CARE HOMES FOR OLDER PEOPLE
St. George`s Home 116 Marshall Lake Road Shirley Solihull West Midlands B90 4PW Lead Inspector
Monica Heaselgrave Unannounced Inspection 9th January 2006 10:20 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.V276349.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.V276349.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 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.V276349.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. 4th July 2005 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.V276349.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of two inspection visits this year. The first inspection of July 2005 was an announced inspection. Both reports should be read in conjunction in order to get a fuller picture of the service. Since August 2005 St. Georges has been under new ownership. The care manager and staff team have remained relatively unchanged. This was an unannounced inspection, the first inspection since the home changed ownership. The inspection took place over a three- hour period. On arrival severe staff shortages were evident, and the care manager had been on long -term sick leave. None of these factors had been reported to the Commission. The staffing situation was the main focus of the time spent in the home. The absence of the manager made it difficult to establish if all the previous requirements made, had been met. The deputy was unable to collate this information. There were 25 service users on the premises, and a further two in hospital. The inspector spoke with six service users and looked around some parts of the building and external grounds. A number of records were sampled, and a copy of the staff rotas taken to check staffing levels. The district nurse was spoken to. The proprietor arrived and met with the inspector to discuss progress made since the last inspection. Discussion also took place regarding the seriousness of the short staff and lack of notifying the Commission of both the care staff shortages and the long- term absence of the care manager. Although still on sick leave, the manager arrived part way through the inspection. The deputy was required to rectify the immediate staff shortages, which was done. An immediate requirement report was left with the deputy requiring her to maintain staff levels and submit weekly rotas to the Commission to monitor that this is being managed consistently. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 6 The manager stated that her return to work was imminent. Both she and the deputy were advised that further unannounced monitoring visits might be undertaken to ensure compliance with staffing requirements. What the service does well: What has improved since the last inspection?
Requirements were made for the manager to ensure that care plans include details of service users bathing preferences. Care plans now include this detail, but staff shortages have meant the frequency of bathing, as commented by both service users and staff, has not been consistently maintained. Since the last inspection staff have received training in Disability Awareness, which has enabled them to respond to the specific needs of a service user. One requirement was made in relation to providing suitable dining room tables and chairs that would provide service users both the support and comfort they needed. The new proprietor has purchased new furniture, which service users feel is comfortable. This requirement is now met. Some new initiatives were evident in trying to provide service users with varied activities. This had included a Christmas party a fire works display, and a video night. The service users had enjoyed these. The new proprietor is purchasing new plasma TV and DVD player that he hopes will provide service users with a better quality of entertainment, with DVDs that may be more specific to their past and personal interest. The complaints record viewed now details the nature of the complaint, the action taken to rectify this and the outcome and feed- back to the complainant. There was an improvement in recording the details of complaints. A change of ownership took place in August 2005. Prior to this a number of repairs and maintenance issues were required to be addressed In the past five months, the new owner has undertaken a lot of work on the environmental issues that were outstanding, which has both improved the safety and comfort of service users.
St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 7 The communal lounge and dinning area were clean tidy and comfortable. New dining room furniture has been purchased which is more suited to the needs of the service users. Carpets in communal areas have been cleaned, and no odours were evident. The new proprietor stated he is addressing the maintenance and redecoration, to include replacement of carpets that are worn. This is planned for this year. The bathroom hoist chair had been repaired, and this facility is now available for use by service users. The emergency call system in the ground floor bathroom has been repaired and is in working order, enabling service users to call staff for assistance. The broken lock on the ground floor toilet had been replaced, providing more privacy for service users. Signs had been fitted to toilet areas to assist service users in locating them. The inspector was informed that broken window restrictors had been repaired but these were not viewed on this occasion. The proprietor stated that repairs to the roof had been completed; there was no evidence of leakage at this visit. At the previous inspection the COSHH cupboard door key was broken. Cleaning materials normally stored in this cupboard had been appropriately re-located to a secure facility. A new key has been purchased and items were securely stored. The broken drain cover to the rear of the property has been replaced, reducing the risk of service users falling or tripping. The proprietor has met the majority of requirements made, which has improved the level of safety and comfort for service users. What they could do better:
In October the manager was taken ill. This led to a period of long-term sick leave. During this time Requirements were made for the manager to ensure that care plans include details of service users bathing preferences. Care plans now include this detail, but staff shortages have meant the frequency of bathing, as commented by both service users and staff, has not been consistently maintained. The management of risks needs to improve. Service users who are likely to wander had not had their risk assessment updated.
