in line with relevant policies and procedures and monitor staff practices to ensure they are in line with training received and good practice The Registered Person must ensure that ensure that all staff receive relevant training commensurate with their role The Registered Person must ensure that care plans reflect service users preferences for daily routines for example preferred time of getting up and going to bed. The Registered Person must ensure staff receive/or update mandatory training where required. The Registered Person must ensure that appropriate infection control procedures are implemented and followed by all staff. The Registered Person must ensure that the rear garden is made safe for service users to enjoy. Worn or damaged garden furniture must be replaced. The Registered Person must take steps to address the issues of laundry being regularly mixed up and given to the wrong service users. This is a previous requirement. The Registered Person must ensure that service users receive appropriate support at mealtimes in a respectful and dignified manner. The Registered Person must ensure that there is a programme of daily social activities developed in line with service users preferences. When DS0000064009.V288166.R01.S.doc 20/06/06 30/07/06 20/07/06 31/07/06 24/06/06 07/07/06 30/06/06 24/06/06 24/06/06 St. George`s Home Version 5.1 Page 32 32 OP37 17(2)6&7 33 OP15 12(1)(a). 34 OP12 16/(2) (n) 35 OP8 17(1) 36 OP9 13(2). 37 OP7 14(1)(ad) 2(a)(b) 38 OP7 13(4)(c) 39 OP38 26 activities are scheduled but not able to be undertaken, for example inclement weather, alternative activities must be undertaken The Registered Person must ensure that gaps in employment history must be explored and recorded. This is a previous requirement. The Registered Person must ensure that food-monitoring charts are consistently maintained. This is a previous requirement. The Registered Person must ensure that all service users have an individual social activity plan in line with their preferences. The Registered Person must ensure that records of monitoring of service users are kept. The Registered Person must ensure that staff that administer medication have received accredited training, and adhere to the medication policy at all times. This is a previous requirement. The Registered Person must ensure that assessments are reviewed at the point of significant change, and that they have determined they can meet the service users needs, and appropriately manage any risks identified. This is a previous requirement. The Registered Person must ensure that risk assessments are more detailed and accurately reflect the risk posed and the measures put in place to minimise the risk. This is a previous requirement. The Registered Person must DS0000064009.V288166.R01.S.doc 20/06/06 20/06/06 31/07/06 27/06/06 30/07/06 30/06/06 30/06/06 30/06/06 Page 33 St. George`s Home Version 5.1 40 41 OP38 OP38 23(4)(5) 17(1)(a,j) 18(2) undertake the regulation 26 visits. Copies of these must be forwarded to CSCI The Registered Person must 07/07/06 ensure the hoist is either repaired/replace The Registered Person must 30/05/07 ensure that records of any accident affecting the service user must include the nature of the accident, the date, the time, and whether treatment was required. The Registered Person must ensure that the records are kept up to date, and accurately reflect the accident or incident described. The staff must be closely monitored and supervised regarding their recording of such events. This is a previous requirement. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St. George`s Home DS0000064009.V288166.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 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.V288166.R01.S.doc Version 5.1 Page 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!