CARE HOMES FOR OLDER PEOPLE
St George`s Residential Home St George`s Road Millom Cumbria LA18 4JE Lead Inspector
Nancy Saich Unannounced Inspection 1st March 2006 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 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 Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St George`s Residential Home Address St George`s Road Millom Cumbria LA18 4JE 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) 01229 773959 Goldcare Facilities Management Limited Ms Janet Bosanko Care Home 38 Category(ies) of Dementia - over 65 years of age (5), Learning registration, with number disability (1), Old age, not falling within any of places other category (37) St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 37 older people (OP) of whom 5 may have dementia (DE(E)). 1 Person over 18 years of age with a learning disability (LD) Sufficient staff must be on duty at all times to meet the specialist needs of people in the service user categories identified. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 26th July 2005 Date of last inspection Brief Description of the Service: St Georges is a residential home that offers care and services to people in the categories described above. The home is a Grade II listed building that has been extended and adapted to provide accommodation for up to thirty-eight people. The home is set in its own grounds and is within walking distance of the centre of Millom.The home is owned by Goldcare Facilities Management Limited and Janet Bosanko manages the home on their behalf. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started around 9.30 in the morning and lasted until mid afternoon. Nancy Saich, the lead inspector, met with the residents either individually or in groups. She also spent time with the staff on duty and the manager. She met visiting friends, relatives and other visitors and discussed things in the home with all of these people. She also gathered information by sending out questionnaires to all of the above people some weeks before the visit. She went all around the building and checked on records and documents that backed up what she saw or what was said to her. What the service does well:
The home is good at making sure that residents get good health care and there was evidence on the day that showed that residents saw the doctor or nurse when they needed. The staff in the home were seen treating the residents in a dignified and respectful way. The residents said that the staff treated them well and were careful about keeping things private. One person said “I find the staff very courteous…overall they are first class…”. Another person said, “Everyone does a very good job…” Residents and visitors on the day talked about activities and their daily lives. Most people were happy enough with what was on offer and some people had ideas for how to improve this. Relatives said they were made welcome in the home and that local groups and individuals were encouraged into St.Georges. Residents were happy with the food provided and said they had enough choice of well-prepared food. The home is fairly good at listening to residents concerns and complaints and the manager agreed to look at keeping good systems in place to make sure that residents always feel satisfied with the care and services they get. The home is clean, warm and comfortable for the residents. They said they felt relaxed in their home and that staff kept their rooms tidy and did their washing properly. The staff in the home have received the right kind of training so that they can do their job properly. They were enthusiastic about training and several people said that training had helped them look at how they spoke to residents and how they supported and helped them. They felt that the training had allowed them to look at the way they did things in a practical way.
St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 6 The home’s manager is a fit person to run the home, being of good character and having enough experience and training to run the home. What has improved since the last inspection? What they could do better:
The manager had admitted someone who was under the age of sixty-five and this goes against the conditions of the home being registered. She must make sure she doesn’t do this again unless she applies to the Commission for Social Care Inspection for a temporary change to the registration. The manager agreed that she needed to look again at the way residents were helped to make choices about daily living and about the way things developed in the home. One or two people said that they wanted some changes and things done differently. The inspector recommended some areas where the manager might want to think again about how to involve residents. People told the inspector that there had been some staff shortages due to ill health. One or two people felt that this meant there were some problems with covering shifts and staff breaks. The manager discussed how she was trying to makes sure that she had enough staff to deal with any absences. The roster
St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 7 showed that staff ratios had been a problem but were improving. It was recommended that the manager makes sure this keeps on improving. The manager needs to make sure that she keeps asking residents and other interested parties about matters of quality. The inspector also asked residents and relatives to keep talking to the manager when they had concerns or suggestions. She also needs to make sure she can work towards improving the quality of care and services. She needs to be open about future planning so that residents can see that action is being taken to move things forward. The owner of the home needs to put together a plan to show residents, staff and visitors how things will be improved in the future. This business plan needs to be sent to the inspector with some more details of how much will be spent on the business in the future. 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. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 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 Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is normally good at this but has admitted one person who they were not registered to take. EVIDENCE: The inspector spoke to newly admitted residents and with a social worker who all said that the manager had gone out to see new residents and checked that they would fit into the existing group and that the staff could give them the kind of care and attention they need. One person who said this had been done very well was not over age sixty-five and this meant that the manager had gone against the terms of the registration. The inspector did not think that in this instance the admission was a problem as the person was shortly leaving the home. The manger needs to make sure that she applies to change the registration categories before a younger person is admitted. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The home is working on making improvements in all of the above areas so that the way they deliver care is as good as it can be. EVIDENCE: The inspector read all of the care plans and saw that the manager and her staff had made a lot of improvements to these written plans that help residents to get the kind of care they need. They were more detailed and had been signed by residents. Staff were aware that they were important and were hoping that they would soon reflect the good care they felt they gave residents. The inspector is prepared to give the manager more time to get these plans right for residents. The inspector judged that daily notes also need to be written with the care plans in mind. The manager discussed how she was going to improve this bit of the records. There were one or two issues that came up in the returned questionnaires that the inspector felt the manager needed to do a little work on. These were about talking to health care professionals and the manager agreed to look at these things. The inspector will check this again at the next visit. The residents said that they got to see the doctor or nurse when they needed to. The inspector saw a couple of examples in the notes when the records
St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 11 didn’t show what the doctor said or when the nurse visited. These problems are dealt with in the standard about records (See Standard 37 below). Apart from one person who thought that sometimes the nurse didn’t visit as quickly as they wanted, residents were happy with the way their health was looked after. Medicines kept in the home were checked on and they were all in order. The manager had improved all the systems and staff had attended training. Staff were careful to give out the medication without being distracted and the inspector thought that this meant the staff were focussing on getting it right all the time. Residents said that the staff treated them properly and helped them keep their dignity and privacy. Questionnaires also said that residents were treated properly. There were some queries raised about staffing levels and how the staff responded to needs. This is dealt with later in the report under ‘staffing’. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents have good life choices but further consultation might make this even better. EVIDENCE: Residents said that they were happy enough in the home and they did, more or less, get what they wanted. One or two people said they wanted to do more and were a bit bored. However the staff and the manager and some of the other residents said there were things to do. A number of people were enjoying a regular film afternoon during the inspection. The home does have an activities organiser and the manager said that they tried their hardest to give people things to do and to get them out. Staff said that often this was difficult as residents then changed their minds. The manager and staff said they were prepared to look again at how they helped people to have choice and control about activities. The visitors book and the returned questionnaires gave a picture of a home where relatives and friends were generally made very welcome and this meant that there were a lot of visitors in and out of the home. Some residents do go out to town alone and staff said they did try to take residents out when they could. The residents have visits from community groups including visitors from the nearby church.
St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 13 The inspector thought that there were some things about the daily routines (for example the time that people went to the dining room for lunch and what kind of activities there are on offer) that could be looked at again to give residents just a little more choice and control and the manager agreed to look at this when she did the quality assurance checks. These things were a few simple things that might just help residents feel more in charge of things. The residents said that the food was really good quality and that there was plenty of choice and that they could have snacks and drinks when they asked. One or two people made snacks and drinks themselves in the small kitchenette and they liked being able to do this. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home needs to keep talking to residents about quality to make sure that concerns and complaints are kept to a minimum. EVIDENCE: The home had the complaint procedure available around the home. This tells residents how to complain. All of the returned questionnaires apart from one said that people knew how to make a formal or informal complaint. One person spoken to said a complaint had been dealt with but the issue had come up again. Residents said that they could make a complaint if they needed to but most people said they didn’t have anything that worried them. The home has made sure that all staff have had the chance to learn more about how to protect residents from harm. They had done some reading and had discussed how best to do things. There was plenty of information available for staff to access. The manager knew how to deal with any potential problem. Residents said that there was nothing unpleasant going on and that they would tell the manager if there was anything worrying them. Visitors said that they had no concerns. Two staff are going to do more in-depth training about these matters. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 This is a pleasant and comfortable home where residents feel relaxed and ‘at home’. EVIDENCE: St. Georges’ is within walking distance of Millom town centre and the front of the home looks out over open space. Residents can use the very well tended garden. The home has suitable sitting and dining areas. The large glass fronted lounge that faces the garden was very pleasant on a crisp, sunny morning and later in the day residents spent time in the other lounge where a video was being shown. The inspector checked all parts of the home. One or two areas of the home needed a little bit of attention. The manager said that there were plans to redecorate the dining room and other parts of the building. There was evidence around the home that old furniture was being cleared away. The home was tidy in all areas and was fresh and clean. Residents said their washing was done properly and all the beds had nice fresh linens on them. Staff were seen using things like gloves and aprons and there was special hand