St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 8 A risk assessment for accessing the toilet and bathroom areas in the event of a service user falling had not been devised. Where risks are highlighted, remedial and immediate action must be taken. There has been a failure to maintain minimum staff levels, and a failure to notify this to the Commission. Unsafe staffing levels compromise the capacity of staff to ensure the safety of service users. At the previous inspection all the standards relating to service users choices and expectations were met. However at this inspection it is evident that staff had not been able to maintain these standards consistently. Comments from service users indicated that their usual preferred routines had suffered, in particular the frequency of bathing. The views of relatives regarding the management of complaints was not obtained as there were none visiting at the time of the inspection. Anecdotal comments suggest that service users had concerns about things that affect their care, but had not raised them as complaints. Lots of improvements were noted in terms of providing a more safe and comfortable environment for service users. The erection of a side gate to protect service users from wandering into the road has yet to be completed. A programme of redecoration and carpet replacement will greatly enhance the comfort of service users. There has been little progress in formalising the training needs of staff, to ensure staff are trained and competent to care for service users. It was not evident that robust recruitment procedures had been practiced to ensure service users are not put at risk. In addition to the short falls in maintaining appropriate staff numbers, the care manager had been absent since October, which left the deputy and senior staff member to run the home. There was a failure to notify the Commission of the absence of the manager, and make interim management arrangements. There was a failure to alert the Commission to the staffing difficulties being experienced. An immediate requirement was made for weekly rotas to be submitted to the Commission to ensure minimum staff ratios are being maintained. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 9 Adequate managerial support must be maintained to ensure incidents that could affect the well being of service users are reported to the Commission, to ensure the protection of service users. The training needs of staff need to be formalised to ensure that they are equipped to meet the needs of service users. Recruitment information on new staff must improve in order to safeguard service users. The long-term absence of the manager has clearly impacted on meeting some of the managerial requirements made at the previous inspection. The deputy was unable to collate this information in her absence. The areas of concern identified under this section of the report must be addressed with urgency in order to provide the required safeguards for service users. 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.V276349.R01.S.doc Version 5.1 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.V276349.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4 were assessed and met at the previous inspection. EVIDENCE: St. Georges does not provide intermediate care. No further standards were assessed on this visit. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 There has been minimal progress in ensuring the service users care plan includes up to date risk assessments. The lack of progress in this area, and failure to maintain minimum staff levels, could potentially place service users to risks, which could otherwise be avoided. EVIDENCE: At the previous inspection standards 7, 8, 9 and 10 were assessed. Two standards were met, one was not met and one had minor shortfalls. Requirements were made for the manager to ensure that care plans include details of service users bathing preferences. Care plans now include this detail, but staff shortages have meant the frequency of bathing, as commented by both service users and staff, has not been consistently maintained. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 13 Since the last inspection staff have received training in Disability Awareness, which has enabled them to respond to the specific needs of a service user. Three requirements remain outstanding: *The proprietor stated that a side gate is being erected to ensure the safety of service users who may wander. Builders were present on site carrying out this work. *Risk assessments for those service users who were likely to wander had not been updated. *The deputy stated that the risk assessment for accessing the toilet and bathroom areas in the event of a service user falling had not been devised. Where risks are highlighted, remedial and immediate action must be taken. Risk management must improve to ensure service users are not exposed to known risks. There has been a failure to maintain minimum staff levels, and a failure to notify this to the Commission. Unsafe staffing levels compromise the capacity of staff to ensure the safety of service users. St. George`s Home DS0000064009.V276349.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 The preferred routines of service users have been compromised by a period of staff shortages. EVIDENCE: All of the above standards were assessed at the previous inspection of July 2005. One requirement was made in relation to providing suitable dining room tables and chairs that would provide service users both the support and comfort they needed. The new proprietor has purchased new furniture, which service users feel is comfortable. This requirement is now met. At the previous inspection all the standards relating to service users choices and expectations were met. However at this inspection it is evident that staff had not been able to maintain these standards consistently. Serious staff shortages were evident on arrival, and staff rotas showed that minimum staff levels had not been maintained for a number of weeks. Comments from service users indicated that their usual preferred routines had suffered, in particular the frequency of bathing.
