Inspection on 01/02/07 for St George`s Nursing Home

This inspection was carried out on 1st February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St George`s Nursing Home 24/04/08

St George`s Nursing Home 16/08/07

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 Nursing Home 30 Stamford Street Stalybridge Tameside SK15 1LD Lead Inspector Mrs Fiona Bryan Unannounced Inspection 1st February 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 Nursing Home DS0000067061.V329732.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 Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Nursing Home Address 30 Stamford Street Stalybridge Tameside SK15 1LD 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) 0161 338 6908 0161 338 5858 Mr David Hetherington Messenger ** Post Vacant *** Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (50), Physical disability of places over 65 years of age (50) St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 50 service users to include: *up to 50 service users in the category of PD (Physical disability under 65 years of age). *up to 50 service users in the category of PD(E) (Physical disability over 65 years of age). *up to 50 service users in the category of OP (Old age not falling within any other category). No service user under the age of 55 years of age to be admitted to the home. No more than 50 service users to be admitted to the home requiring nursing care. Two registered nurses to be on duty 24 hours a day. A home manager must be appointed who is a first level registered nurse and supernumerary to the above staffing levels. 14th September 2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: St George’s is a converted school, which has been extended, standing in an elevated position above Stalybridge town centre. St George’s provides nursing care or personal care for up to 50 service users. The home is owned and operated by Mr David Messenger. The home is under the day-to-day control of a full time manager, who is also a registered nurse. Accommodation is provided over two floors serviced by a lift. All of the bedrooms are single. All the rooms in the extension have en-suite facilities. Sixteen of the 28 bedrooms in the original building have en-suite facilities, whilst the others have toilet accommodation nearby. Four communal rooms offer a variety of settings in which service users are able to receive visitors, socialise and participate in activities. The home is situated near to Stalybridge town centre, close to local shops and bus routes. There is ample parking for those who choose to travel to the home by car. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 5 Fees for accommodation and care at the home range from £341.66 to £458.75 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was held on the 1st and 2nd February 2007 and was the second key inspection. The home did not know in advance that the site visit would take place. Since the first key inspection a random inspection to look specifically at how the home dealt with medicines was carried out on 27th November 2006. A short report of this inspection was given to the home and is available on request for any member of the public wishing to read it. During the site visit for this inspection time was spent talking to residents, relatives and staff and observing the home’s routine and staff interaction with residents. Four residents were looked at in detail, looking at their experience of the home from their admission to the present day. A partial tour of the building was conducted and a selection of staff and residents’ records was examined including records of care, medication records, employment and training records and staff duty rotas. The only key standard that was not looked at was the standard about how the home dealt with residents’ money as this was found to be satisfactory at the last site visit. Over the past 12 months the home has been without a permanent manager, as despite recruitment to the post 2 previous managers did not stay. This situation has had an effect on the home in that improvements sought at the last inspection have taken longer. A new manager has now been appointed who is in the process of applying for registration with the CSCI. What the service does well: Residents and relatives liked the staff and said they were friendly and caring. One resident said, “It’s lovely here, I’m very happy; this is my home”. Another resident said, “You couldn’t get anything better. It’s nice and clean. The staff are very nice. If you want anything you just press the buzzer and they come”. Another resident said, “they look after you” and “you can have a good laugh with some of them”. Staff were observed to be patient and respectful when caring for residents. Residents felt that their health was monitored and cared for properly and they said that their GP was called out if needed. One relative said she “couldn’t fault the care” and another relative said they were “quite satisfied with the standard of nursing care – two of the nurses are excellent”. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 7 Residents said their visitors were always made welcome and a relative confirmed this saying that she had been told to help herself to a cup of tea whenever she visited. No bad smells were noted in the home and everyone spoken to said the home was always nice and clean. Residents’ rooms were homely and personalised with their own possessions. What has improved since the last inspection? What they could do better: Whilst record keeping has improved since the last inspection, staff need to make sure that if a resident is admitted as an emergency, they assess all the resident’s needs as soon as possible after admission to be certain that they meet them. Care plans usually addressed residents’ personal care and physical health care needs but staff also need to develop care plans to meet residents’ mental health, social and emotional needs to ensure all care is delivered properly. Sometimes residents were assessed as being at risk for example of falls but did not have a plan in place to say how the risk would be reduced. Risk assessments also need to be updated when there are changes to the resident’s condition. Two residents did