Inspection on 16/08/07 for St George`s Nursing Home

This inspection was carried out on 16th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St George`s Nursing Home 24/04/08

St George`s Nursing Home 01/02/07

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 Janet Ranson Unannounced Inspection 10:00 16 August 2007 th 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.V339354.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.V339354.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 Lynne Berry 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.V339354.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. 1st February 2007 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.V339354.R01.S.doc Version 5.2 Page 5 Fees for accommodation and care at the home range from £331. 75 to £488.77 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the key inspection, which included an unannounced site visit. The site visit took place on 16th August 2007 and covered a period of seven and three quarter hours from 10.00 until 17:45. The manager had previously completed an annual quality assurance assessment (AQAA) and a data set that gave the inspector certain information about the service. From these details a selection of service users and their relatives were invited to complete a small survey setting out their comments on identified care issues. Some of the residents who had completed the survey had also indicated they would like to speak with the inspector. In total five residents and two relatives spoke with the inspector as well as a nurse and carer. Their comments have been included in the report. The inspector also observed the staff at their work and talked to residents at the time of their evening meal. A selection of records was examined and the inspector also looked around the building. What the service does well: Those residents and relatives who spoke with the inspector said they liked the staff who were friendly and caring. One resident noted in the survey form “all the staff are quite efficient and helpful – and they’ll all help.” The staff were observed to be patient and respectful when caring for residents. They told the inspector that they felt supported in their role by the management. The residents said they felt secure and happy that their health was being monitored. One relative said he “couldn’t fault the care” provided to his relative. He went on to say the home kept him informed of any changes in his relatives condition. A regular visitor to the home felt he was made welcome by the staff and the management. The home was clean with no noticeable bad smells. Visitors and residents said the home was usually fresh and clean. Residents’ rooms were in the main homely and personalised with their own possessions. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The recording and documentation concerning care planning and monitoring could be better. Greater attention is needed to ensure the residents whole needs are taken into account. As identified during previous inspections the general maintenance of the home is not addressed in a timely manner. The television reception was poor and as such was causing upset for those residents who rely on it for entertainment. It had been reported and the manager was also aware of the problem but there had been a lack of response to improve the situation. The quality of the meals remains a source of dissatisfaction for those residents who spoke to the inspector. Food and drinks were served in poor quality crockery that was mismatched. The dessert was served on a soup dish and cups were presented without saucers. The water in the satellite kitchens was not hot enough to ensure the cutlery and crockery would be left in a hygienic state after being washed up. A plastic feeder cup was found to be heavily soiled and stained. Dishwashers in these areas would improve the situation and reduce risk of cross infection. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 8 The poor lighting in the communal areas has also been identified in previous reports. Tall trees close to the front of the property are also blocking any natural light. They should be chopped back away from the windows; this would also improve the outlook for the residents. New lighting fixtures have been purchased which should make some improvement but there was no sign of when they were to be installed. Additional supplementary lighting should be provided in the lounges for those residents who may wish to read or carry out other activities. Residents’ money held for safekeeping in the office should be accessible at all reasonable times. Alternative arrangements should be made in the event of the administrator being away from the office for whatever reason. The ratio of carers with a National Minimum Qualification at level two (or above) has improved since the last inspection but still does not meet with the minimum standard of fifty percent. The induction training does not conform to the standards laid down in the Skills for Care standards. 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.V339354.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.V339354.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 (Standard 6 intermediate care is not provided at St Georges.) Quality in this outcome area is adequate. Failing to thoroughly document the initial assessment could have an impact on the resident’s individual needs being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated she (or another senior person) would always go to meet potential residents to carry out their own assessment and to introduce herself. At this time the people could be invited to the home to sample a meal and to see for themselves what was on offer. They would also be provided with a statement of purpose and service users guide. It was recognised that this was not always possible and depended on individual circumstances. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 11 A resident wrote in response to the question; Did you receive enough information about this home before you moved in so you could decide if it was the right place for you. “I came on a days visit and had dinner and tea, had a look around the home and spoke with one or two people and decided to come on a regular basis.” Another resident wrote in response to the same question, “the next door neighbours came to look around for me and said it was OK.” The majority of residents are placed at St Georges by local authorities who are responsible for carrying out an assessment of needs. The home also carries out their own assessment. The documentation was checked. It is a pre-printed system that has been especially designed for the purpose. Providing all the “prompts” are completed the system meets with the standards. However this was not the case and there were gaps in the information that had failed to be completed. This situation has not improved since the last inspection. It is not satisfactory that carers are required to provide care without adequate details of the residents’ needs. Greater attention is required by those staff who are responsible for carrying out assessments so that they are thoroughly documented and by those who are responsible for their supervision. St George`s Nursing Home DS0000067061.V339354.