St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 15 Some new initiatives were evident in trying to provide service users with varied activities. This had included a Christmas party a fire works display, and a video night. The service users had enjoyed these. The new proprietor is purchasing new plasma TV and DVD player that he hopes will provide service users with a better quality of entertainment, with DVDs that may be more specific to their past and personal interest. St. George`s Home DS0000064009.V276349.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, 18 The management of service users complaints is not adequate. Events within the home that affect the care provided to the service user had not been resolved. This does not provide service users with the confidence that complaints will be listened to, taken seriously and acted upon. EVIDENCE: At the previous inspection a requirement was made in relation to these standards. The complaints record viewed now details the nature of the complaint, the action taken to rectify this and the outcome and feed- back to the complainant. There was an improvement in recording the details of complaints. Since the last inspection there have been no complaints made to the Commission regarding this service. However a request was made to the Commission to follow up concerns regarding infection control procedures. During the visit the district nurse was spoken with who stated that she had no concerns regarding infection control. She currently visits daily and confirmed that liquid hand-wash; paper towels and clinical waste containers were available. She spoke positively about the care staff, stating that they followed
St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 17 advice, and ensured service users are seen in their own rooms to protect their privacy. The district nurse also oversees the management of a service user who has diabetes and felt this is managed appropriately. The views of relatives regarding the management of complaints was not obtained as there were none visiting at the time of the inspection. Two service users stated that if they had concerns they felt they could talk to staff and were confident they would listen. Service users asked, were not sure if they had been given a copy of the complaints procedure but did state staff had told them to inform them of any complaints or worries they may have. However they also commented that staff levels had been low over the Christmas period, and so staff had been busier than normal. This had affected service users in that, their usual bath routines had been interrupted. A couple of service users commented that their clothes sometimes get mixed up in the laundry. From these anecdotal comments it is evident that service users had concerns about things that affect their care, but had not raised them as complaints. It is important to remember that many older people do not like to complain, but if they are to be truly confident that their complaints are to be listened to; and taken seriously, the manager and staff team must demonstrate that shortfalls in the care provided are managed effectively. The complaints logbook was viewed and showed that three relatives, and five service users had made complaints over the past year. The details recorded indicated that, in one instance theft had been reported to the police, but a similar incident had not. It was not evident that these instances had been reported to the Commission under regulation 37. Any event, which adversely affects the well being of a service user, must be reported to the Commission in order to protect them from potential financial abuse. The accident records were viewed and these showed that there had been seventeen accidents in a three-month period. Staff shortages were evident for some of this period. It is very concerning to note that events that affect the welfare and protection of service users, such as theft, or ongoing staff shortages, are not reported to the Commission, and potentially place service users at further risk. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 25, 26 There has been a significant improvement in the maintenance of the property, which now provides a more safe and comfortable environment for service users. Accommodation was clean and free from odours. EVIDENCE: At the inspection in July 2005, standards 19, 20, 21, 22, 25 and 26 were assessed. Three of these standards were not met and three had minor shortfalls. Maintenance of the home was poor and service users did not live in a safe and comfortable environment. Since that time, there has been a change of ownership, and the new proprietor has met or partially met many of the requirements made in relation to repairs, maintenance and up keep of the property.
