CARE HOMES FOR OLDER PEOPLE
St Georges Hotel St Georges Road Truro Cornwall TR1 3JE Lead Inspector
Ian Wright Announced Inspection 10th January 2006 10:00 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 Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 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 Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Georges Hotel Address St Georges Road Truro Cornwall TR1 3JE 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) 01872 272554 01872 242162 Mrs Christine Elizabeth Little Mr Rolf Little Mrs Elizabeth Julie Coon Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st July 2005 Brief Description of the Service: St. Georges Hotel is registered to provide care for up to 22 service users who are elderly. The home is within level walking distance of the centre of Truro. The building and its grounds are well maintained, and the home has suitable facilities to meet the needs of service users. The registered providers are Mr and Mrs Little and the registered manager is Mrs Coon. The ground floor of the home is wheelchair accessible, and a chairlift links the ground floor to the upper floor. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place in just under six and a half hours. The inspection was carried out on an announced basis. Some of the ‘core’ standards, and standards not inspected at the last inspection, were assessed. The inspector was able to speak to many of the service users, and some of the staff members on duty. The inspector examined the care records, and inspected the building. What the service does well: What has improved since the last inspection? What they could do better:
Two requirements have been made on this inspection. Firstly medication procedures must be improved. Although the system is generally effective, two items of prescribed medication were found in the
St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 6 medication cupboard, which did not have labels on them. All medication must be prescribed to a specific service user and a record of its administration must be kept. All staff must have training regarding the administration of medication arranged, for example, by a pharmacist. Secondly training required by regulation must be delivered to all staff. For example all staff must have training in infection control, food hygiene and first aid. The induction checklist must also include issues regarding abuse and adult protection. 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 Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 7 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 Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4 Suitable information is provided to enable service users to know what services are available to them, and enable them to be aware of their rights and responsibilities. Suitable links have been developed with external professionals to ensure service users health and social care needs are met. EVIDENCE: Copies of the statement of purpose and service user guide were inspected. The registered persons said all service users had received a copy of the service user guide. Copies of the statement of purpose and service user guide are also available to visitors in the hallway. From discussion and records it appears there are suitable links with external professionals such as general practitioners, community psychiatric nurses and district nurses. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 9 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, 9, 11 Suitable care plans are in place to enable service users to receive satisfactory care from staff. However risk assessments (e.g. regarding moving and handling) could be more detailed. Medication procedures require some improvement e.g. only medication prescribed to individuals must be administered to them, and all staff must receive formal training. EVIDENCE: All service users have a care plan, which includes a risk assessment. The inspector recommends risk assessments contain more detail e.g. regarding moving and handling. Care plans are reviewed on a regular basis. The medication system was inspected and is generally satisfactory. However two items kept in stock Loperamide and Senna did not have any labels stating whom they were prescribed for. All medication must be prescribed for a specific service user, and a record of its administration kept. The pharmacist regularly checks the medication system and found this to be satisfactory on his last visit. Records show four staff did not have formal training regarding the administration in medication. The registered persons said these staff had been
St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 10 instructed how to administer medication by a senior member of staff. Formal training however must be arranged. The registered persons have developed a policy regarding the care of service users who are dying. This is satisfactory. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 11 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, 15 Routines and activities are tailored according to individual service users lives. Meals available to service users are to a good standard. EVIDENCE: Service users said they could get up and go to bed when they wished, and have autonomy how they organised their time. Some structured activities are arranged e.g. bus trips, entertainers etc. Several service users go out on their own and one person has a voluntary job. The home is ideally suited for the town centre. A range of games / paints etc. are available for service users to entertain themselves. A Methodist minister held a service on the day of the inspection. The hairdresser was also present. The inspector shared a meal with service users. This was to a high standard. The inspector spoke to several service users who all said they felt food was to a good standard. A choice is available on the menu and special diets are catered for. Support from staff at meal times was observed to be appropriate. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 12 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 Appropriate arrangements are in place so any complaints are resolved effectively and service users are protected from abuse. EVIDENCE: Service users receive appropriate information how to make a complaint. A complaints comments book is situated in the lounge which seems a good idea as it is accessible to service users. The Commission for Social Care Inspection has not received any complaints regarding this home. The registered provider has a suitable adult protection procedure. All staff have a Criminal Records Bureau check, and where appropriate, staff have received a Protection of Vulnerable Adults check. Staff are required to read the providers policy regarding adult protection when they commence employment. It is recommended staff are shown the Cornwall Social Services ‘No Secrets’ video as part of their induction, regarding abuse and adult protection. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 13 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): 19-26 St Georges Hotel provides suitable accommodation to meet the needs of service users living there. The home is clean, pleasant and hygienic. EVIDENCE: The property is very well maintained, appears to be safe, is very comfortable and homely. Furnishings and decorations particularly in the communal areas are of a high quality. The home has two lounges where service users can choose to relax. In one lounge there is a large TV and a water cooler. The other lounge is used for relaxing, reading or activities. Other facilities such as bathrooms and toilets are suitable. The home was clean and hygienic on the day of inspection. Bedrooms are suitable for purpose, and pleasantly decorated. Some bedrooms are on the small side, but service users all said they were happy with their accommodation. Bedrooms are lockable and service users are provided with a key where this is appropriate. Appropriate moving and handling equipment is provided. The home also has a stair lift, which is suitably maintained.
