CARE HOMES FOR OLDER PEOPLE
St Georges Residential Home St Georges Road Millom Cumbria LA18 4JE Lead Inspector
Nancy Saich Unannounced 26 July 2005 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 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 Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service St Georges Residential Home Address St Georges Road Millom Cumbria LA18 4JE 01229 773959 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Goldcare Facilities Management Limited Janet Bosanko Care Home 38 Category(ies) of 37 OP - Old Age registration, with number 5 DE(E) - Dementia, over 65 of places 1 LD - Learning Disability St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 37 older people (OP) of whom 5 may have dementia (DE(E)). 2. 1 Person over 18 years of age with a learning disability (LD) 3. Sufficient staff must be on duty at all times to meet the specialist needs of people in the service user categories identified. 4. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 17 January 2005 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 accomodation 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 th home on their behalf. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted by Nancy Saich. The visit started just after nine a.m and lasted for approximately seven hours. The inspector spoke to residents privately in their rooms and in small groups in the lounge and the dining room. The staff team and the manager were involved in discussions throughout the day. The inspector toured all areas of the building and checked on documents that confirmed the things that people talked about during the visit. What the service does well:
The home is good at ensuring they understand all the needs of potential residents before they admit them to the home. The home provides good health care that allows residents to remain or achieve good health. The home arranges suitable activities and entertainments for residents and everyone was happy with the food provided. The residents felt able to complain and thought the arrangements for dealing with complaints would be managed properly. The home provides a clean and comfortable environment for the residents. The garden was extremely attractive on the day of the inspection and residents commented on how nice the garden was to look out on or to sit in on fine days. There were enough suitably trained staff to provide a responsive service to residents. Residents felt there were enough staff at all times to meet their needs. New members of the team were properly recruited by the manager who ensured they had references, did not have a criminal record and had not been dismissed from any other care setting. The manager completes routine checks of the environment and systems in the home. These things coupled with consultation with residents ensure that the quality of the care and services provided are maintained. Health and safety provision is good in the home. Things like fire safety and food hygiene are well managed. This gives residents a safe and comfortable home where they can be relaxed and live without worry about their environment. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: 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 Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 8 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 standard(s) 3 The home is good at ensuring that they only admit residents who they can give appropriate care to. EVIDENCE: Residents said that they had been visited before they were admitted to the home and that the manager and the staff ensured that they knew all their needs before they came into the home. This checking out of what people wanted and expected was confirmed through meetings with the manager and social workers a few weeks after admission. The inspector saw records of these meetings. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 9 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 standard(s) 7,8,9,10 The home needs to improve arrangements for allowing residents to play a part in devising their own care plans. Health care provision was good but the manager needs to ensure that all staff are aware of how to manage controlled drugs. The current arrangements could compromise the safety of residents. EVIDENCE: The inspector looked at a number of documents that set out how care should be given. These ‘care plans’ belonged to people she had spoken to in depth. These residents said they hadn’t seen their care plans and were not sure what was in them. The inspector could not find anyone who had signed his or her plans. Most of these residents were assertive people who knew their own minds and were keen to have their needs know. The inspector also checked on other care plans and found they were a little more detailed than they had been they did not give an accurate description of how to deliver care. The care plans need to have more depth and more breadth of content and most importantly they need to really ‘belong’ to the residents. There were two requirements made about care plans at the last inspection and the manager and her team have tried to improve them with
St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 10 only limited success. The inspector thinks that the team need to review the way they look at this skill of devising care plans and try to engage residents in a much more meaningful way. A new requirement is made about care planning. There was evidence in the residents’ files that they received visits from a range of health care professionals. Residents spoke about the way the staff helped them access the doctor or the district nurse. The residents said they were generally in good health due to the way the staff sought support for them. It was good to note that the cook knew who was feeling a little under the weather on the day and could adapt the menu to tempt them with a lighter option. The inspector thought that manager and staff were very aware of how people were and she noted that they checked out with them how their health was. The arrangements for managing medication were generally well managed but there was major problem with the way staff were recording how they administered certain types of powerful medication. The staff had given one of these ‘controlled’ drugs without another staff member witnessing the administration. They were also failing to check the quantity in store both before and after administration. These are necessary checks to prevent any problems with managing controlled drugs. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 11 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 standard(s) 12,13,14,15 The home manages these matters quite well and residents were happy with the way the daily routines and activities were arranged. EVIDENCE: Some residents said that they wanted to go out more but other people said the staff or their relatives took them out on a regular basis. Some residents had quite active social lives and knew what was happening in the local community. Others said they went out to the local church and there was a notice of regular services and communions held in the home. The home employs an activities organiser and several people said they participated in things like quizzes. Other residents preferred to spend time in their own rooms reading and watching T.V. A number of people said they enjoyed sitting out in the garden or simply looking out of their rooms at the garden and the ducks on the home’s pond. Residents said they got up and went to bed more or less as they chose and that they could spend their days where they wanted. Several visitors were in the home on the day and they said they were made very welcome and could come to see their friends and family when they wanted. One or two people said they wanted a little more control over the care they received and this is dealt with under the standard about care planning.