St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 16 wash in all of the bathrooms and toilets. These things are important to stop infection spreading. The staff were aware of how they needed to deal with this to keep residents safe. Residents said they thought the home was very nice and they were happy with levels of cleanliness. They were relaxed in their own rooms and in the shared areas. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 The home is aware of the need to have good staffing levels and is working towards this. EVIDENCE: One or two of the questionnaires said that there had been some staff shortages and that this had meant the care was not as prompt as it might be. The manager and staff also said that there had been a problem mainly due to illness and that they had tried their best to provide good levels of care. Some questionnaires said that at times staff hadn’t been available as quickly as they wanted. A couple of people commented on staff having breaks together. Some residents said that staff worked harder when there were shortages and that things were better than they had been. The manager said they were recruiting new staff and looking at how the staff cover was arranged. The rotas did show that this problem was getting better. Staff shortages had meant that people queried how the staff managed to care for the residents when they were short handed. The manager explained how she was recruiting staff and the inspector saw the paperwork for this. Everything was in order and the manager was aware of how to check that she employing the right kind of people in the home. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33,36,37,38 There are some aspects of the management of the home that need to be improved on to make sure things run smoothly for the residents. EVIDENCE: This home is managed by a person who is suitably qualified and experienced to carry out her job. She is a person of good character and her staff and residents respected her judgement and trusted her. The inspector valued her openness, honesty and willingness to discuss areas where she thought the systems in the home could be improved on. The manager does have a way of checking that routines are checked in the home and has some systems for asking residents, staff and visitors for their views. She agreed that she needed to pull all these things together and prepare a report that would show where good quality was being met and where it wasn’t and what was going to be done about improving things. She also said that the provider hadn’t produced a new business and financial plan. The inspector needs to know how the provider will move the home
St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 19 forward in the next twelve months and how much money he intends to put into the home. The manager also said that she hadn’t written down formal one to one meetings with staff since last year. Every member of the team who delivers care needs to have a chance to talk about their work with residents at least six times every year. This had not been done. The inspector checked on a number of records and found that some were very good and detailed but there were some problems. Some of the daily care records didn’t show how care was followed up. For example sometimes when a resident asked for the doctor the records didn’t show that the doctor was called or what was said when the visit was made. The records of one to one meetings with staff weren’t as detailed as they might be and that things weren’t recorded although the manager and staff said they were done. The manager agreed that she needed to make sure she could back up her actions with good recording. This problem of not recording actions was seen in different records. One of these related to the fire drills and instructions. The night staff should have these talks every three months but these were only recorded every six months. New staff must have two instructions when they first start work and these weren’t recorded. All other health and safety matters were being recorded and the systems were good. The home was free of hazards on the day and the staff were aware of health and safety responsibilities. Residents said that the staff made sure that things were safe for them. St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 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 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 2 X 2 2 2 St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) & (2) Requirement The registered person must ensure that all care plans are suitably detailed and meet the stated needs and aspirations of the residents. (This is an outstanding requirement with an extended timescale) The registered person must ensure that new residents under the age of sixty-five are not admitted unless there is a variation to the registered categories on the home’s certificate. The registered manager must complete an audit of the quality assurance system The registered person must supply an up to date business and financial plan. The registered manager must ensure that all staff have regular supervision. Written notes must be taken and available for inspection The registered person needs to check that records relating to residents care and the provision of services are detailed and up to
DS0000022666.V281060.R01.S.doc Timescale for action 30/04/06 2. OP3 14 (1) 30/04/06 3. 4. 5 OP33 OP34 OP36 24 25 (1) and (2) 18 (2) 30/04/06 30/04/06 30/04/06 6. OP37 17 30/04/06 St George`s Residential Home Version 5.1 Page 22 7. OP38 23(4) (d) date. The registered manager must ensure that night staff receive instruction on fire safety every three months and that new staff have instruction twice in the first month. 30/04/06 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 OP14 Good Practice Recommendations It is recommended that the registered person look at issues of autonomy and choice when completing care plans, looking at daily routines, checking on quality and making plans for the future of the home. It is recommended that the manager review the way she encourages comments, suggestions and complaints. It is recommended that the registered manager makes sure there is enough staff available at all times to deliver care to residents. It is recommended that the registered provider create a new format for his monthly visit reports that shows more detail of self-regulation and quality monitoring. 2 3 4 OP16 OP27 OP33 St George`s Residential Home DS0000022666.V281060.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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