Inspection on 09/08/07 for St George`s Ltd

This inspection was carried out on 9th August 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 Ltd 03/08/06

St George`s Ltd 27/01/06

St George`s Ltd 03/03/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St George`s Ltd Croxteth Avenue Liscard Wallasey Wirral CH44 5UL Lead Inspector Julie King Key Unannounced Inspection 9th August 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St George`s Ltd DS0000060055.V345955.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 Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Ltd Address Croxteth Avenue Liscard Wallasey Wirral CH44 5UL 0151 630 6754 0151 638 8721 colin.stgeorges@tiscali.co.uk 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 (Liverpool) Ltd Colin John Moore Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 60 nursing beds, with up to 18 OP/E PC within the total number. Accommodate six (6) named service users under the age of 65 years, within the total number of 60. To accommodate one named service user under the age of 55. Date of last inspection 3rd August 2006 Brief Description of the Service: St Georges is a two storey converted building located in the Liscard area of Wallasey and close to local amenities. The home is registered to provide nursing care for 60 older persons and 18 of the beds may accommodate clients who require personal care only. The large reception area is welcoming and the reception desk is staffed during office hours. A large lounge, a dining room and a visitors room are provided on the ground floor and a second lounge/dining room on the first floor. There are also quiet sitting areas in various parts of the building. Televisions, videos, music centres and an in house library are provided. Both single and shared accommodation is available. A selection of bathrooms and toilets are provided and assisted bathing facilities are available however, en suite facilities are not available. A large lift serves both floors. There is an enclosed rear garden area, which is currently undergoing renewal. There is parking for some cars at the front of the building and a car park at the rear. Fees at St Georges range from £378 to £574 per week dependent on the level of service required. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of a key inspection, this site visit was conducted over one day; during which a full tour of the premises took place, and staff and care records were examined. The registered manager accompanied the inspector throughout this visit. A selection of staff on duty plus some residents were spoken to during this visit. No relatives were present during this site visit, but multidisciplinary healthcare team members were questioned to obtain their views on the service. What the service does well: What has improved since the last inspection? What they could do better: The recording and updating of resident’s care files, especially when an actual need is identified would help ensure that all residents get the most appropriate care at all times. Also the recording of medications requires improvement to fully comply with good, safe practice. Staff inductions are below the expected standard and not fully compliant with current health & safety requirements. Also some areas of the environment, especially floor and wall coverings are in need of replacement as soon as practicable. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 6 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 Ltd DS0000060055.V345955.R01.S.doc Version 5.2 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 George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, and the home is able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: The management and staff understand the importance of having sufficient information when choosing a care home, and have developed clear information to help prospective residents understand what services the home can provide. The manager provides a Statement of Purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a Service user Guide. The guide details what the prospective resident can expect and gives a clear account of the services provided, the accommodation, qualifications and St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 9 experience of staff, how to make a complaint and recent CSCI inspection findings. All the residents have full access to a copy of the Guide, and when requested the manager can provide a copy of the Statement of Purpose and Guide in a different language to suit the needs of the resident. Admissions are not made to the home until a full needs assessment has been undertaken. For people whom are self funding and without a Care Management Assessment the assessment is always undertaken by a skilled and experienced member of staff. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service obtains a summary of the assessment and a copy of the care plan. Admissions to the home only take place if the manager is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Prospective individuals are given the opportunity to spend time in the home as either a trial visit, or just a look around and a chat with the current residents. Residents spoken to said that they “had met someone” from the home prior to admission, and that “my family was involved” during this process. New residents are provided with a Statement of Terms and Conditions/Contract; this sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. This gives a clear understanding of what residents can expect. The manager promotes opportunity for discussion and clarification. Terms and conditions are reviewed on a regular basis. Standard 6 was not assessed as this home does not provide intermediate care. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place for all residents. This provides staff with most of the information they need to meet the resident’s needs. EVIDENCE: The manager and staff involve the residents in the planning of their care and how it affects their lifestyle and quality of life. Staff spoken to appeared to understand the importance of residents being supported to take control of their own lives, and evidence was available that the residents are encouraged to make their own decisions and choices as far as possible. The care plans are usually person centred and are written in plain language, are easy to understand and looks at most areas of the individual’s life. Daily reports are generally reflective of the care delivery, but it was suggested to the manager that regular audits are undertaken regarding daily report documentation (or lack of it in a couple of cases). Staff seem to have the skills St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 11 and ability to support and encourage residents to be involved in the ongoing development of their plan. A key worker system allows staff to work on a one to one basis and contribute to the care plan for the individual. Each care plan includes a number of key risk assessments for daily activities such as mobility, falls and nutrition, which are reviewed regularly, usually, but not always on a monthly basis. Residents spoken with said that they “could talk to the girls at any time”, and that “I am asked about what I want”. Medications were examined as part of this site visit, and a number of areas for improvement were noted. The recording on medication administration records (MARs) was not fully compliant with current good practice, as some MARs had transcriptions, which were not double signed, and there were gaps on numerous records, including for short-course antibiotic therapy. By not recording medications properly the staff are potentially putting residents at risk of maladministration, missed medications or ineffective antibiotic therapy, potentially leading to resistance. It was also suggested that the provider gave consideration to obtaining a better medication fridge thermometer, as the one seen was not providing accurate daily recordings. There are policies and procedures in place to ensure that residents using the service are informed of their rights to confidentiality, and an explanation of when staff may have to share personal information with necessary persons such as other health professionals. Access to advocacy services is available for all residents as they wish. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. Meals in this service are good, offering choice and variety, and cater for resident’s special dietary needs. EVIDENCE: Since the previous site visit, the provider has appointed a designated activities co-ordinator for 30 hours per week. The co-ordinator assists and helps enable able bodies and less able residents to have a meaningful activity session on a regular basis. Activities offered range from reminiscence therapy, hand massage, newspaper reading out loud and more physical large board games for those who are able. Records are kept of activities offered, but it was suggested that separate records are kept for each resident to help ensure Data Protection Act compliance. All the residents are encouraged to develop and maintain personal and family relationships, and are able to access information and specialist guidance about advocacy as needed. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 13 The manager and staff promotes individual rights and choices, but also considers protection of individuals, helping to support residents to make informed choices. There is a good level of local community involvement within the home which includes visits from local ministers of religion, luncheon clubs and local schools at Christmas and Easter time. The service is committed to the principles of inclusion and promotes and fosters good relationships with the community. The menu is varied with a number of choices, and includes a variety of dishes that encourage individuals to try different foods. Residents spoken with told us that they “loved the food”, and that there was “plenty to eat” whenever they wished, including if they are hungry at night. The meals appear balanced and nutritional, and cater for the varying cultural and dietary needs of the residents using the service. Care staff were observed sensitively and unobtrusively giving assistance with feeding for all residents who required it; and appeared aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 14 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): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment, and has a complaints procedure that is clearly written and easy to understand. The complaints procedure is available to everyone living at the home and is displayed in a number of areas within the service. Residents and others involved with the home appear to understand how to make a complaint, and said they “knew the manager would look into it” if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The Wirral policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Staff spoken to said they knew when incidents need external input and who to refer the incident to. The manager understands the procedures for Safeguarding Adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 15 incidents, rather than a lack of understanding about when incidents should be reported. Training of staff in the area of protection is regularly arranged and other training around dealing with physical and verbal aggression is also made available to staff as needed. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 16 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): 19,20,21,22,23,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the resident’s rooms are personalized, providing these residents with a homely place to live. EVIDENCE: The home provides a physical environment that meets the specific physical needs of the residents who live there. The home is comfortable and has a programme to improve the decoration, fixtures and fittings; but some areas are in need of upgrading in order to provide a safe, clean place for all residents to live. A number of carpets, especially in rooms 114, 115, 119, 203 & 213 require replacement rather than deep cleaning as they are badly stained and marked. The residents can personalise their rooms as they wish and said that they can have some input into the décor of their own rooms. Some en-suite facilities are available, and there are sufficient communal bathing areas that meet the St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 17 needs of the residents, with some bathrooms hopefully being turned into shower rooms soon, which would provide more choice for the residents. Some of the communal bathrooms seen had soaps left out on the sides of the bath – this practice must cease as it poses a risk to health and safety, and infection control risk due to cross-contamination. The residents are not always able to have the option of a single room immediately on admission and needed to share for a short time, but the staff are open and transparent about timescales and options. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. There is a consistency of care within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: Staff rotas show that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. Staff members undertake external qualifications beyond the basic requirements, and the manager encourages and enables this, recognising the benefits of a skilled, trained workforce. Accurate job descriptions and specifications define the roles and responsibilities of staff. Residents spoken with said that the “staff are nice”, and “the staff are very good in here”, but “sometimes I have to wait a bit” [after ringing the nurse call bell]. The manager ensures that most staff receive relevant ongoing training that is focussed on delivering improved outcomes for the residents; but some of the recently employed staff’s personnel files were examined, and a lack of recorded inductions was clearly evident. It is essential that all staff are thoroughly inducted into their new roles so they can practice in a safer manner and have a better understanding of their roles St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 19 and responsibilities under relevant health and safety, and other relevant legislation. The manager has a good recruitment procedure that defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality care and for the protection of individuals. Staff spoken to confirm that the management was clear about what was involved at all stages and was robust in the following of its procedure. There are contingency plans for cover for vacancies and sickness and there is little use of agency or temporary staff. Staff meetings take place regularly. Supervision sessions are held, and staff said they find them “useful”. Notes are taken of meetings and sessions. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 20 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): 31,32,33,34,35,36,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home benefits from an established staff team, thus helping to improve the quality of care given to residents. EVIDENCE: The Manager has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities, and works to continuously improve services and provide an increased quality of life for residents with a focus on equality and diversity issues. There is an ethos of being open and transparent in all areas of running of the home. The manager is aware of current developments both nationally and by CSCI and plans the service accordingly. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 21 The management team promote equal opportunities, have people skills and understand the importance of person centred care and effective outcomes for the residents. The staff’s practice, skills, and knowledge, is based on ongoing development, gained through training and enthusiasm for the role. The service has sound policies and procedures, which the manager effectively reviews and updates in line with current thinking and practice. The staff follow the policies and procedures of the home, and the staff team are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. Management processes ensure that staff receive feedback on their work. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The home has a good record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. Records are of an acceptable standard and are routinely completed, but daily records for residents could be improved, as must the recording of staff inductions. The manager ensures risk assessments are completed and taken into account in planning the care and routines of the home. The registered person appears to have the skills and ability to deliver good business planning, and effective financial controls, they provide a quality assurance and monitoring process to ensure efficient running of the home, which gives value for money and delivers effective outcomes for the people who use the service. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X 2 3 3 St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement A service user plan of care generated from a comprehensive assessment is drawn up with each service user and provides the basis for the care to be delivered. (Outstanding from last inspection). Staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines. The standard of the environment must be improved in order to provide a safe, well kept place for residents to live. Cleanliness must be improved throughout the home, especially regarding floor coverings in resident’s bedrooms. Timescale for action 10/11/07 2 OP9 13 10/08/07 3 OP19 23 10/11/07 4 OP26 16 10/11/07 St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 24 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 OP7 Good Practice Recommendations It is recommended that all resident’s risk assessments are updated, as the resident’s clinical needs change, rather than wait until monthly reviews are due. 2 3 4 OP38 OP38 OP36 It is strongly recommended that no toiletries are left in communal areas at any time. It is recommended that COSHH training is completed by all kitchen and domestic staff as soon as practicable. It is recommended that regular supervision takes place for all staff, including housekeeping and kitchen staff. St George`s Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Ltd DS0000060055.V345955.R01.S.doc Version 5.2 Page 26 - 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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