Inspection on 03/05/07 for St George's Home

This inspection was carried out on 3rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 09/07/2008.

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 3rd May 2007 11:00 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.V337912.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.V337912.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.V337912.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. 25th April 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 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 fees do not include hairdressing, newspapers, outings and private chiropody. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection includes a visit to the service. The home was sent an Annual Quality Assurance Assessment (AQAA) but the inspection took place before the date that it needed to be returned to us and therefore could not be used as part of this inspection. An AQAA is a selfassessment 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. Four 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. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. Other records examined during this inspection included, care records, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Notification of incidents received by us from the home and any other information received were also examined. This inspection took place between 11am to 9pm What the service does well: The home gave a first good impression with electrically operated gates at the main entrance, an attractive porch and reception area. Ample parking has been provided in the new car park at the front of the home. Most of the home offered comfortable, well maintained and safe surroundings for the people living there and was mainly free from offensive odour. All care files looked at contained a full assessment of need covering all the required areas. The manager had carried out a pre-admission assessment to make sure the home could meet the persons’ needs before any decision was made to offer a placement. Assessments are reviewed and revised as circumstances change. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 6 Risk assessments were in place for falls, nutrition, moving and handling and tissue viability. Weight charts were also in place as part of the monitoring of the residents’ health. Care files contained evidence of visits to, or visits, by other health professionals, such as the GP, optician, dentist and chiropodist indicating that on going health needs are being met. There are steps taken to protect the dignity and privacy of the people living at the home. The staff were seen to care for residents in a respectful manner and this was confirmed by residents who were spoken with. The lounge, which was used by most of the residents, had a lively atmosphere with staff and residents interacting well. Residents spoken with said that they felt occupied during the day. Visitors spoken with said that they were always made to feel welcome and were offered refreshments when visiting. Residents spoken with agreed this. Residents are afforded the opportunity to make other choices in their daily lives. They have a choice of meals which was observed during the visit, and residents said that they could get up and go to bed and have their bath when the wished. Residents’ involvement in the meetings, and the minutes of those meetings, also showed that they had an input to the day-to-day living at the home. People moving into the home are able to bring personal possessions with them as was demonstrated when viewing bedrooms. Such items as photos, pictures, plants and small pieces of furniture were in evidence. Residents were animated during mealtimes, which were obviously a social event. Those spoken with said that they enjoyed the food, which on the day of the visit was well presented, nutritious and tasty. Over 88 of the care staff had achieved either National Vocational Qualification (NVQ) Level 2 or 3 in Care, or equivalent, and the deputy manager was in the process of undertaking NVQ 4 showing that the greater majority of staff have been assessed as competent to carry out their care role. The manager had been at the home for eighteen years. She had completed NVQ 4 in care management training and was undertaking the Registered Managers Award. She is therefore appropriately qualified and experienced for the role of registered manager. Evidence was seen at the home to confirm that all the equipment was being regularly serviced and maintained. All in house checks on the fire system were up to date although there was no evidence seen of recent fire awareness training. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There are requirements that need to be met in order to improve the service provided at the home. • Contracts (Terms of Conditions) are only given to residents admitted to the home under health or social care management referrals but must be provided to all residents living at the home, in order that all residents are aware of the terms and conditions of residency. • Care plans require more attention, as they do not contain sufficient detail relating to how to meet the needs of individual people. They are not reviewed monthly or revised as circumstances change and therefore some needs are not recorded. This creates the risk of needs not being met. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 8 • There are some shortfalls in medication as follows- - The medication trolley on occasions left unlocked and unattended. -There were some errors found in the number of tablets that should have been remaining in the trolley. Staff drug audits need to take place to assess staffs’ competence in giving the right medication to the right person at the right time. –Eye drops and creams did not have the date of opening on the containers. This is necessary as they become unstable after a given time - the eye drops need to be discarded 28 days after opening; emollient creams 3 months after opening; any ointment containing a substance to treat a condition 28 days after opening. • Detailed records are maintained in the complaints log but it continued to be unclear from the records how or when complainants had been notified of the outcome of any investigations or if they were satisfied with the outcome. It is therefore not certain that complainants can be confident that they have been listened to. • Not all staff have undertaken training related to adult protection in order to have the knowledge and skills required to further safeguard residents from abuse. • The smoking area in the lounge does not prevent other people in the other sitting areas from sufferings the effects of smoke. • Some bedrooms and some communal areas are in need of redecoration and refurbishment. • There are no shower facilities at the home and therefore residents do not have the choice of the type of bathing that they have. • Although grab rails had been fitted since the last inspection these had come away from the wall. Securely fitted grab rails enable residents to have support as they move around the home. • Two bedrooms that were viewed had an offensive odour that detracted from the comfort for the occupants. • There are insufficient domestic and catering staff available and therefore care staff carry out domestic tasks that takes them away from the care of the residents. • Not all staff have undertaken up to date mandatory training related to health, safety and welfare related matters such as moving and handling, health and safety, food hygiene, first aid and fire awareness. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 10 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.V337912.R01.S.doc Version 5.2 Page 11 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): 2,3 Quality in this outcome area is adequate. Not all residents have a terms and conditions statement. Pre-admission assessments are carried out before a decision is made regarding placement. They are reviewed and revised appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement had been carried over from previous inspections with regard to the need for residents who are self funding to be issued with the terms and conditions of their residency. The registered manager advised that these had not yet been issued but were in the process of being devised with the aid of the consultants used by the home. Four care files were looked at and all contained a full assessment of need covering all the required areas. The manager had carried out a pre-admission St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 12 assessment in each case before a decision was made to offer a placement. Those residents who were referred to the home by health or social services had summaries of the care management assessments and care plans which were a source of information for the home’ care plans. Assessments are reviewed and revised as circumstances change. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 13 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 shortfalls in the information included in care plans and in their reviewing and updating that could mean that needs are not met. Errors in medication storage and administration could create health risks to people living at the home. People are cared for respectfully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and other staff at the home have worked very hard to improve care plans and continued to be transferring all care plans on to the new format. This format had been supplied to the home on a computer CD and completed by accessing the appropriate phrase from a selection in the programme. However these plans seemed very complicated to complete and difficult to access information. The manager said that they have taken a great deal of time to complete and was not confident that they gave the required information. The care instructions include the type of staff training required St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 14 and the management tasks required to enable staff to be able to carry out care tasks rather than what care staff have to do to ensure the needs of the resident are met. The plans were not person centred, and related to general training, policies and procedures. For example, for oral health care the aims were, “to ensure access to oral health services; To ensure staff receive appropriate personal care training.” the action to be taken was, 1. To facilitate access to oral health services, as required; 2. To ensure staff receiving oral hygiene training. 3. To ensure staff supervision of oral hygiene practice.” This does not set out in detail the action that needs to be taken by care staff to maintain good oral health care for the resident. The care plans could not easily include the resident in making decisions about their own care. The manager had begun to add her own version of the residents’ daily routine for ease of reference and these were more in line with what is needed. Not all care plans had been reviewed monthly and there was evidence that they were not updated as circumstances change. There were some care needs not included in the plans, for example the care plan of one resident did not refer to a pressure sore (a break in the skin due to pressure causing poor blood supply to the area) that had been noticed 2-3 days before or record that a resident was no longer eating but taking supplement drinks. Staff knew about these needs but being dependent on good verbal communication and staff memory carries the risk of residents needs not being met. Care files contained evidence of visits to, or visits, by other health professionals, such as the GP, optician, dentist and chiropodist indicating that on going health needs are being met. Risk assessments were in place for falls, nutrition, moving and handling and tissue viability. Weight charts were also in place as part of the monitoring of the residents’ health. Medication is administered from a lockable trolley and a multi dose system (when the majority of the medication is pre-packed in bubble