St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 19 Thirteen requirements were made in relation to improving environmental standards. These requirements were assessed at this inspection in order to clarify what progress had been made. A walk around the ground floor accommodation confirmed that bedroom doors were not wedged open. One lady was sitting in an armchair in the doorway of her bedroom, the deputy stated that this lady had just seen the district nurse, and her bedroom door was open as she was waiting for staff to assist her to the lounge. Staff must be mindful of using any means of propping doors as this is in contrary to fire regulations, and could place service users at risk. The communal lounge and dinning area were clean tidy and comfortable. New dining room furniture has been purchased which is more suited to the needs of the service users. Carpets in communal areas have been cleaned, and no odours were evident. The new proprietor stated he is addressing the maintenance and redecoration, to include replacement of carpets that are worn. This is planned for this year. The bathroom hoist chair had been repaired, and this facility is now available for use by service users. The emergency call system in the ground floor bathroom has been repaired and is in working order, enabling service users to call staff for assistance. The broken lock on the ground floor toilet had been replaced, providing more privacy for service users. Signs had been fitted to toilet areas to assist service users in locating them. The inspector was informed that broken window restrictors had been repaired but these were not viewed on this occasion. The proprietor stated that repairs to the roof had been completed; there was no evidence of leakage at this visit. At the previous inspection the COSHH cupboard door key was broken. Cleaning materials normally stored in this cupboard had been appropriately re-located to a secure facility. A new key has been purchased and items were securely stored. The broken drain cover to the rear of the property has been replaced, reducing the risk of service users falling or tripping. The proprietor has met the majority of requirements made, which has improved the level of safety and comfort for service users. There are some St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 20 outstanding requirements, which now need to be met. These are summarised as follows: * A programme of redecoration and carpet replacement, with time scales is required to be submitted to the Commission. * A thermostatic mixer valve is required in the staff toilet. * A date of completion for the erection of side gates to the property. Whilst work is seen to be underway for the erection of side gates to the property, a date of completion must be identified. In the interim, those service users who are vulnerable to the risk of walking out of the building must have a full risk assessment in place, and appropriate supervision from staff, in order to protect their safety. * Assisted bathing facilities must be considered when updating the two domestic bathrooms, which currently do not meet the needs of service users. St. George`s Home DS0000064009.V276349.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 Staffing levels have not been maintained consistently, and on some occasions have been unacceptably low. This has meant that the needs of the service users have been compromised. There has been little progress in formalising the training needs of staff, to ensure staff that are trained and competent to care for service users. It was not evident that robust recruitment procedures had been practiced to ensure service users are not put at risk. EVIDENCE: At the inspection of July 2005, three of these standards were assessed and found to require improvement. Progress in meeting the standards has been minimal, and in the case of staff numbers, has deteriorated. Three standards remain unmet, and a new requirement has been made in relation to unacceptable staff levels. The home is registered to provide care and accommodation to twenty-nine older persons. Minimum staffing levels are four care staff, in addition to management and ancillary staff. This was an unannounced inspection. On arrival at 10:20 am there were severe staff shortages. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 22 There were twenty-seven service users being accommodated, two of these were in hospital, twenty-five were in the building. The deputy manager was on duty, with two care staff a cook and a cleaner. A volunteer was available to make drinks. The deputy stated that two care staff had phoned in sick for the shift. During the time the inspector was present, two replacement staff were called in for duty, the second arriving at 11:35 a.m. by which time three hours and thirtyfive minutes of the shift had passed. Staff levels were not maintained consistently; on occasions there were shortfalls of two staff. This would leave a skeleton staff of two care staff plus the senior or deputy, to meet the needs of up to 29 older people. These are seriously concerning levels to operate on, and more concerning to note that this situation had continued for a period of time. The rotas showed that staff were working on occasions a mixture of days and nights, and in some instances two shifts were worked back to back, i.e. 8-3 a.m. and 3-9 p.m. shifts. There had been so many alterations to the rota it was difficult to establish what hours were actually worked, or indeed how accurate or reliable this information was. It is essential that the rotas be clearly set out, identifying the staff member, their role and their qualifications to undertake that role. Their total weekly hours, and the start and finish times of each shift they are to work must be clear and legible. In addition to the short falls in maintaining appropriate staff numbers, the care manager had been absent since October, which left the deputy and senior staff member to run the home. There was a failure to notify the Commission of the absence of the manager, and make interim management arrangements. There was a failure to alert the Commission to the staffing difficulties being experienced. Further discussion with the deputy and two service users highlighted other concerns. The staff shortages affected the frequency of bathing opportunities for service users. Whilst their care plans do identify their preferred routine, staff had been unable to support them in this area of their care. The accident records were viewed and these showed that there had been seventeen accidents in a three-month period. Staff shortages were evident for some of this period. St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 23 The proposed rota for the week was viewed to ensure that any gaps were covered. This was actioned on site. An immediate requirement was made for weekly rotas to be submitted to the Commission to ensure minimum staff ratios are being maintained. Adequate managerial support must be maintained to ensure compliance with the Care Homes Regulations, specifically notification of all incidents that could affect the well being of service users, via regulation 37. The inspector did not establish at this visit, whether 50 of the staff team is NVQ trained, as was required by 2005. In order to meet this standard the manager should submit a training matrix so that this can be demonstrated. At the previous inspection the manager was required to improve the recruitment information gathered on new staff. This requirement remains outstanding. At the previous inspection, a requirement was made to ensure all newly appointed staff have a POVA 1st check carried out at the time the CRB (Criminal Records Bureau check) police check, is applied for. This remains outstanding. Three staff had commenced work in the home since the last inspection; all require a police check and POVA 1st. The proprietor stated that these have been delayed due to the necessity for him to register under an umbrella body. It is envisaged that this requirement will be met in the short term. Staff files showed a mixture of training had been undertaken. Since the last inspection a requirement to undertake training in Disability Awareness has been met, and this is appropriate to the current needs of one service user. Infection Control, Manual Handling and Fire Awareness had also taken place. The long-term absence of the manager has clearly impacted on meeting some of the managerial requirements made at the previous inspection. The deputy was unable to collate this information in her absence. The areas of concern identified under this section of the report must be addressed with urgency in order to provide the required safeguards for service users. St. George`s Home DS0000064009.V276349.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, 33, 36 The home is not being managed properly and there is a lack of leadership and direction to staff in ensuring service users receive consistent quality care. Failure to take action on some practices, such as poor staffing, does not safeguard the health, safety and welfare of service users. EVIDENCE: At the previous inspection standards 31, 36, 37 and 38 were assessed. Standard 36 was met. Standard 35 has not been assessed. On arrival severe staff shortages were evident. There were two care staff short on the morning shift, and this was not rectified until arrival of the inspector, by which time the shift had been short for three hours and thirty-five minutes. Mornings are a particular peak period where all service users require a degree of assistance. The inspector was seriously concerned that care staff could not
