Inspection on 05/02/08 for St George`s Nursing Home

This inspection was carried out on 5th February 2008.

CSCI found this care home to be providing an Adequate service.

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 04/12/06

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 0L1 4RU Lead Inspector Michelle Haller Unannounced Inspection 09:00 5 February 2008 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 DS0000031914.V358737.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.V358737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s Nursing Home Address Northgate Lane Moorside Oldham Lancashire 0L1 4RU 0161 626 4433 0161 678 2473 admin@stgeorgescarecentre.co.uk www.stgeorgescarecentre.co.uk St George`s Nursing Home (Oldham) Ltd 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) Joanne Fogg Care Home 77 Category(ies) of Dementia (42), Mental disorder, excluding registration, with number learning disability or dementia (10) of places St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - code N, to people of the either gender whose primary care needs on admission to the home are within the following categories: Dementia - Code DE (maximum number of places: 42); Mental disorder, excluding learning disability or dementia - Code MD (maximum number of places: 10). The maximum number of people who can be accommodated is: 77. 4th December 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 (Oldham) Limited and is registered to provide nursing care to 77 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. There are three units on the ground and two units on the first floor. 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. An extension to the home was completed in April 2007. A copy of the home’s last inspection report was available from the main reception of the home. The current weekly fees range from £436 to £1200 dependent on the package of care required. Further details regarding fees are available from the manager. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection which included 2 visits to the service, of which one was unannounced. This means the manager did not know in advance that we were coming to do an inspection. During the visits we looked around the building, talked to 9 residents, 5 relatives and staff including the manager and other members of the management team. We observed the interaction between people living in the home and examined care plans, files and other record concerned with the care and support provided to people at St Georges. We also looked at all the information that we have received, or asked for, since the last key inspection. This included the annual quality assurance assessment (known as the AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well the provider and manager feel the outcomes are being met for people using the service. It also gave us some numerical information about the service. 8 surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints and adult protection investigation. What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement and we considered the information we had from the previous key inspection. What the service does well: The manager makes sure that people have their needs assessed before they move into St Georges to make sure that the service can meet their needs. Parts of the home have been refurbished and provide very pleasant and spacious living accommodation. People are able to fully personalise their bedrooms and make them comfortable and homely. The management team are working towards improving the outcomes for people living in the home through employing consultants, training, and work with local primary care trust. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 6 People who are able to make a choice are supported in the choices they take. Family involvement is encouraged and supported. The manager co-operates with the Commission For Social Care Inspection (CSCI) and aims to improve the care and support provided. What has improved since the last inspection? What they could do better: The manager should ensure that she can show that complaints are fully investigated. The manager needs to facilitate a lifestyle and activities that meet the needs of people living at St Georges so that they are kept active and entertained. Some of the equipment in the satellite kitchen on Beale Unit needed to be better cleaned. The manager needs to make sure that arrangements are in place which staff keep to, so that this area stays clean. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 7 We recognised that the manager has a period of time off work which has resulted in the residents, relatives and staff meetings not taking place as regularly as they did. The manager needs to resume these meetings to allow everyone to have the opportunity to comment on and influence the services provided. The manager also needs to make sure that systems she puts into place for such feedback are sufficiently robust for staff to continue in her absence. Training is in place, however, we did observe some practice which showed us that staff would benefit from additional specialist training to meet the diverse needs of people living in the home, and that care staff are given more guidance in how to work with people with emotional and mental health needs. 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.V358737.R01.S.doc Version 5.2 Page 8 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.V358737.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence, including a visit to this service. The manager makes sure that staff know what people need by ensuring that basic personal and health care assessments are completed before people move into St Georges. EVIDENCE: Information in the care files that we examined and from information provided by relatives and staff confirmed that people’s needs were assessed before they moved into St Georges. During the inspection a member of staff was spoken to who had returned from assessing the needs of a person who was in hospital. This is good practice supporting the manager to make sure that she is aware of the needs of people wishing to come into the home. The manager stated in the AQAA ‘If the St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 10 prospective service user has complex needs a case conference is usually held with staff from St George’s attending.’ The assessments that were looked at provided enough information to allow the personal care and health needs of people to be identified. The information included the support needed concerning: diet, moving and handling, medical health and diagnosis, mental health and diagnosis, communication and sensory needs, personal care including hygiene and continence needs. In some cases, there was a brief description of personal preferences, interests and expected lifestyle was also documented. This part of the assessment needs to provide more detailed information so that staff are aware of the lifestyle people wish to follow. The names and addresses for people who were to be contacted on the person behalf was also recorded this means that people are kept informed of requests or progress once the person has moved into St Georges. A relative commented ‘‘ Yes, Joanne (the manager) visited him before he moved into the home.’’ Other relatives stated that they had visited the home and had been made welcome prior to their relatives moving in. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 11 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. This judgement has been made using available evidence, including a visit to this service. There are inconsistencies within the care planning to adequately provide staff with the information they need to satisfactorily meet residents needs. EVIDENCE: The care plans and health care records for eight people were read through and other observations, such as the way people were spoken to and the way they looked, were made. The care plans that we read provided instructions about the actions staff must take to meet people’s needs. The clarity and relevance of the instructions varied, with some providing guidance that fully related to the individuals assessed needs while others did not. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 12 The main areas for concern related to mental health needs and dealing with behaviour that could be described as ‘challenging.’ In the majority of cases where this was identified instructions in the care plan was either unclear or omitted. Observation made during the inspection showed that peoples’ mental health needs were not always dealt with effectively. This means that some residents and staff experienced levels of stress that frequently resulted in raised voices, verbal confrontations and negative physical gestures. These observations were discussed with the manager during the inspection, she stated that a number of nurses were qualified Registered Mental Health Nurse’s. In spite of this, the behaviour management and responses to mental health needs were not effective, and so some people continued to be in agitated states. Specific risk assessments and corresponding risk management plans were in place in some instances, but there were times when identified health needs were not adequately managed. There were examples where peoples weight needed to be closely monitored and this did not take place and there were instances when the effects of specific mental health diagnoses were not planned for, so staff did not know how to get the best outcomes for these people. The care plans and dependency needs assessment were reviewed monthly and updated. The manager also wrote in the AQAA that: ‘Care plans are serviceuser specific and are updated monthly or more frequently if changes suggest that this is required.’ Correspondence, records and daily reports confirmed that people received routine and specialist health care and monitoring such as dental check-ups, opticians, podiatry and, speech and language therapy, psychiatric, nursing and other specialist input for example from the community mental health team or social work team. Daily records varied in the amount of detailed information they provided, and the information was not particularly personal, relating specifically to care plans, and so did not show that staff always saw people as individuals. We observed people were not always treated with dignity and respect, as there was a lot of raised voices, restricting of peoples movement- especially during a mealtime- and, at times, some people were ignored. Many people, especially the women were dishevelled and their hair was untidy and looked dirty. Clothes looked clean and people did appear fully dressed. The medication administration process was observed and checked, there were some gaps and some medication had not been signed into the home properly, however there has been improvement since the previous inspection and all medication was stored safely. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 13 During the inspection the manager confirmed that qualfied nurses were responsible for administering medciation, training records confirmed that medication training was provided. The majority of people who commented felt that the home usually met their care needs. Comments included ‘I think care he gets is excellent and we are involved’ and ’Quality of care is magnificent I haven’t come across any problems with staff they speak to people with respect and are lovely with them.’ And ‘The staff look after you – show you respect – I’m given a choice of what I put on.’ ‘The nursing staff are quick to call in the GP if there are any worrying health problems- water infections and chest infections, etc. The GP surgery is very good- they always come quickly.’ And ‘I’m very pleased with staff- they look after you, feed you make you feel comfortable. Although most people were content with health care provided during the inspection areas needing improvement were identified. Staff complete nutritional assessments to identify if dietary care-plans or risk assessments are needed. Dietary records were kept for some residents with poor appetites and referrals to the dietician were made. We noted that people were not always weighed with sufficient frequency to adequately monitor weight gain or loss. This was discussed with the manager. Staff need more instructions and supervision as they go about their work. This is so the standard of personal care and the way they speak to and approach people is improved. Staff will then know how to show people respect and help people to achieve their best in relation to how they look, which should then promote a feeling of contentment and good wellbeing. Staff need in-depth training in relation to working with people with dementia. Whilst we know that dementia care training is provided, the staff we observed did not demonstrate through their practice the learning they had acquired. The manager needs to make sure that care plans and risk assessments relating to mental health and behavioural issues are always developed and provide information that is up-to-date and in keeping with the latest research and ideas in these areas. The manager needs to make sure that the action is always taken to try and prevent further deterioration in health while specialist intervention is been waited for. St George`s Nursing Home DS0000031914.V358737.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. This judgement has been made using available evidence, including a visit to this service. The routines in the home are flexible and people are able to make choices. There are not enough interesting and stimulating activities organised for people living at St Georges although some people were content with the activities in the home. EVIDENCE: An activities co-ordinator and an assistant activities co-ordinator have been employed. In the weeks previous to the inspection, activities for the more independent residents had included quizzes, floor games and arts and crafts. There is a well-equipped therapeutic kitchen available and some people had enjoyed cookery. The manager stated that life story books were been compiled with the assistance of people’s families although there was no system in place for gathering the same information for people without family involvement. We spoke to the activities co-ordinator and she told us she was in the process of starting a range of activities including arts and crafts, games and outings. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 15 Residents’ comments from people we spoke to about activities and through the surveys included: ‘There are no day to day activities, we have been on a couple of meals out at local pubs, a trip to Blackpool zoo and Alexandra park last year. There is nothing going on at the home except occasional singers brought in from time to time - but they are sometimes on other units and I don’t always feel like going to the other units.’ Others commented -‘I don’t often get taken out for meals with the other patients.’ And ’no activities within the home.’ ; -‘They could do with more social interaction they used to have entertainment regularly but not any more’. And ‘Activities are a bit hit and miss- some people going out all the time.’ One visitor told us ’Very nice staff – not sure about activities- I take him to the pub for a shandy, family can bob in when they want. My daughter visits in the evenings.’ And ‘Wife can visit when she wants for as long as she likes’ The activities co-ordinator was observed speaking to people about their interests and likes and dislikes. A member of staff we spoke to said “they’re starting to arrange outings, going out for lunch next week”. The records that were kept by the activities co-ordinator were detailed and written in a respectful manner and helped to identify activities that people enjoyed. This information should be used to develop more regular individual and group activities. From records we looked at people with higher dependency needs were offered fewer activities, such as the people living on Strinesdale Unit. The Manager has acknowledged through the information supplied to us prior to the inspection (AQAA) that they have recognised that there can be improvements in this area. Improvements identified include “improving the person centred culture among the care staff through greater understanding of individual care and on going training to develop and implement an ethos. Engage service users and families in more frequent meetings to discuss how the home is developing the range of leisure and social activities they wish to see take place”. Observation of interactions between some people and some staff were task focussed. We did not observe care staff as being responsible for engaging people in meaningful activities. The provision of activities from what we observed is left to the activities personnel. It is important that all staff are able to converse with and relate to people about their interests and social expectations. Religious observance is supported and a minister visited the home and provided Holy Communion for people during the course of the inspection. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 16 People are able visit their friends and relatives freely and without restriction. The routines in the home are flexible and where people express a view their preference is respected. Comments included: ‘we make own drinks when we visit-and visiting not a problem- we can come anytime and staff are friendly and spend time with the family.’ Meals and food in the home is generally considered to be good and enjoyed by the residents. People are able to choose when to eat although this flexibility can cause problems if it is not dealt with on an individual basis. One person noted: ‘they take too long sometimes- sometimes staff are still feeding people at 10:15 and then they have to eat lunch at 12:30.’ The evening meal is served at about 17:00 and it was reported that supper was served before people went to bed or at about 21:30. The lunch on the day of the inspection was corned beef hash, cauliflower and red cabbage followed by ice cream. The mealtime that was observed on Strinesdale unit was poorly managed and the environment was unpleasant. We observed 4 people sitting at the dining table or about 1 hour before the lunch time meal was served. During this period whilst residents could have freely left the table, the staff through verbal prompts and gestures actively encouraged people to remain at the table for this period of time. The table was not laid with cutlery and neither were salt, pepper or sauces provided, and not everyone was given red cabbage. The menu is on a 3-week rotation and people had the choice of a cooked breakfast each day including bacon, eggs, black pudding, sausages, hash browns, bacon and beans, scrambled eggs. Lunch choices included of cottage pie, meat and potatoes pie, roasts, fish, lamb casserole, beef; traditional foods such as rag pudding, corned beef hash, cheese and onion pie, braised steak and other meat dishes; evening meal was usually a home made soup such as asparagus, scotch broth, vegetable, leek soup, pea and ham soup, beef and tomato soup, followed by chicken drumstick, curry and rice, steak Canadian, prawn cocktail, egg and chips and a hot deserts included apple sponge and custard, milk puddings, coconut sponge, strawberry or apple crumble; lemon sponge, fresh fruit and cheese cake jelly, chocolate mousse. The alternative choice was sandwiches. Comments about the food included: ‘It’s alright-not haute cuisine but it’s pretty good and filling- the wife brings me some in –what I like.’ Other comments included ‘The food is beautiful- always smells nice and he eats well.’ And ‘The quality of the meals is OK although some things could be improvedfor example there too many sandwiches.’ A member of staff we spoke to said “no-one complains, supper depends on what people want, usually about 21:00, and they have whatever they want – toast, whatever”. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 17 The management of meals and mealtimes needs to be reviewed to make sure that dining is a pleasant and stress free experience for all the residents. The manager must make sure that the environment is improved so that meal times are a pleasant event that promotes positive social interactions and allows people to enjoy eating their food. St George`s Nursing Home DS0000031914.V358737.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): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There is a complaints system in place with some evidence that people feel that their views are listened to and acted upon. Procedures are in place to protect people living in the home from abuse. EVIDENCE: The complaints record was requested and the manager stated that no formal log was kept but said that complaints were dealt with immediately. Not keeping records of complaints means that the manager cannot clearly evidence how she handles complaints in respect of the number received, the type of complaint (which would allow the manager to identify if a pattern was occurring) and what she has done to resolve the complaint. A comment in the service user survey was: ‘I wrote complaining about the laundry and received a verbal acknowledgment of receipt of my letter but no further correspondence regarding any follow-up or improvement.’ Further discussion on this with the manager confirmed that she had taken steps to improve the laundry system. The complaints policy was examined and this states that ‘All complaints are responded to in writing’. The manager is advised to follow this policy. This policy needs to be updated, as the contact information for CSCI has recently changed, and therefore needs updating in the procedure. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 19 In the main people felt that they knew how to complain and that they were listened to: ‘‘My daughter speaks to the nursing staff on the unit (Haven) or if things can’t be resolved she either speaks to or writes to the manager.’ And ‘Yes I know how to complain.’ And ‘if I have a problem it is generally sorted, the manager is very good- there isn’t a lot to complain about by and large no problems. The owner is also very good because he is approachable.’ In-house training in the Protection of Vulnerable Adults (POVA) is provided to staff. The programme was read through and covers: safe and good practice, what is abuse, reading through the abuse policy, highlighting the agreed Oldham MBC adult protection policy, definitions of the types of abuse, prevention, protection and skills needed to minimise the risk. The home operates an adult protection policy that is in line with the Oldham Metropolitan Borough Council (OMBC) procedure. There has been one investigation under this policy since the previous CSCI inspection and, at a meeting involving the local council and CSCI, it was found that the manager had responded correctly and taken all the steps required to deal with the problem. The training records indicate that about one third of new and established staff have received in-house training in the protection of vulnerable adults in the past 2 years. It is required that all staff should receive this training. It is advisable that the OMBC training unit POVA course should be accessed so that staff are given the opportunity to learn from people who are specialist in the area. This would also encourage more openness by giving them the chance to reflect and examine their responsibilities and role in relation to POVA issues away from the work environment. Staff who were interviewed were aware of the issues surrounding abuse and responded by saying that the training they had received was useful and said they would, after making sure that people were safe, report any allegations or suspicions to more senior staff. St George`s Nursing Home DS0000031914.V358737.