packs) is in use at the home. The trolley was left unlocked and unattended on occasions whilst tablets were taken to individual people. This creates a risk to residents and lack of security of the medication in the trolley. Methods of avoiding this were discussed. The medication of the residents who were case tracked was checked. The Medication Administration Record Sheets each included a photograph to ensure the medication was given to the right person. There were no unexplained gaps in the Medication Administration Record Sheets. Receipt of medication received was recorded on the charts as had been required at the last inspection. An audit was carried out on the medication of three of the residents and errors were found with three sets of tablets having more tablets left than records indicated that there should be. The requirement for drug audits to be carried out following the previous inspection is carried over in this report. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 15 Eye drops continued not to have the date opened on the container. This is necessary, as drops need to be discarded after 28 days as they become unstable. Two jars of the same prescribed cream were seen in one of the shared bedrooms that were left out on the vanity unit. One of the residents in this room suffers from dementia. One opened jar had not been dated. The other jar remained sealed. These creams need to be stored safely so as to protect residents with limited understanding. Emollient type creams should be discarded after three months and therefore the date of opening is required. Only one jar needs to be out at a time. The manager attended to this promptly. The only controlled drugs in use were Temazepam and records were in good order. There are steps taken to protect the dignity and privacy of the people living at the home. The staff were seen to care for residents in a respectful manner and this was confirmed by residents who were spoken with. A payphone with a soundproof hood for privacy had been provided for residents’ use. Shared rooms had adequate screening for when personal care is to be carried out. Staff used preferred names of residents. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 16 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. People living at the home are occupied and stimulated and are able to make choices in their daily lives. Visitors are welcomed and residents enjoy the meals provided which are nutritious and varied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The lounge, which was used by most of the residents, had a lively atmosphere with staff and residents interacting well. The manager advised that activities are based on residents’ wishes and had been a subject on the agenda at the recent residents meeting. Minutes of the meeting showed that ideas for outings had been put forward and the manager was being pro active at meeting these wishes. Outings to a Glenn Miller appreciation concert and ‘Hello Dolly’ Musical were planned and residents had asked for cinema trips and dances. One resident regularly attended dances and said that he enjoyed this and going out with friends. There was an activity programme displayed that the manager advised was used as a guide and depended on the residents’ choice. Care plans looked at included interests and preferred activities. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 17 One resident spoken with chose to stay in the bedroom for all but mealtimes but said that staff always pass on the information about what activity or entertainment was taking place and occasionally joined in. “Whatever is going on they come to ask me if I want to join in” This indicated that not only did staff ensure that residents knew of the activities taking place but also that residents had the choice not to attend if they wished. Residents spoken with said that they felt occupied during the day. A television was on throughout the day in both parts of the divided lounge. One of the televisions was controlled by a specific resident who chose what programmes everyone in the room would watch and what the volume should be. The management of the home are attempting to address this and the issue was discussed amongst residents at the recent meeting when other residents said what they thought of this to this resident. Visitors spoken with said that they were always made to feel welcome and were offered refreshments when visiting. Residents spoken with confirmed this. Apart from the activities previously discussed residents are afforded the opportunity to make other choices in their daily lives. They have a choice of meals which was observed during the visit, and residents said that they could get up and go to bed when the wished. Residents’ involvement in the meetings, and the minutes of those meetings, also showed that they had an input to the day-to-day living at the home. The manager said that there was to be a resident/relative meeting the following month and that it was hoped that there would be a good response. This would also create an opportunity for those residents with limited understanding to be represented at the meeting. Residents are able to bring personal possessions with them as was demonstrated when viewing bedrooms. Such items as photos, pictures, plants and small pieces of furniture were in evidence. Meals were taken in the attractive dining room. Although otherwise suitably the spindle backs off the dining chairs do not offer comfort and one resident who had a back problem complained of being in pain from them. A cushion was provided once staff were aware of this. The home has two sittings for meals to ensure that there are sufficient staff available to assist residents where most required. Residents and staff seem to be happy with this arrangement. Assistance was available when needed and was offered sensitively. Residents were animated during the meals, which were obviously a social event and those spoken with said that they enjoyed the food, which on the day of the visit was well presented, nutritious and tasty. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 18 The kitchen area was visited briefly and appeared to be in good order. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 19 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 adequate. Complaints are taken seriously by the home but it is not clear if complainants are given the information to be confident they have been listened to. Residents are safeguarded from abuse but training has not been undertaken to give appropriate knowledge and skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is contained in the Service User Guide which all residents and their representatives receive. A copy of this was seen in bedrooms visited. Detailed records were maintained in the complaints log but it continued to be unclear from the records how or when complainants had been notified of the outcome of any investigations or if they were satisfied with the outcome. It is therefore not certain that complainants can be confident that they have been listened to. Staff spoken with were asked what they would do if a resident or relative made a complaint and they answered appropriately, indicating that the home would take complaints seriously. Residents and visitors spoken with said that they knew who to speak with if they had any concerns. The visit to the home took place on the day of the local elections. Some residents were taken to the polling station to vote by their relatives and by the manager. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 20 The home has an adult protection policy that was not examined on this occasion. Staff questioned about adult abuse were able to say what types of abuse there were and what to do if they became aware of any suspicion or allegation of any incident of abuse. They were also aware of whistle blowing and said that it would be “their duty” to report any bad practice or abuse. Not all staff have undertaken training in adult protection in order to further their knowledge and skills to identify suspicion of abuse to safeguard residents. There have been no adult protection allegations since the last inspection. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. Some areas of the home are in need of attention so that people living at the home enjoy the same comfort, safety and homeliness provided in the rest of the home. There should be a choice of type of bathing facilities available to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home gave a first good impression with electrically operated gates at the main entrance, an attractive porch and reception area. Ample parking has been provided in the new car park at the front of the home. The lounge area is divided into three sections and has a dining area attached. All these areas have suitable domestic type furniture and fittings and were clean and appeared homely and comfortable. One small area of the lounge is a St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 22 smoking area, with an impermeable floor covering, and although windows were open smoke could be smelt in the open plan sitting areas beyond. This could be unpleasant and cause a health hazard for some people living and working at and visiting the home. The registered provider should consider making the smoking area a separate room during the redevelopment of the home. A fish tank separating the lounge and dining room was nicely maintained and was of decorative interest for residents. There are some areas that are in need of attention. Bedrooms visited had some furniture in poor condition. One wardrobe door would not close, a vanity unit looked old and in need of repair or replacement, a vacant bedroom had a shabby non-slip floor covering that needed replacing and curtains were thin and worn in some bedrooms. Other bedrooms visited were suitably furnished and decorated. All beds seen were hospital-type and commodes seen were institutional in appearance. A shared bedroom contained two separate sets of storage space for the occupants to give them their own space but the toothbrushes and one tube of toothpaste were all in one mug. There was no identification on these and one toothbrush was very dirty. A requirement from a previous inspection was met with toiletries returned to individual bedrooms and labelled with the name of the owner. This room was in need of redecoration and although not a safety hazard had unattractive exposed pipework from floor to ceiling. One of the institutional-looking ceiling tiles was loose. These concerns detract from comfort for the people occupying this room. The first floor accommodates bedrooms, two bathrooms, a sluice room and a balcony with seating for residents’ use. The corridors on this floor were in need of redecoration. The manager advised that there were plans for an extension and redevelopment of some areas of the home and that improvements were being postponed until then, but in the meantime the shortfalls seen in the environment detract from the appearance and the comfort for people living at the home. The owner has provided several new items including a cooker, dishwasher, microwave and vacuum cleaners to improve working at the home. Grab rails had been fitted in a corridor, as was required from a previous inspection to offer support for residents, but the manager said that these had come away from the wall. These must be replaced and to a standard where there is no risk of them coming away from the wall again as this poses a very real risk to residents who may lean on them for support. The home was generally clean in all the areas viewed and was free of offensive odour apart from two bedrooms viewed. These had also been identified at the St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 23 previous inspection. The manager advised that the carpet in these rooms were cleaned regularly but they had not managed to remove the odour. Storage would seem to be a problem as a second medication trolley, a set of ladders (locked in place) and a hoist were stored in an alcove on the first floor corridor and the sluice was being used to store walking frames waiting to be collected by the supplier, a vacuum cleaner, a large number of cushions and domestic cleaning equipment. However no equipment or cleaning materials were stored in a hazardous manner. The laundry area was briefly viewed and although it was small was in good order. It is sited away from any food preparation or eating areas. There are plans for an improved laundry area in the redevelopment plans. Staff had access to protective clothing, disposable aprons and gloves, and were aware when to use them in order to prevent cross infection. All communal hand washing areas had disposable towels and soap dispensers thereby assisting in maintaining infection control. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 24 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 shortfalls in the time care staff spend with residents that may have an impact on their needs being met. Recruitment practices safeguard residents from the appointment of unsuitable employees. The majority of care staff have a qualification that shows they are competent in their role. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care staff levels would appear to be appropriate for the needs of the current residents, but care staff carry out some domestic tasks that take them away from working with residents. For example they do the laundry outside the laundry assistant hours; domestic staff only work mornings and care staff clean the toilets and the floor of the dining room after meals outside of these hours; there are several evenings a week when the care staff have to attend to the teatime meal when there is no chef. This inevitably impacts on the care that residents receive. Over 88 of the care staff had achieved either National Vocational Qualification (NVQ) Level 2 or 3 in Care, or equivalent, and the deputy manager was in the process of undertaking NVQ 4 showing that the greater majority of staff have been assessed as competent to carry out their care role. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 25 Three personnel files of staff were inspected. These were chosen to include the most recently appointed staff and demonstrated that the recruitment practice had improved since the previous inspection, safeguarding residents from the employment of unsuitable people. These files all contained the appropriate documents including two references, a Criminal Records Bureau disclosure, evidence of induction, a health declaration, staff supervision records and evidence of training and development. Whilst staff files included evidence of induction training it was not evidenced that this training was in line with Skills for Care Induction Standards for content and duration to ensure that new staff have the knowledge and skills to safely and effectively work unsupervised. Other training undertaken varied amongst the staff group with not everyone having undertaken the mandatory training as was required at the previous inspection. This requirement therefore carries over in this report. Staff have undertaken training related to Learning Difficulties in order that they can meet the needs of a resident with these specific needs. Staff do not get paid for training unless they are on duty. National Minimum Standards say that there should be a minimum of three paid training days per year for all staff. All health and safety related training, which is mandatory, should not cost the employees. Staffing levels cannot be reduced to accommodate training sessions as staff on duty cannot be available to meet the needs of residents whilst undertaking training. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 26 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 adequate. A person who has the required experience and qualifications manages the home. There are shortfalls in the health and safety training and opportunities for staff meetings provided to staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been at the home for eighteen years. She had completed NVQ 4 in care management training and is currently undertaking the Registered Managers Award. Staff spoken to said that they felt supported by her and residents said that they could speak to her about any concerns. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 27 The manager said that, as was required from previous inspections, all conversations with residents and their representatives was now recorded on their care notes. Daily records suggested that this was the case. With reference to an outstanding requirement for all staff to have the opportunity to attend regular staff meetings the manager said that whilst these had not been regular a meeting was planned for the forthcoming week. Staff meetings are a way of enabling staff to affect the way in which the service is delivered and it is recommended that this becomes a regular occurrence. Residents attend residents meetings to give them an opportunity to be involved in the way services are provided and a relatives/residents meeting was due to take place later in the month. A quality assurance programme was being implemented with surveys being distributed to staff, residents and relative surveys for feedback on the services provided at the home. Feedback about the service they receive was also asked for at residents’ meetings as was evidenced in the minutes of the meetings and in discussion with one of the resident’s spoken with. The manager was in the process of completing the Annual Quality Assurance Assessment that is issued by us. This is a self-assessment and a dataset tool that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. The manager was carrying out formal staff supervision and notes to these meetings were seen in staff files. The manager advised that she is on target to carry these out six times a year with all staff. Staff spoken with said that the home holds some monies for some residents and that records of transactions are maintained and receipts of any spending kept. These transactions were not inspected on this occasion. A requirement related to making the garden secure in order to protect residents with limited understanding who may wander away from the home has been met with the provision of electric gates and a connecting CCTV camera in the office. Old garden furniture has been disposed of. The home’s accident book was looked at. The version used at the home was in line with data protection but as it was small it did not afford space to enter the detail required. The treatment or action taken as a result of the accident was not recorded. Evidence was seen at the home to confirm that equipment was being regularly serviced and maintained. All in house checks on the fire system were up to date although there was no evidence viewed of recent fire awareness training. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 28 Not all staff have completed mandatory health and safety training and the requirement for this is carried over in this report. This puts people that work and live at the home at risk from unsafe practices. St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 3 3 2 x x x 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 2 St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 30 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 All people living at the home must have a terms and conditions statement. This will ensure that they have the information they require about terms ands conditions of residency. (Previous time scales of 07/07/06 and 01/05/07 were not met.) 2. OP7 15(1)(2) All people using the service must 30/07/07 have an up to date, individual, detailed care plan that gives care staff clear guidance. This will ensure that residents receive person centred support that meets their needs. (Previous time scales of 30/06/06 and 01/05/07 were not met.) 3. OP7 13(4)(c) Residents with challenging behaviour must have risk assessments in place that detail how staff manage the presenting behaviour. This will ensure that DS0000064009.V337912.R01.S.doc Timescale for action 30/06/07 30/06/07 St. George`s Home Version 5.2 Page 31 4. OP7 13(4)(c). the behaviour is managed to a satisfactory conclusion. (Previous time scale of 01/05/07 was not met.) Where there are risks that are risk assessed but not reduced, the assessment must be reviewed, updated and other strategies explored. This will ensure that the risk is minimised. (Previous time scale of 01/05/07 was not met.) When medication is administered to people living at the home • There must be an audit that includes staff competency. This will ensure that the correct medication is given to the right person at the right time. • Eye drops and creams must be must be dated on opening. This will ensure that they are disposed of at the correct time so that unstable medication is not given to residents. • The maximum, minimum and current temperatures of the medication fridge must be recorded daily. This will ensure that it stores the contents at the correct temperature. (This was not assessed on this visit). (Previous time scale of 14/04/07 was not met.) 30/06/07 5. OP9 13(2) 30/06/07 6. OP9 13(2) Medication must be kept secure at all times. This will ensure the safety of people living at the home. All areas of the home must be DS0000064009.V337912.R01.S.doc 30/06/07 7. OP19 23(2)(b) 30/08/07 Page 32 St. George`s Home Version 5.2 8. OP22 23(n) 9. OP26 16(1)(k) 10. OP27 18(1) 11. OP30 18(1)(a) decorated and furnished to provide comfort and meet the needs of the people living at the home. Grab rails that are safe and suitable for use must be provided to support residents’ mobility. This will ensure the safety of the people living at the home. Residents surrounding should not have any offensive odour. This is to ensure that they are living in comfortable and hygienic surroundings. There must be sufficient staff in number and skill mix to reduce domestic tasks carried out using care hours to the minimum. This will ensure that the needs of the people living at the home are met. New employees must undertake induction training in line with the specifications laid down by Skills for Care. This will ensure that new staff have the skills and knowledge to safely and effectively work unsupervised. (Previous time scales of 30/06/06 and 01/05/07 were not met.) 30/06/07 30/06/07 30/08/07 30/07/07 12. OP30 18(1)(a) 13. OP38 17(1)(a,j) 18(2) All staff must undertake all 30/06/07 mandatory training in associated health, safety and welfare subjects. This will ensure that they staff are able to work safely and in the best interests of the residents. Records of any accident affecting 30/06/07 people living in the home must be accurately recorded to include in detail all elements of the accident and any action required. This will ensure that the appropriate monitoring and reporting of accidents to DS0000064009.V337912.R01.S.doc Version 5.2 Page 33 St. George`s Home safeguard people living at the home. (the previous timescale of 14/04/07 was not 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. Refer to Standard OP15 Good Practice Recommendations The times that meals are served should remain under review to ensure they are appropriate for the needs of the residents. The record of any complaints should clearly detail how and when complainants are notified of the outcome of any investigations and if they are satisfied with the response, so that they are confident that they have been listened to and that action has been taken. Staff should undertake training related to adult protection to further safeguard residents from abuse. The smoking area should be reviewed so that the rest of the lounge areas are non-smoking. Staff meetings should be held regularly to give staff the opportunity to affect the way the service is delivered. 2. OP16 3. 4. 5. OP18 OP19 OP32 St. George`s Home DS0000064009.V337912.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V337912.R01.S.doc Version 5.2 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. 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