Inspection on 04/12/06 for St George`s Nursing Home

This inspection was carried out on 4th December 2006.

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 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 05/02/08

St George`s Nursing Home 26/01/06

St George`s Nursing Home 15/06/05

St George`s Nursing Home 17/11/04

St George`s Nursing Home 26/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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 Northgate Lane Moorside Oldham Lancashire OL1 4RU Lead Inspector Tracey Rasmussen Unannounced Inspection 4th December 08:45 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 DS0000031914.V319913.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 DS0000031914.V319913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Nursing Home Address Northgate Lane Moorside Oldham Lancashire OL1 4RU 0161 626 4433 0161 678 2473 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) www.stgeorgesnursinghome.co.uk St George`s Nursing Home (Oldham) Ltd Joanne Fogg Care Home 55 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (20), Physical disability (15), Physical disability over 65 years of age (25) St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No Service User to be admitted into the home who is under 30 years of age. The Manager must be supernumerary at all times. A minimum of 2 Registered Mental Nurses and a minimum of 2 Registered Nurses must be on duty between the hours of 8 a.m. and 3 p.m. A minimum of 1 Registered Mental Nurses and 2 Registered Nurses must be on duty between 3 p.m. and 8 a.m. Service users to include up to 20 OP, up to 20 DE, up to 30 DE(E), up to 15 PD and up to 25 PD(E). 26th January 2006 Date of last inspection Brief Description of the Service: St Georges Nursing Home is a purpose built nursing home, which was first registered in October 2002. The home is owned by St Georges Nursing Home Limited and is registered to provide nursing care to 55 people, primarily to older people with dementia type illnesses. The home also offers general nursing care unit and an early onset dementia facility on the ground floor. St. Georges is situated in Moorside, approximately three miles away from Oldham Town Centre. Access to the Pennine Moors is literally minutes away. Local amenities and access to local bus services are readily available. Close to the home is a new housing estate and a medical practice centre has recently been built. Outside the home, some borders have been planted, patio areas developed and other areas around the building have been grassed. Limited car parking facilities are available. Accommodation is provided over two floors. Each floor is split into two separate suites and each suite provides a lounge, dining room and bathroom facilities. Keypad security locks are used in the home. All bedrooms are spacious single rooms providing en-suite facilities. Varied bathing facilities are available on each floor. Facilities are also available for service users and visitors to make a drink. The home is currently being enlarged and a side extension to the home is being built. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 5 The home is a no-smoking home. A copy of the home’s last inspection report was available from the main reception of the home. The current weekly fees range from £469.26 to £935.00 dependent on the package of care required. Further details regarding fees are available from the manager. There are some additional charges for personal items, escort service and some hairdressing requirements. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced key inspection site visit on the 4th December 2006 The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents (however it should be noted that conversation with the majority of residents was difficult due to the severity of their illness); talking with visitors; interviewing the manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. Two requirements were made at the last inspection and these had been addressed although recommendations to improve further have been made. One requirement and a number of recommendations have been made at this inspection. A brief explanation of the inspection process was provided to the manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback of the findings from the inspection visit. What the service does well: The home was peaceful and offered a relaxed atmosphere. On the Beal Unit resident’s were very active walking about whereas on the other units residents were more sedentary. Staff were friendly with residents and went about their duties in a professional manner. Residents living on the Haven unit said, “I have been in another home. It was not as good as this. Nurses are terrific” and “staff are pleasant and polite”. Visitors in the home said, “staff are very good” and “It is the nicest home I have ever been”. The home was clean and odour free and provided modern single roomed accommodation. Visitors were welcome into the home and meals and food were described as good. Equipment and facilities to meet the different and varied care needs of the residents was available. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 7 Complaints were treated seriously and investigated properly as the home’s procedures requires. Most staff had had training to ensure residents were safeguarded as far as possible from abuse and they knew what to do if they suspected abuse. Employment recruitment practices were reasonably safe so staff who may have posed a risk to residents were not employed. Staffing levels in the home were appropriate to meet the needs and dependency levels of the residents. Staff had had training and over 60 of the care staff team had a NVQ 2 qualification. Quality assurance systems were established which means standards of service were monitored and improved when issues were identified. Resident’s personal monies were maintained safely and health and safety practices were safe. What has improved since the last inspection? What they could do better: On the whole the home provides a consistent quality standard of care but this site visit identified a number of areas that need improving to ensure the continued wellbeing of residents. Medication practices do need to improve as a priority. Medication for one resident on Beal unit had been borrowed from another unit because they had ran out and one resident on Haven unit had not been administered one of the prescribed medications because it was also out of stock and had been so for a number of days. Other areas of medication practice need also reviewing and improving to ensure safe working practices are promoted. The manager confirmed she would review and improve medication practices. Care plan documentation needs to be improved and developed so care plans are recorded consistently for all care needs and this information needs to be ‘person centred’. This means that information about the resident’s personal wishes and preferences should also be included. Evaluation of the care plans should also be undertaken so that the effectiveness of the care provided to residents is reviewed and changed if necessary. Social stimulation and support needs developing. The home had been without an activity person since September. The manager stated she was attempting to recruit some one to this position, however residents and staff spoken with said that there was very little going on. Records of activities that residents joined in should be recorded and information about whether the resident enjoyed or benefited from these noted. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 8 Attention is also required to ensure that employment vetting records include the start date of the new staff member and full working histories should be obtained. Some care staff work shifts in excess of 14 hours. This should be reviewed so that resident care is not compromised by tired staff. All staff should receive training in managing challenging behaviour and breakaway techniques. The home should ensure that the information guides (Statement of Purpose and Service User Guides) are readily available in the home and a copy of the home’s terms and conditions are included with the service user guide. Signed copies of the home’s terms and conditions should also be held in the home. 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 DS0000031914.V319913.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 DS0000031914.V319913.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): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supplied with information about the services the home offers and so can make a fully informed decision about the suitability of the home. Resident’s needs were assessed before they moved into the home and the home confirmed they could meet the needs of the resident on admission. EVIDENCE: The manager reported that the home’s information guides (Statement of Purpose and Service User Guide) were usually readily available from the reception area of the home. These information booklets explain what services and facilities the home offers to people. At this visit the manager had to print copies of the Service User Guide and place them at reception. Copies of St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 11 previous inspection reports were available at the reception and a notice board contained information about the home. A copy of the home’s Statement of Purpose was not available and this should be also available in the reception. The Service User Guide did not have a copy of the home terms and conditions of residency but the guide did contain information in relation to fees and periods of notice. One resident spoken with said she had a copy of the information guide which she was given two years before, when she arrived in the home. A relative said she felt sure she had a copy of the guide at home but couldn’t be sure because she received so much information about her relative’s placement in the home. Copies of signed terms and conditions of residency were not available in the home, however service agreements from the local authority were available. A copy of the home’s terms and conditions was provided to the inspector and this stated that the information was available in large print, audio cassette and other languages if required to meet individual and specific care needs. One resident and one relative did confirm that they received written notification about any changes in fees or service. Staff spoken to were not aware of the fees resident’s paid or the terms and conditions of residency. Three resident care files were seen, one from Beal, Haven and Strinesdale units. These contained detailed information about each of the residents care needs. The care records on Haven and Strinesdale units included information that indicated that the home had made pre-admission assessments or checks on the resident’s care needs before they came into the home. This enabled the manager of the home to assess whether the new resident’s care needs could be met properly by the services provided in the home. One newer resident in the home confirmed that the manager came out to see him and chatted with him about the home and his needs. He said ‘I have been in another home it was not as good as this. The nurses are terrific’. A pre-admission assessment for a newer resident on Beal Unit was not readily available. This is necessary so the home can ensure it can meet the needs of new residents. Other professional assessments from social workers and from community nurses were available on all the residents care files seen. Care records on Haven and Strinesdale units had written care plans detailing the type of care and support that would be required in response to the identified needs from these assessments. Not many residents living in the home could comment on the quality of service provided in the home due to the severity of their illness. But two residents and one relative were positive about the home. One relative said; ‘staff are very good’ and a regular visitor said ‘It is the nicest home I have ever been in’ St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 12 Intermediate care (standard 6) is not provided. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Residents receive care and support in a respectful and dignified manner. Some of the care planning documentation was not sufficient to meet the personal and health care needs of residents. Medication practices are not safe and therefore potentially put residents at risk through poor practice. EVIDENCE: The home provides nursing care and support across a range of needs which includes younger and older people with dementia and general nursing care. Only a couple of residents were spoken with at this visit but both provided positive feedback about living in the home. Comments included; “they respect your needs and wishes” and “staff are pleasant and polite”. The home was calm and peaceful. On each unit good interactions between staff and residents were observed. Staff chatted with residents in a calm and relaxed manner. Residents were on the whole presentable and dressed St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 14 according to their preference and age. Some residents were cared for in bed and this was reported to be in response to their care needs. One resident said that he was much more comfortable in bed. Records of contact with community health services such as GP, community mental health teams, chiropody and optical support were available. Staff spoken with were positive about working in the home. Staff said they were trained and supported to do their job and several had achieved a NVQ 2. Three care planning records were seen, one from Beal, Haven and Strinesdale. The quality of the information recorded was variable. On the Beal unit a newer resident’s care plans frequently referred to identifying the resident’s preferences for example ‘note likes and dislikes’ and ‘on admission note all interests and hobbies’ and ‘note the importance of religious spiritual needs’. Information to identify that staff had responded to these interventions and taken the time to sit with the resident and relatives to find out likes, dislikes and preferences were not available even though several weeks had passed since admission. Evaluations of care plans on Beal unit were also inadequate in that they consisted of a review date with no information about the effectiveness of the care delivered or the progress achieved with the resident. A recommendation, made at the last inspection to ensure meaningful evaluations about the quality of care being delivered and it’s effectiveness had not been implemented. By contrast the care planning information seen on Haven unit was detailed and person centred which means that information about the resident’s preferences, likes and dislikes was used in the care planning process. The care plan seen on Strinesdale was reasonably detailed but would benefit from more person centred information. Care plans viewed contained assessment information based on the activities of daily living, moving and handling, nutritional, falls, skin and Waterlow pressure area risk assessments. However where a risk or need was identified a care plan had not been consistently recorded. Care plans did include references to promoting privacy and dignity. One care file did refer to using restraint but did not specifically detail this intervention and it is strongly recommended that the home undertakes a risk assessment of these interventions and involves appropriate next of kin and professionals in the risk assessment process. The CSCI must also be informed of all incidents involving restraint. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 15 Each unit has a secure medication storage room. The medication storage room on Beal unit was not accessible due to the building work being undertaken at the side of the existing home. Medications were being stored on the Haven unit. At this visit medication was only reviewed on the two downstairs units of the home. Controlled drugs and medications stored in refrigerators were satisfactory. However there were two incidences of the home running out of medication for two residents. Medication was being ‘borrowed’ from another resident for one of these residents and the second resident had not had his medication for a number of days. This is unsatisfactory and must be improved. This was discussed with the manager and she stated she would implement systems to review medication procedures and practices to ensure similar situations do not reoccur. A number of other areas of development were also required and these included up dating nursing staff medication administration signatures, ensuring a photograph of the residents were available on the resident medication record; ensuring handwritten additions to the medication record sheet were signed and dated by the person writing on the sheet and record of all medication disposed of is maintained. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. Social activities and stimulation needs to improve to ensure the diverse needs of the residents are met. Residents are offered a choice of meal at mealtimes and the quality of the food was good and nutritious. Lifestyle preferences were respected and visitors were welcome. EVIDENCE: The home has not had a activities coordinator since September and as a result the quality of planned activities has been variable. The nurse on duty on Beal unit said that they tried to go out with residents as often as possible. One staff member said activities included going into town shopping, visiting Dovestones, going out for a pub lunch and on occasion trips out in the minibus. In contrast one resident on Haven unit said –‘there has been no co-ordinator since September’. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 17 ‘There is nothing is going on’ and ‘there are no spare staff to go shopping’. A visitor to the home said, ‘there is an occasional pub lunch; they use to do skittles and throwing the ball – but activity person has left”. Observations in the home including the upstairs units did indicate that there was little social stimulation being provided. Care planning records could also be more detailed so that social preferences were recorded and the types of stimulation residents responded to noted. The manager was aware that the social aspects of the service does need developing and as interim measure each unit had been allocated a budget to spend over Christmas to make the festivities special. Staff were polite and supportive to residents and residents responded positively to staff. Routines in the home enabled residents to make some choices such as rest and retirement times. Residents that could (Haven Unit) confirmed that the daily routines were flexible. “I prefer to stay in bed’ and ‘I have a shower every other day’ were examples provided by a resident of how his preferences were respected. Visitor confirmed that they were welcomed into the home and confirmed that staff “respect needs and wishes” of residents. A choice of meals were provided from breakfast where a cooked meal was provided every day to tea time. Menus were available and these offered a three week rolling rota. One resident said he had for lunch “cottage pie, carrots and cabbage and peaches and cream – it was very nice”. The home does hold catering meeting with the residents but it was reported that not many resident attended this. It was noted that in some lounge areas where meals were served advice notices were pinned up for staff. This does detract from the homeliness of the home and they should be removed. St George`s Nursing Home DS0000031914.V319913.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 good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that staff are trained to respond appropriately to suspected abuse. Residents can also be confident that all complaints will be treated seriously. EVIDENCE: Since the last inspection visit the manager had received one complaints and this had been responded to according to the home’s complaints procedure. Records were available of the complaint and this included the actions undertaken in response to the complaint were recorded. Residents and visitors spoken with said they wasn’t aware of the specific complaint procedure but said they felt able to speak with both the manager and the owner of the home if they had any concerns. Staff responded appropriately when asked about complaints by indicating they would direct the complainant to a senior person. Most staff reported that they had received training in abuse and the protection of vulnerable adults and were able to discuss the content of their training and St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 19 relate it to the home environment. Records were available of staff training. Staff also confirmed they had undertaken NVQ training and this also included information and training in abuse. Staff who have not had this training should be provided with it. There has been two safeguarding adult protection meeting recently at the home both were in relation to residents allegedly causing injury to each other. Following the second incident a formal notification to the CSCI and the safeguarding adults unit in Oldham were not provided in a timely manner. In response this the manager had identified a weakness in the home’s reporting strategy and had developed a flow diagram showing the procedure to be followed following an allegation of abuse. Copies of the flow diagram were displayed for all staff in the offices on each of the units. The home’s staff room also had various information displayed on abuse and what to do if abuse was suspected. St George`s Nursing Home DS0000031914.V319913.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well maintained home that was clean and odour free. . Specialist equipment is available which means the different needs of each resident could be met promptly. EVIDENCE: The home was clean and odour free and domestic staff were observed to be thorough in undertaking their duties. Residents’ bedrooms were warm and bright and had been made homely with their possessions. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 21 An extension was being built on one side of the home and this had resulted in some communal areas being affected slightly. Assurances were provided that this was a short term measure which would only be in place until the new building had been completed. It was noted that some areas in the homes such as walls and upholstery were showing evidence of wear and tear. The manager reported that all these areas were being addressed in conjunction with the furnishing of the new building. The kitchen and laundry areas are situated on the ground floor of the home and were not seen at this visit. The maintenance man was observed working in the home. His duties included attending to the day to day repairs, general maintenance of the home and monitoring health and safety. Service reports were available which detailed the on going maintenance in the home and this included fire safety records. A variety of equipment was available in the home to ensure the physical care needs of the residents could be met in a timely manner. St George`s Nursing Home DS0000031914.V319913.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 good. This judgement has been made using available evidence including a visit to this service. Recruitment vetting practices, staffing levels, training and skill mix were on the whole, appropriate to meet residents’ needs and promote their health and safety. EVIDENCE: The home had a peaceful atmosphere and all staff spoken with were pleasant. Staff were positive about working in the home. Comments from residents and visitors included; “The Nurses are terrific”; “Staff are very good” and “Nice friendly staff”. Three employment files for newer staff to the home were seen and all three had PovaFirsts available, however the start dates of the new employees were not available therefore preventing a thorough check from being undertaken. One staff file had only one reference although the manager said she thought this had been received. Full and thorough checks are needed to ensure far as possible that new staff working in the home do not have a history of abusing people. Start dates and full working histories are also required. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 23 Records were available to indicate that the home did train staff from the start of employment with induction training to on-going training and NVQ. The manager did state that the induction training was going to be reviewed to ensure it complied with Skills for Care. Other staff members detailed various training courses they had attended and these included health and safety, fire safety and abuse. A number of staff had had training in managing challenging behaviour, however some of the care staff spoken with had not had this training. This should be provided particularly for staff working in high risk areas. It was reported that over 60 of care staff had got their NVQ 2. The staffing rotas were available and indicated that staffing levels were maintained at appropriate levels to meet resident’s care needs. Although the home did still allow staff to work shifts of over 14 ½ hours. This is a concern because it is unlikely staff can provide the same quality of care at the end of a shift as provided at the beginning of their duty shift. St George`s Nursing Home DS0000031914.V319913.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home, on the whole, promotes the health, safety and wellbeing of the residents. Residents do have a say in how the home is run so they are provided with opportunities to contribute to the daily routines of the home and arrangements are in place to ensure resident’s money is safe. EVIDENCE: The manager is a registered nurse and has started training for the Registered Manager’s Award. Discussion with residents, staff and visitors indicate that the manager’s style of management is one of openness. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 25 The manager acknowledged that one area of communication in the home did recently break down but she had reviewed this and implemented a strategy to prevent this from happening again. The home had established quality-monitoring systems that included regularly auditing of different aspects of the service provided; regulation 26 notices were available and monitoring of staff sickness, accidents and incidents. Questionnaires had been sent out to resident and relatives and minutes were available of a recent relative and resident meeting. The notice board at reception contained feedback from both questionnaires and meetings. Staff meeting had been undertaken and minutes were available. Systems were in place to hold resident’s personal money safely. Fire safety records and maintenance records were available these were up to date and indicated regularly monitoring and checks were undertaken in the home. Practices observed in the home followed health and safety guidelines. St George`s Nursing Home DS0000031914.V319913.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 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 St George`s Nursing Home DS0000031914.V319913.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. 2 Standard OP9 Regulation 13 Requirement The registered person must ensure that medication practices are developed and improved to ensure that residents do not go without prescribed medication. Medication must not be ‘borrowed’ from another resident. Timescale for action 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The registered person should ensure that the Service User Guide, including a copy of the home’s terms and conditions of residency and a copy of the Statement of Purpose are readily available in the home. The registered person should ensure that signed copies of the home’s terms and condition of residency are held for each resident in the home. The registered person should ensure that all prospective residents in the home benefit from a recorded preDS0000031914.V319913.R01.S.doc Version 5.2 Page 28 2 3 OP2 OP3 St George`s Nursing Home 4 OP7 5 6 OP12 OP8 7 OP9 8. 9 10 OP12 OP27 OP29 11 OP30 admission assessment and this readily available and used to develop appropriate care plans. The registered person should ensure that all interventions that may be considered restraint are risk assessed and next of kin and professional care managers are involved in the risk assessment process. The registered person should ensure that person centred social stimulation is provided to each resident and this is recorded within his or her plan of care. The registered person must ensure that care plans reflect the person centred care and interventions provided in the home and these are regularly evaluated for their effectiveness The registered person must ensure medication administration signatures are updated: a photograph of the resident is available with the resident medication record; handwritten additions to the medication record sheet are signed and dated by the person writing on the sheet and a record of all medication disposed of is maintained. The registered person should ensure that an activity person is recruited for the home as soon as possible. The registered person should ensure that the homes practice of allowing staff to work shifts of 14 plus hours is reduced. The registered person should ensure all the required employment vetting documentation is obtained including staff start dates and this is filed appropriately so that the required amount of information is obtained to enable informed decision making. The registered person should ensure that all staff receive training in managing challenging behaviours and breakaway techniques. St George`s Nursing Home DS0000031914.V319913.R01.S.doc Version 5.2 Page 29 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 DS0000031914.V319913.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. 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