not feel that there had been any real changes for the better since the last inspection. One resident said, “There have been no real changes since your last inspection” and another said,” There have been no improvements for the better since last time you were here”. The manager St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 8 recognised that as a lot of the time during her first weeks in the job had been spent looking at paperwork some of the changes she had made would not be very apparent to residents. Time now needs to be spent concentrating on some of the issues that directly affect them so their experiences of life at the home can be improved. On the first day of the site visit a number of health and safety concerns were identified in the environment. Although, at the request of the inspector most of these issues were dealt with by the second day of the site visit, the manager needs to develop robust systems to properly check and maintain the equipment and building as failure to do this could lead to a risk to the health and safety of residents, staff and visitors. Although the manager has sent out residents’ satisfaction surveys and held one residents/relatives meeting, many residents and relatives spoken to did not feel that their views were always acted upon very quickly. As mentioned above, the manager needs to address issues which residents see as impacting on them. Staff training has been minimal since the last inspection and staff need training in a wide range of topics to be sure they have the skills and knowledge to care for the residents properly and to ensure that they use safe working practices. The manager has done a full audit of all the training delivered to date but now needs to actually book the necessary training for staff. Some of the things that the CSCI asked the owner to do at the last key inspection have not been done. The owner was asked to keep the CSCI informed of the improvements to the home and he has not done this either. There are arrangements in place (through the organisation) for the area manager to visit the home and support the new manager in her job but there was no evidence this has happened. 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 Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 10 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): 3 Quality in this outcome area is adequate. The assessment procedures for most residents ensured that the home was aware of their needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Four residents were case tracked. One resident had been living at the home for a long time and therefore her initial assessment was not examined. Of the other 3 residents, 2 had assessments completed which were reasonably detailed. The third resident had been admitted as an emergency and no care management plan from social services had been supplied. The homes own assessment was lacking in detail and risk assessments had not been undertaken. This potentially put the resident at risk that their needs might not be properly identified and met. However, discussion with the staff showed that St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 11 although the records were not fully completed they had a good awareness of the resident’s care needs and were able to recount what they were able to do for themselves and what they needed help with, so the poor record keeping did not have an impact on the standard of care the resident was receiving in this instance. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. The arrangements to meet the personal and health care needs of residents were satisfactory but further improvements in record keeping would provide greater consistency in monitoring and evaluating the care provided. The systems in place ensure that medication is managed suitably promoting residents well being. Residents and their representatives felt they were treated with respect. This judgement has been made using available evidence, including a visit to this service. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 13 EVIDENCE: Four residents were case tracked. Record keeping had in general improved since the last inspection. Care plans had been written for 3 of the residents. The fourth resident who had recently been admitted as an emergency had only very minimal care planning in place. However, as discussed in the previous section, the poor documentation was not in this case having an impact on the care the resident was receiving. Care plans for the other three residents generally addressed their physical and personal care needs in a person-centred way but social, mental health and emotional needs were not recognized and planned for. Also in some cases where risk assessments had identified the resident as being at high risk, for example of falls, there was no corresponding care plan to address this. Risk assessments were not always reviewed appropriately to take into account changes to the resident. Care plans had in the main been reviewed monthly but could have been more detailed, as they often only said that the care plan had been reviewed and was still valid, without offering any further evaluation of the effectiveness of the planned care. Records provided evidence that residents had seen GP’s, chiropodists and opticians and residents’ health was monitored, for example one resident with diabetes had regular blood sugar tests. Residents said that health care services were accessed for them if they were needed. Many of the residents had been given the flu vaccination; one resident said she had chosen to refuse it. Many of the residents and relatives spoken to said the nurses and staff were very good. One relative said, “you couldn’t fault the care” and one resident said “you couldn’t get anything better, the staff are nice. If you want anything you just press the buzzer and they come”. Another resident said two of the nurses were “excellent”. One resident who was being nursed in bed on the first day of the site visit looked clean and comfortable. Since the random inspection undertaken by the pharmacist inspector, the medicines policies have been updated to include the information required. Suggestions were made as to how to improve them further to provide specific information for staff on the actual procedures to follow within the home. During the site visit the nurse was observed administering medicines using good practices. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 14 The manager said she had started to audit the medicines to ensure that procedures were followed correctly. A new system has been developed to record when topical creams are applied; a form is kept in the resident’s room for the carer to sign when the cream has been applied. The form is then filed with the resident’s medicine administration record when it is completed. Medicines had been signed for on receipt and records were mainly satisfactory. Some residents needed photographs for identification purposes. An assessment had been undertaken for one resident who administered some of her own medicines to ensure that she was safely able to do so. The room temperature in both treatment rooms was very hot. Consideration needs to be given as to how to reduce the temperatures in both rooms as medicines should not be stored in temperatures above 25ºC. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. Efforts have been made to improve the opportunities for social interaction and stimulation for residents. Visitors are encouraged and welcomed into the home to enable residents to maintain family contacts. The provision of food within the home is variable and not always to the satisfaction of residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the last inspection one of the carers has been designated to organise activities and has been set some specific time to do this. Examination of the duty rota showed that up to about 10 hours was designated for this. The activities organiser was not available to speak to at the time of the site visit but the manager showed the inspector the record of activities that had taken place. This showed a few activities such as bingo, quizzes and sing-aSt George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 16 longs. The manager said that the activities organiser was tending to spend more of her time with individual residents rather than arranging many group activities. Time spent with individual residents was used chatting and reminiscing, reading the paper and looking at old photographs or going shopping. However, the perception of many of the residents was that there were few activities going on in the home and they did not feel that this was an area that had improved since the last inspection. One of the residents said, “one of the girls is supposed to have taken over but we’re lucky if we get bingo once a week. A screen was bought for showing films but that’s gone by the board”. Another resident said, “ Before (when the previous activities organiser was employed) there was something going on every Tuesday, Wednesday, Thursday and Friday and I would come out of my room but I don’t go into the lounge anymore as everyone is asleep”. Another resident said there were no activities, just “an odd game of bingo”. Social care plans had not been agreed with residents and individual records showed that for many residents opportunities for social interaction and leisure events were limited. The relatively small number of hours allocated to the activities organiser is spread thinly between all the residents. Visitors said they were made welcome at the home. One visitor said she had been told she could make herself a cup of tea whenever she wanted. Routines in the home had some degree of flexibility as one resident said she liked to stay in bed until mid afternoon and other residents said they could go to bed when they wanted. However, the arrangements for meals still did not suit a number of residents. One resident had asked for her main meal to be served at teatime instead of at lunchtime as she preferred this but had decided to change the arrangement back as her meal was saved from lunchtime and reheated and was therefore not very appetising. Comments about the food provided by the home were generally negative. Despite the issue being raised at the last inspection the main meal is still being served at lunchtime, which a number of residents said they did not like. Other complaints were that the food was sometimes cold, that the meat was “shredded” even if the resident did not have a problem swallowing and that there was not much choice. Comments were “the food isn’t great”, “people are sick of sandwiches”, “there is a choice of fillings in the sandwiches and you can have white or brown bread”. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 17 One staff member agreed that the food was not always good and recounted a recent occasion when “everyone went mad because the choice was spaghetti on toast or cheese and crackers”. Although a member of staff went round each day and asked the residents what their choice was for the meals the following day, no menu was displayed, although this had been requested and agreed at a residents meeting in October 2006. Residents all said they could have a cooked breakfast if they wanted one and all said that they were offered supper of a hot drink and biscuits, teacakes or toast. The home operates a four-week menu, which displayed a range of varied and balanced food. Lunch on the first day of the site visit was beef stew and dumplings, chips, carrots and green beans. The alternative written on the staff’s service sheet was turkey or cheese salad but no one was observed being served this. One resident had corned beef. Dessert was tinned mandarin oranges. However, it was noted that the menu did not fully correspond with the food that was served. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is adequate. The home has a complaints policy, which is known to residents and relatives and allows them to voice concerns. Safeguarding adults procedures are not robust enough to fully ensure that residents are protected from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure and since the last inspection the manager has opened a complaints record to log any complaints received and the action taken. However, no complaints had been recorded, although one resident said she had complained to the manager about a number of issues. The manager confirmed that she had received several complaints and recognised that it was useful to record all concerns and complaints even if they were quickly resolved, as part of the quality assurance measures in the home. In this way, minor complaints and irritations can be recognised and larger underlying causes of complaints may be highlighted. Residents and relatives knew who to complain to. However, whilst it was evident that the manager was listening and in some cases resolving the problem directly, some complaints had been passed through to the head office St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 19 and were awaiting further action. However the manager did not always communicate this to the residents/ relatives so they were not sure if their complaint was still being dealt with. Although a requirement was made at the last inspection the majority of staff still require training in safeguarding adults procedures and the prevention of abuse and dealing with challenging behaviour. The manager was aware of this but had not arranged any training. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 20 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, 25 and 26 Quality in this outcome area is adequate. Residents live in a home that is in need of some environmental improvement but some improvement has been noted in residents personal spaces and further improvements are planned. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the last inspection a new hoist has been purchased and the manager reported that 6 bedrooms had either been decorated or were being decorated. New carpets had been provided in the communal rooms but new light fittings were still on order. No odours were detected around the home and two relatives said they felt the home was always nice and clean. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 21 During a partial tour of the home on the first day of the site visit the inspector noted a number of areas of concern. The home was extremely hot (26ºC) and many people were complaining about this. Residents said they had asked to have the heating turned down in their rooms but this was not possible, as the heating system within the home does not allow for this. The lift was not working. Staff said it had not been working properly for several weeks and a part had been ordered. On the day of the site visit the lift was not working at all so residents could not move between floors but could still access their own rooms. Staff were having to carry heavy trays and pans of food from the basement to the first floor, causing a hazard to their health and safety. Minor jobs, such as replacing light bulbs, hanging pictures for new residents or repairing small items of equipment are dealt with by a maintenance team that travels between all the homes in the company. Therefore although jobs are usually dealt with it may not be as quickly as the manager or residents would like. Residents said “anything that wants doing you have to wait”. Parts of the home were very dark and gloomy as a number of strip lights and bulbs were not working. One resident said “I don’t want to go in the lounge, it is dingy and dark”. Other maintenance issues were noted that were brought to the attention of the manager during the site visit and a number of these matters were dealt with by the second day of the visit. Assurances were given that the remaining matters would be attended to. Despite the lounges being decorated and carpeted within the last year the general appearance of them could be improved. It was noted that a resident was seated in a chair that appeared to be unsafe. The manager was aware of this but had not been able to negotiate an alternative with the resident or the provider. Several double glazing units around the home were blown, making it difficult for residents to see out of the windows. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. The home usually has sufficient staff on duty to meet the needs of the residents. However staff have not received formal training to ensure care follows best practice This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Examination of the staff duty rotas for the weeks beginning 22/1/07 and 29/1/07 showed that staff levels were being maintained at the levels required under the old staffing notice issued by the health authority. Staff said that people would phone in sick at short notice and this was causing low morale. The manager was aware of this and was taking steps to deal with staff absence. Personnel files for current staff were not examined at this site visit but 2 files had been started for new people who were about to commence employment at the home. These provided evidence that their CRB’s had been applied for and the manager was waiting for their references to come back as well before they commenced employment. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 23 Examination of staff training records showed no evidence of any training since the last inspection. The majority of staff require training in topics such as moving and handling, fire safety, food hygiene, safe guarding adults and first aid. The manager has completed an audit of all staff’s training records to determine what needs to be provided and has identified various topics that she wishes staff to attend, such as the management of medicines, infection control, venepuncture and dementia awareness. However none of this training had been firmly booked at the time of the site visit. It was reported that health and safety training would be arranged by the company’s head office. Of 14 care staff 4 carers had either NVQ2 or 3. One carer was undertaking NVQ2, 2 carers were undertaking NVQ3 and 1 carer was undertaking NVQ4. These figures do not meet the expected ratios of staff having NVQ’s to meet the standard. Inspection of the induction programme in use at the home showed that it was not in line with the Skills For Care Common Induction Standards and needs to be updated. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is adequate. The manager and provider are not sufficiently monitoring the care and health and safety for residents and staff. Residents have had limited opportunities to comment on how the home is run and systems to monitor and improve service quality are not good enough. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the last inspection a new manager has been appointed, who is in the process of applying for registration with the CSCI. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 25 The manager has identified priorities such as staff training, quality assurance, the environment, record keeping etc. and has made a start on a number of them such as updating policies and procedures, undertaking environmental assessments, commencing staff supervision sessions, introducing a complaints log, providing COSHH data sheets and developing new menus. However, 2 residents spoken to did not feel that there had been any significant improvements in the operation of the home since the last inspection. One resident said, “there have been no real changes since your last inspection”. Another resident said, “There have been no improvements for the better since last time you were here”. A residents/ relatives survey had been sent out and one residents’/ relatives’ meeting was held in October 2006. Some issues were discussed and action agreed which has not yet been not carried out, for example residents said they would like whiteboards on the dining room walls to display the menus but this has still not been done. It was agreed that there would be another meeting in a month to review progress but no further meetings had been held. Residents and relatives all confirmed that they saw the manager around and about the home “from time to time”. However, no one said they actually spent any significant time with the manager giving their views or suggestions about the home. This was discussed with the manager who agreed that since she had started working at the home her time had been spent mainly in the office dealing with paperwork and she hoped to be able to start spending more time with the residents in the near future. The manager also acknowledged that further meetings should be held with the residents or their representatives to review the changes that were being made and gain feedback from them. The manager was not getting sufficient support from the owner of the home as there was no evidence that regular visits to monitor the quality of the home had been undertaken. A number of health and safety issues were identified at this site visit, these were discussed with the manager. St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement The registered person must ensure that where risks to residents are identified a care plan is developed to minimise the risk. Risk assessments must also be reviewed to reflect changes to the residents’ condition so that any further care or action needed can be provided. (Timescale of 07/11/06 not met). There must be at least one staff member trained in 1st aid on each shift. All staff must receive training in safeguarding issues. Any member of staff who is involved in the preparation, cooking and serving of food must receive training in food hygiene. Any member of staff who is involved in moving and lifting residents must receive training in how to do this properly. Timescale for action 31/03/07 2 OP18 13 30/06/07 St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 28 3. OP38 13 The registered person must ensure that health and safety checks, servicing and maintenance of the building and equipment are carried out in compliance with Health and Safety legislation. 30/04/07 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 OP3 Good Practice Recommendations The registered person should ensure that a full assessment is undertaken as soon as possible after admission for any resident coming into the home as an emergency. The registered person should ensure that all medication retained within the home is stored at the appropriate temperature. The registered person should ensure that further consultation is arranged with residents to discuss their wishes regarding social activities in the home. The registered person should ensure that further consultation is arranged with residents to discuss their wishes regarding the food provided by the home. The registered person should ensure that residents care plans address all aspects of the health, personal and social care needs of the residents. The registered person should ensure that residents or relatives are clear about the outcome of any concerns, complaints or suggestions they make. The registered person should consider employing an onsite maintenance person to ensure that maintenance jobs are carried out in a timely manner. DS0000067061.V329732.R01.S.doc Version 5.2 Page 29 2. OP9 3. OP12 4. OP15 5 OP7 6. OP16 7. OP19 St George`s Nursing Home 8. OP20 The registered person should consider the layout of the communal rooms to make them more appealing and homely for residents. The registered person should ensure that residents are able to individually control the heating in their own rooms. The registered person should ensure that blown double glazing units are replaced. The registered person should ensure that the dependency of the residents is taken into account when determining how many staff should be on duty. The registered person should ensure that 50 of the staff group are trained to be NVQ level 2. The registered person should ensure that new employees receive induction training in line with Skills for Care Common Induction Standards. The registered person should ensure that Regulation 26 visits are carried out at the home at least once a month and a report supplied to the CSCI. The registered person should ensure that proper audit systems are set up to monitor issues such as health and safety, record keeping and practices and procedures within the home. The registered person must ensure that residents care plans address all aspects of the health, personal and social care needs of the residents. The provider (or his representative) need to complete a report of their monthly visit to the home to demonstrate they are monitoring and evaluating the care provided. 9. 10. 11 OP25 OP25 OP27 12. 13. OP28 OP30 14. OP33 15. OP33 16 OP33 St George`s Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Nursing Home DS0000067061.V329732.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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