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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Overall the home are clean and well decorated and people had a pleasant and comfortable place to live. The home was free of unpleasant odours. EVIDENCE: A tour of the building was completed. There are five units at St Georges, each was warm and free from unpleasant odours. A programme of refurbishment and updating is near completion and has included the installation of wet rooms with specialist baths and showers, a gym and therapeutic kitchen. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 21 This programme needs to be extended to all areas of the home because the carpets and furniture in Strinesdale and Haven were stained and dirty. The environment on Strinesdale is poor in comparison to the other units. The environment on Beale Unit is not fully adapted to the needs of people with dementia, for example, all the doors are the same colour and although signage is in use this was very pale and did not contrast with the background, the manager stated she would be taking advice from dementia care specialists in relation to this. Some equipment on the satellite kitchen on Beale Unit was dirty. We note that information supplied to us in the AQAA details that ongoing refurbishment is in place to prevent deterioration to the physical environment. Some bedrooms entered were personalised and suited the taste and needs of the occupant. The manager told us that the rooms which were less personalised were usually occupied by people who have no significant family involvement. In such instances, wherever possible, staff should identify if the person needs any assistance in personalising their room and making it more homely. People were pleased with their private accommodation and said: ‘I am very pleased with my room I have all my home comforts.’ And ‘Have a look- it’s got all that I need.’ En-suite areas with showers installed were available. These were warm, dry and seemed pleasant to use. Craftwork made by the residents was on display in the home. A quiet room for relatives to use with a telephone for private phone calls is available on Medlock Unit. People were observed mobilising around the home independently and facilities were adapted to make use easier for people and safe for staff. St George`s Nursing Home DS0000031914.V358737.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): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The staff complement is carefully managed and training is made available to ensure that staff can meet the needs of people they are caring for. EVIDENCE: Staffing numbers at St Georges are as follows on Beale unit there are 15 residents supported by 1 qualified nurse and 4 carers during the day and 1 qualified nurse and 1 carer during the night; on Brookdale there will be 10 residents supported by 1 qualified nurse and 4 care staff during the day and 4 staff in total at night; on Haven unit there are 15 service users supported by 1 qualified nurse and 2 carers during the day and 2 night staff; on Strinesdale there are 27 residents with 2 qualified nurses and 5 care staff during the day, and at night there is one nurse and 2 or 3 carers. Training records confirmed that an induction program had been introduced so that new staff are provided with training about care, health and safety, abuse and the policies and procedures of the home and basic training in moving and handling. The manager confirmed that this training was in keeping with the Skills for Care training organisation recommendations St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 23 A percentage of staff have completed fire safety, infection control, grief and loss, communication, palliative care, including the Gold Standard framework and infection control. The training organiser reported that over 80 of staff has attained the National vocational qualification (NVQ) award level 2 in care which conflicts with information provided by the manager in the AQAA which details 46.9 , although from the information provided to us during the inspection, we were unable to verify either figure. We do know that NVQ training is in place for staff at the home. The manager aims to provide care and support to people with mental health and dementia care needs. We found that staff had not received sufficient specialist training in these areas. We also observed that staff did not always respond in the best way to people with these needs. In order to provide the best support all staff should receive training relating to the different aspects of dementia care and mental health. We observed that this training should include conflict resolution, anger management, communication, and activities for people living in residential homes and the effects of different types of dementia and mental health diagnoses. Staff files were examined and each contained a copy of the application form proof of identification, a current photograph and evidence of Protection of vulnerable adults check (POVA First). Not all Criminal record certificates were in place however there was evidence that these had been applied for. Some people commented that there was a lot of staff movement in recent months. This was discussed with the manager who confirmed that members of staff had decided to apply for new jobs coming up on the refurbished units, and that attempts had been made to minimise the effects. Staff rosters indicated that when agency staff were employed the same nurses were used and they tended to go to the same units. Comments included ‘The staff are very caring and very good performing their difficult jobs.’ And ‘very nice staff’. St George`s Nursing Home DS0000031914.V358737.