St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 14 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 Suitable staffing levels are provided to care for service users. The registered persons have a suitable approach to national vocational training. Some improvement is required to staff induction and to ensure all staff have training required by regulation. Recruitment practices and records are satisfactory. EVIDENCE: Suitable staffing is provided. At least three staff are on duty between 0800 and 1100, and two staff are on duty throughout the rest of the remaining day. One waking night staff and one sleep in member of staff are on duty during the night. Auxiliary staff e.g. a cook and a cleaner are employed. Mrs Coon said seven staff have either NVQ 2 or 3. All staff have received a Criminal Record Bureau check (and Protection of Vulnerable Adults check as applicable). Recruitment practices and records are satisfactory; for example references are taken up for individual staff, suitable identification is obtained and staff receive a contract of employment. It is recommended a record is kept of any references, which are initially obtained verbally. The registered providers explained a generally satisfactory approach to staff training. Records showed all staff have fire and manual handling training. However there were some gaps in staff receiving first aid and food handling training. All staff must also receive training in infection control. The registered persons said all staff are required to read the registered provider’s adult protection policy, however this must be recorded on the induction checklist.
St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 15 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, 34, 35,36, 38 Management of the home is highly effective. Suitable financial procedures are in place regarding the business and service users finances. Health and safety precautions are maintained to a good standard. EVIDENCE: The registered persons have suitable experience, knowledge and skills to manage the home. They are very keen to maintain high standards and ensure the national minimum standards are met. The registered manager ensures her knowledge and skills are updated. The registered persons provide appropriate day-to-day supervision of the staff team, and the team appears well developed, caring and effective. Management seemed approachable and friendly with other staff. All staff have an annual appraisal.
St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 16 The registered provider confirmed accounts are kept. There is no reason to question financial viability for example there is clear financial investment in upgrading the building, staffing levels are well maintained and there was plentiful food supplies in stock. Some moneys are kept in the office to assist service users with budgeting. This is stored appropriately and accurate records are kept. Records are also kept of fees paid. Legal advisors are involved in assisting service users with their moneys where necessary. The registered providers said they would look after valuables if necessary. The registered persons said all service users have a safe box in their bedrooms. Health and safety precautions are satisfactory for example in regard to servicing of moving and handling equipment, fire, gas and electrical equipment etc. Suitable testing procedures are in place regarding the prevention of Legionella. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X 3 3 3 X 3 St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 Requirement The registered persons must ensure: • All medication must be prescribed for specific service users, and for its administration kept. • All staff that administer medication must receive external training regarding the administration in medication (e.g. from a pharmacist). All staff must receive: • Training as required by regulation for example such as manual handling, first aid, infection control, food handling and fire training. • Induction training regarding adult protection and this must be included on the induction checklist. All staff should be shown the Cornwall Social Services ‘No Secrets’ video as part of their induction regarding abuse and adult protection.
DS0000041932.V264147.R01.S.doc Timescale for action 01/05/06 2 OP30 18 01/05/06 St Georges Hotel Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP29 Good Practice Recommendations Service user risk assessments should contain more detail e.g. regarding moving and handling A record should be kept of verbal employment references. These must always be confirmed in writing. St Georges Hotel DS0000041932.V264147.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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