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 & 10 Quality in this outcome area is adequate. Improvements are needed in the recording of care plans and related information to ensure all documentation is accurate and consistent. Failure to maintain appropriate records may result in the individual needs not being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The poor documentation, as detailed in the previous section, continued into the care planning process. The pre printed document had failed to be fully completed. The information was minimal and focussed mainly on the physical tasks and did not document emotional and recreational requirements. Monthly reviews of care had been carried out and the term “no change” documented against each date. There was no effort taken to evaluate the outcomes of the care plan or to involve the resident in this process. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 13 Records provided evidence where residents had seen their doctors, the chiropodists and opticians. The residents said they were satisfied that their health was checked and healthcare professionals were involved where the need had been identified. Two visitors said they were happy that their relative’s health was monitored. Further to this they said that the home usually contacted them or kept them informed of changes in their relatives health. Neither of the visitors could remember being involved in the care planning process. A resident wrote in the survey in response to the question; “Do you receive the medical support you need?” “The doctor comes when called and my tablets are always OK.” A Primary Care Trust Pharmacist had carried out an audit on the medications in June 2007. A report on her findings was available for inspection purposes. The manager stated that the comments and suggestions contained within the report had been addressed. Greater attention is required for those residents who are not capable of maintaining their appearance. Two residents in one of the lounges had overlong and dirty fingernails. Their clothing was soiled with food. There was no dignity in this situation for these two people. This was brought to the attention of the nurse in charge at the time. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 &15 Quality in this outcome area is adequate. The residents are not being provided with a quality of life that reflects their lifestyle and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Within the care plan there is an area that documents the resident’s previous lifestyles, hobbies and interests. This had failed to be completed in the care plan that was examined during the inspection. The absence of such important information means that the carers do not have an insight into the resident’s emotional or spiritual needs. There have been several activities organisers employed at the home. The last two did not stay long enough to make an impact. The manager explained that the person who is currently employed to provide stimulation and activity was previously a kitchen worker. It was felt that she already had knowledge of the residents and aptitude for the new role. Some of the residents said they used to have “fun and games” but had not experienced much recently. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 15 Another resident wrote in response to the question in the survey; Are there activities arranged by the home that you can take part it? “I never was much of a bat and ball for grown up people fan.” A visitor spoke at length about the care his relative received at St Georges. He was a regular visitor and said he was usually made welcome and spoke warmly of the staff. A further visitor also confirmed his satisfaction with the standard of care provided to his relative. This person said he (or his sister) was always advised of any changes to his relative’s condition. During the inspection a resident came into the office to see if someone could provide him with change for a large denomination note. He was advised that due to the absence of the administrator the safe was not accessible. This has the potential to prevent the residents from obtaining their own money and is unacceptable. Alternative arrangements must be made so that the residents have access to their funds at all reasonable times. Any arrangements regarding residents’ limitations to access their monies should also be noted in the service users guide. Each lounge has a dining area. The lighting in these areas was very poor as noted elsewhere in this report (standards 19 & 26). The daily menu was clearly and accurately documented on a wipe clean board on the wall. The evening meal was observed. The inspector asked the residents for their comments regarding this meal and the general quality of the food provided. One resident said, “The soup was vile. I’m not sure what it was supposed to be, but I would have liked a bread roll with it.” This person described the consistency of the soup as being like “sloppy mashed potato” or “wallpaper paste.” The menu stated it was vegetable soup. Another resident had left a large proportion of her sandwich. The reason given was because the bread was “not nice”. This person said she would have preferred “cut” bread. It was noted that there was a choice of white or brown sliced bread. The sweet on the menu was a bakewell tart, the residents were not happy at the appearance of this as they felt it should have had icing and cherries on it. The sweet was poorly presented on a soup dish. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 16 A further resident said he had really enjoyed the lunchtime meal of ham and pineapple. In general the residents complained about the quality of the meals provided. It is understood that the menus have recently been changed to provide more alternatives and to reflect the resident’s preferences. There are plans to totally refurbish the kitchen, which is located in the lower ground floor. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff knowledge and understanding of adult protection issues provides a safe environment to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager maintains a record of complaints that have been made to her. According to the documentation provided to the inspector prior to the inspection, there had been seven complaints in the past twelve months; they had all been resolved within the twenty eight days. The manager had responded in the appropriate manner when it was recognised that a resident might have suffered from financial abuse. A safeguarding adults investigation remained ongoing at the time of the inspection. Responses in the residents surveys all confirmed they knew how to make a complaint. Those residents who spoke with the inspector said they would speak to either their family or the “matron.” One person said she had St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 18 complained (about her television reception) but did not hold out much hope of a speedy or satisfactory conclusion. A requirement was made at the last inspection that the majority of staff still needed the appropriate training in safeguarding adult’s procedures and the prevention of abuse. This had now been addressed. Carers were able to tell the inspector that they had attended the training and to demonstrate their understanding of their individual responsibilities concerning the resident’s protection from abuse. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. St Georges fails to provide the residents with a well maintained and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a history of heating problems at this home and there was a recommendation made at the last inspection concerning it. At the time of the inspection new radiators with thermostatic valves were being installed. This means that the residents will now be able to control the levels of heating in their own rooms to their personal satisfaction. The soft furnishings, carpets and wallpaper in the bedrooms that had been refurbished, are neutral in colour giving a light and airy aspect. The residents St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 20 (and their representatives) in these rooms were very pleased with the overall result. It is understood that all the bedrooms will be redecorated to this standard. Aids and adaptations were in place to meet the residents assessed needs. The lounges had been decorated and carpeted within the last year. The general appearance of them could be improved and made more welcoming. At the last inspection (February 2006) it was noted in the report that the lighting in the communal areas was very poor. There had been no change to this situation. The design of the ceilings created gloomy areas in both of the lounges. With the absence of supplementary lighting it would be difficult for residents to read or carry out handicrafts. This situation was not helped by the close proximity of tree branches. The central light fittings in both lounge areas were insufficient having only three candle type light bulbs. In one lounge one of the three light bulbs was not working although it had been replaced later in the day. The dining areas had light fittings that were flush to the ceiling and again did not give off adequate lighting. Four replacement light fittings had been purchased and were waiting to be installed. Judging from the picture on the box they would be an improvement as they had fittings for five light bulbs. The manager was not able to say when they would be fitted. this situation had the potential to impact negatively on the resident’s quality of life and should be given greater priority. A resident in a wheel chair was positioned directly in front of a television in a lounge. The television reception was very poor. The picture was “snowing” and it was also rolling round. It was impossible to watch the programme comfortably and the resident was not capable of moving away independently. Elsewhere in the building the situation regarding television reception was similar. A resident said she had reported it “last week” but it had not improved. This person was upset as she said it was the only pleasure she had left. The manager said she was aware of the problem; it was thought to be connected with the aerial, and that it had been reported. Each lounge and dining area had small satellite kitchens. Suppers, snacks and drinks are prepared and main meals served from these areas. The majority of washing up after meals is also carried out in these areas, although it is understood that the dinner plates are washed in the main kitchen on the lower ground floor. The water from the hot tap was not hot enough for the purpose of washing up. The inspector removed a plastic feeder cup that was heavily soiled and stained and as such had the potential for cross infection. Dishwashers should be installed in both of these areas to prevent cross infection from cutlery and crockery that may not been cleaned properly. This would give the carers more time to spend with the residents. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 21 The dining tables were laid with a mix of different (non matching) plates, cups and beakers. Cups were being used without saucers; a resident said sometimes she got a saucer but not always. A large amount of crockery was unused in a cupboard. It appeared to be too heavy for some residents to use. It was emblazoned with the company logo, and was not conducive to a homely setting. The manager reported that some of the residents had purchased their own beakers. A resident told the inspector that two sets of china cups and saucers she had brought with her from home, had been broken. It is understood that a maintenance team travels between all the homes in the company attending to general maintenance works. However there is a delay between identifying work that needs to be done and the repairs being carried out. This situation continues to be a source of dissatisfaction both for the residents, their representatives and the staff in the home. The home was found to be clean with no bad odours detected. The residents and their visitors confirmed this was the normal standard of cleanliness and hygiene the home. St George`s Nursing Home DS0000067061.V339354.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 & 30 Quality in this outcome area is adequate. The numbers and skill mix of the staff meet with the residents identified needs. The homes recruitment policy and procedure provides protection to the residents from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the written responses in the surveys, the residents stated that there was “always” staff available when you need them. The visitors who spoke with the inspector also confirmed this to be the case and felt this was an area that had improved under the new manager. The numbers of staff who have left in the past twelve months was documented as eleven full time and seven part time. This is considered to be a high turnover. However the manager notes that this situation has improved over the past six months. The company has a system of “bonus points schemes” in an attempt to keep the staff motivated. The residents who spoke with the inspector said they had not noticed the changes in staffing and felt there was little they could do about it. St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 23 There has been a slight improvement in the numbers of carers with an National Vocational Qualification (NVQ) level two or above that was documented by the manager as six, with a further six working towards it. This equates to twenty seven percent of the carers, which is still below the required standard of fifty percent. Further improvements were noted in the staff training requirements made at the last inspection. Those staff members who spoke with the inspector said they had received much more training than was previously the case. They confirmed they had received (or had a date to attend) all mandatory health and safety training including moving and handling, fire awareness and 1st aid. In addition some carers are studying dementia care and domestic staff infection control. Those carers who spoke with the inspector said they had regular staff meetings and they felt supported in their role. Responding to the question, Do you receive the care and support you need? A resident noted, “If you press a button they’re there. Rarely have to wait.” The systems concerning recruitment and selection are satisfactory. All new starters have the required checks with the Criminal Records Bureau (CRB) and a minimum of two satisfactory references before they commence duty. This means that the residents are safely cared for by staff who have been thoroughly checked and cleared. It is recognised by the manager that the induction training does not comply with those of the Skills for Care standards. St George`s Nursing Home DS0000067061.V339354.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, 35 & 38 Quality in this outcome area is adequate. The manager has started to make improvements to the service but greater attention is required to ensure the documentation and systems are thoroughly carried out. Failure to do this has the potential to impact on the resident’s quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the required qualifications and experience to manage the home and has successfully completed the process for registration as a fit person with the Commission for Social Care Inspection. She has been in post for a period of seven months and has made good efforts at improving the St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 25 quality of care and life at the home and meeting with the requirements and recommendations made at previous inspections. The manager is supported by an operations manager who visits the home to provide supervision in addition to carrying out the requirements contained within regulation 26 of the Care Homes Regulations. The manager has set up meetings with the residents so that they can voice their opinions regarding their quality of life. It is also of some concern that the manager did not have access to the safe to give the residents their own money neither was she aware of the true costs of living at St Georges. It is acknowledged that the administrator is responsible for the resident’s finances and usually deals with enquiries concerning fees however the manager should have knowledge of the fees and access to the safe. It is recognised that some of the issues identified within this report are not in the managers’ control and should be addressed by the registered provider. In particular the slow response to general day-to-day maintenance. The manager had identified priorities such as staff training, quality assurance, the environment, record keeping etc. at the last inspection. She has continued to apply herself to these areas but further work is required to bring them up to standard. According to the data set returned to the inspector maintenance has been carried out on equipment and appliances as required by the manufacturer and in accordance with the health and safety legislation. It was noted in a lounge that the position of a large television blocked the identified means of escape from the area. This was brought to the attention of the manager who thought this area was no longer considered an escape route. She was advised to contact the fire service for confirmation and in view of this remove the signage that could have lead to confusion. No other hazards to health and safety were noted during the inspection. St George`s Nursing Home DS0000067061.V339354.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 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 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 2 X 3 X X 3 St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement Timescale for action 01/10/07 2. OP7 15 All newly admitted residents must first have a fully documented assessment of need carried out. This is so that the home can be certain they can meet the resident’s needs. The residents care plans must 01/10/07 document all aspects of their personal and social care needs. This is so that all of the residents health, emotional and spiritual needs can be met. The meals provided must be are appealing and of an acceptable quality. The resident’s views concerning the quality of the food must be taken into account. The lighting in the communal rooms must be appropriate and adequate for the residents needs. 01/10/07 3. OP15 16 4. OP19 13 01/10/07 St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 28 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. 3. 4. 5. Refer to Standard OP10 OP12 OP14 OP19 OP19 Good Practice Recommendations Those residents who are not capable of caring for themselves should be appropriately supported to this end. The residents should be consulted about their interests and hobbies so that they may continue with their previous lifestyle. The residents should have access to their money that has been put in the safe at all reasonable times of the day. Consideration should be given to providing supplementary lighting in the lounges for those residents who may wish to read or carry out handicrafts. An audit of crockery should be is undertaken so that the resident’s dining experience is pleasurable. Dishwashers should be installed in the satellite kitchens so that the risk of cross infection from inadequate washed crockery and cutlery in minimised. The branches from trees to the front of the property should be pruned to improve the view and the quality of light in the communal rooms. Consideration should be given to employing an on-site maintenance person to ensure that maintenance jobs are carried out in a timely manner. The television aerial should be maintained so that the residents can watch in comfort. New employees should receive induction training in line with Skills for Care Common Induction Standards. Regular meetings should be arranged so that the residents and their relatives can contribute to their quality of life. Any outcomes from the consultations should be made public. 6. 6. 7. 9. 10. OP19 OP19 OP19 OP30 OP33 St George`s Nursing Home DS0000067061.V339354.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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.V339354.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!