St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 25 safely meet the needs of older vulnerable people, which potentially place them at risk. The registered manager has been on long- term sick leave since October. This was an unplanned leave of absence, and one that was not reported to the Commission. The deputy and senior care have run the home on a daily basis. This has been further complicated by a failure to maintain minimum staffing levels. There was a lack of leadership and direction to staff, and whilst the deputy manager endeavoured to run the home, she does not have the skills to discharge this role effectively, as demonstrated in the failure to report these concerns to the Commission. An immediate requirement notice was issued in relation to maintaining minimum staffing levels, and requiring the deputy to forward weekly rotas to the Commission until such time the staff team is stable. The requirements made in relation to standards 31, 37 and 38, at the last inspection remain outstanding. Staff supervision has not been consistent due to the manager’s absence, and a requirement is now made to rectify this. In the absence of the manager it was not possible to establish if she has a relevant management qualification that meets with the standard. At the previous inspection a requirement was made for the manager to receive periodic training to update her skills in relation to staff recruitment legislation. The inspector was unable to establish if this requirement had been met, and so remains outstanding. The deputy was unable to confirm if the requirements made in relation to exploring gaps in the work history of new employee’s had been undertaken. This requirement remains outstanding. St. George`s Home DS0000064009.V276349.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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 2 2 X X 3 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 2 2 2 St. George`s Home DS0000064009.V276349.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 2 Standard OP7 OP7 Regulation 12(2) 12(1)(a) Requirement Care staff must maintain the frequency of bathing, as detailed in service users care plans. Risk assessments for service users who are likely to wander, must be updated. This is a previous requirement. 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 Responsible Individual must ensure that poor staffing levels do not compromise the routines of daily living and activities. All service users and their family, or representative, must be provided with a copy of the complaints procedure. Any event that affects the wellbeing of a service user, such as short staffing or theft, must be reported to the Commission via regulation 37. The Responsible Person must
DS0000064009.V276349.R01.S.doc Timescale for action 10/02/06 13/01/06 3 OP7 13(4)(c) 13/01/06 4 OP12 16(2) (m,n) 4(1)(c) 14 Sch1 37(1)(e,f) 13/01/06 5 OP16 20/02/06 6 OP18 10/01/06 7 OP19 23(2)(b) 15/03/06
Page 28 St. George`s Home Version 5.1 8 OP19 23(4)(a) 9 10 OP20 OP22 23(2)(b) 23(2)(n) 11 OP27 18(1)(a) ensure the outstanding redecoration issues detailed in standard 19 are addressed. A proposed plan of action with timescales should be submitted to the Commission. Bedroom doors must not be wedged or blocked. This causes a fire hazard and places service users and staff at risk. Date for completion of side gate to the property to be confirmed to the Commission. The Responsible Individual must ensure that the two bathrooms, which are currently under utilised, meet, the assessed needs of service users. A plan should be submitted to the Commission. This is a previous requirement. Minimum staffing levels of four care staff and a senior member of staff must be maintained at all times throughout the working day. Copies of the rota must be submitted to the Commission on a weekly basis. Duty rotas must clearly reflect the name, role, qualification of staff, and the hours actually worked. The manager must demonstrate that 50 of the staff team are trained to NVQ level 2. A training list must be submitted to the Commission to confirm this. The manager must ensure that all persons employed 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. 10/01/06 20/02/06 20/02/06 09/01/06 12 OP27 18(1)(a) 16/02/06 13 OP28 18(1)(c) 20/02/06 14 OP29 19 Sch 2 20/02/06 St. George`s Home DS0000064009.V276349.R01.S.doc Version 5.1 Page 29 15 16 OP30 OP31 18(1)(c) 9(2)(b)(i) 10(3) This is a previous requirement. The manager must ensure that staff training meets with the Skills for Care targets. The manager must demonstrate if the previous requirement made in relation to periodic training in recruitment legislation, has been met. Confirmation of a relevant managers qualification is required. The Manager must ensure that staff receives formal supervision on a regular basis. Duty rotas must be legible. Gaps in employment history must be explored and recorded. 01/04/06 01/04/06 17 18 19 OP36 OP37 OP37 18(2) 17(2) 6&7 17(2) 6&7 20/02/06 10/01/06 20/02/06 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.V276349.R01.S.doc Version 5.1 Page 30 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
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