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): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The management of St Georges Care Centre is in the process of developing an open and responsive ethos for people involved in the home which will allow them to influence the running of the home. Health and safety issues are managed appropriately. EVIDENCE: Discussion with the manager confirmed that she had attended courses in relation to adult protection, mental health and palliative care to keep abreast of current practice. The manager is a qualified nurse. The manager discharges her duties in respect of keeping us informed of events in the home which effect the welfare of residents. St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 25 The registered provider and manager have systems in place to operate a safe financial management process which safeguards people from financial abuse. We looked at the ways in which the manager found about how people involved in the home felt about the facilities and service provided. This included meetings for the residents, relatives and staff. We found that this aspect of the home’s quality assurance is not always effective. We found that although people are able to make their views known this was not always acted on. People commented that residents meetings did not occur often enough. We looked at the records of previous meetings. The previous residents meetings showed that people had requested changes many areas including staff attitude, diet and activities. Although some changes were about to be made, people had not been informed of this and kept up to date. We note that the manager was absent from the home due to sickness from July 2007 to November 2007 and subsequently undertook a period of “rehabilitation back to work”. We saw evidence that meetings had taken place with staff, residents and relatives prior to this period of sickness, but that such meetings had not taken place whilst the manager was off sick, nor at the time of this inspection had they resumed. The manager needs to resume these meetings, and for the future, also needs to make sure that what she puts into place, is continued by senior staff in her absence. Due to observations made during the course of the inspection we decided to look at staff supervision. The manager stated that this was under development. As a part of the inspection the previous staff meeting was also read. We found that at this meeting senior staff felt that care staff needed to be supervised more closely. The manager should make sure that all staff are supervised to make sure that they do their jobs properly and that people are treated correctly at all times. The information provided by the manager in the AQAA confirmed that health and safety checks had been completed in accordance with the manufacturers and regulatory instructions. Health and safety training is included on the training calendar. The majority of staff have received fire safety and moving and handling training. Infection control and health and safety training is due to be provided and included on this years training calendar. The training organiser is developing courses in food hygiene and first aid. The number of accidents and incidents on each unit is analysed yearly. We found that this information did not show how accidents were managed however there was no indication that accidents in the home were a problem or cause for concern. St George`s Nursing Home DS0000031914.V358737.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 St George`s Nursing Home DS0000031914.V358737.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 OP8 Regulation 12 Requirement Timescale for action 01/05/08 2 OP10 12 (5) 3 OP26 23 The registered person must make sure that identified needs and how they are to be fully met are detailed in the care plans, so that staff know how to assist people to stay healthy and well. The registered person must 01/05/08 make sure that staff are supported and enabled (through appropriate training) to maintain good personal and professional relationships with residents so that they receive appropriate emotional care and are protected from abuse. The registered manager must 01/05/08 make sure that the kitchen area on Beale Unit is kept clean so that food is prepared and served in a clean and safe environment. St George`s Nursing Home DS0000031914.V358737.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 Refer to Standard OP12 Good Practice Recommendations The registered manager should consult with people living in the home about their interests and make arrangements for them to engage in activities. These activities should be varied enough and in sufficient quantity to give each person the chance of joining in at some level. This will show that all people living at St Georges Care Centre is equally valued regardless of disability, family involvement or other The registered person should consider should look at the way mealtimes are managed so that the time spent waiting for food is reduced, this will reduce confusion and stress for people waiting and so make meal times more pleasant which may encourage people to enjoy eating their meal. The registered person must make sure complaints are investigated by following the home complaints procedure, so that people know that they been listened to and their complaints taken seriously. The registered person should ensure that all staff receives training in managing challenging behaviours and breakaway techniques. The manager should give all people involved in the home the opportunity to comment on the quality of services received so that they feel able to initiate change and also to allow them opportunity to understand when things cannot be exactly as they would like. This will help to promote effective relationships within the home. The manager should begin supervising staff while they carry out their work in order to be sure that they work in a manner that is expected, so that people receive effective support in a manner that fits into the philosophy of the home. 2 OP15 3 OP16 4 5 OP30 OP33 6 OP36 St George`s Nursing Home DS0000031914.V358737.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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.V358737.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. 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