St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 12 Residents did however feel they had a range of options and choices in their lives. Residents were happy with the catering in the home. They said they had good choices at meal times and the food was wholesome and well prepared. The inspector checked the kitchen and spoke to the cook and there was plenty of evidence showing that the staff knew about nutrition and understood the food preferences of all the residents. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 13 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 standard(s) 16,18 The home manages complaints quite well and residents felt that any problems were dealt with appropriately. The arrangements for making sure residents are fully protected from any abuse need to be improved on so that all the staff feel confident in how to manage this. EVIDENCE: The inspector checked on how the manager had dealt with an issue of concern raised. This had been handled in a sensitive and subtle way and the manager’s actions had allowed concerns to be raised and dealt with. Residents all said they would talk to the manager and they felt that she would deal with any concerns in a responsive way. Visitors had no concerns about the services or the delivery of care. There were copies of the complaints procedure in prominent places around the home. The residents were asked about how they were protected from abuse. They all said that there was nothing that they had seen, heard or experienced that they thought was abusive. Again they felt that the manager would deal with anything of this nature that might occur. Visitors said they had no concerns about how the home operated. Staff could discuss what abuse was and they too felt that there were no problems in the home. They would rely on the manager to deal with these problems. The staff and the manager were a little unsure of how they would deal with a serious allegation of abuse and the policy and procedure on this was not as specific as it might be. The manager agreed that further training was called for and a requirement was made about this.
St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 14 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 standard(s) 19,26 The home’s environment was clean and quite well maintained providing a safe and comfortable home for the residents. EVIDENCE: The home is situated near to the centre of town and is set in a beautiful garden. This means that the home is set in a tranquil environment. One person said “it’s like being in the middle of the country but is near to the shops and the church…best of both worlds really…” Lots of people commented on the garden and the duck pond and said how nice it was to sit or look out at the garden. Residents were quite relaxed in the home and there were four communal areas they could sit in. There is also a small kitchen where staff, residents and visitors can prepare hot drinks at any time of the day. A number of residents preferred their own company and spent a lot of time in their rooms. Most of the bedrooms had ensuite toilet facilities. Accommodation is mainly in single rooms. The home has two double rooms and both of these rooms are currently single occupancy. One of these rooms was only just large enough to be thought of as a double room. The inspector thought two people should not
St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 15 really share it, as it would be quite difficult to have two beds in the room. There were no plans to use these rooms as doubles. All the areas seen were clean, warm and comfortable. The manager said that there had been an ongoing programme of decorating and purchasing. Some areas would benefit from further investment but the staff took an obvious pride in keeping the fabric of the building in as good a state as possible. Residents were happy with the way their home was kept clean and said the staff looked after their clothes and bed linens properly. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The staffing arrangements in this home are good, providing well-trained staff in sufficient numbers to keep residents safe and well cared for. EVIDENCE: The inspector checked the staff rotas and found that there were enough staff on duty during the day and night to make sure that residents were cared for properly. Residents and visitors said there were always plenty of staff around in the home. Staff were quite realistic and thought that the staffing levels were “about right”. They did say that at times they wished there were more staff so they could do more activities with residents. Only one new person had been taken on since the last inspection and the paperwork for this was in order. Suitable checks had taken place to make sure this person did not have a criminal record and had not been dismissed from any other care setting. The inspector spoke to all the staff on duty. They said they had received lots of training and this could be seen by the way they worked with the residents. Residents and visitors said the staff were kind and caring and were “good at their jobs…very competent…very able”. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 This home is well managed providing good systems that help the home to run smoothly and promote the wellbeing of the residents. EVIDENCE: During the day the manager and the staff often referred to quality matters. There was evidence around the home to show that all sort of things are routinely checked to make sure that everything is running smoothly. The manager said she tried to ask residents their opinion as often as possible. Residents said they had attended meetings in the past but not so many recently. Individuals did confirm that their opinions were asked about all sorts of things. The manager said she was developing a new quality system and this will be checked again at the next inspection. Staff said they had received health and safety and fire training. They were aware of their responsibilities. The home was hazard free on the day and the inspector saw some of the documents that showed that routine maintenance was being completed. Things like fire checks and water testing were referred to
St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 18 by the manager and staff. The cook had a very good understanding of food hygiene and was careful not to let care staff enter the kitchen to prevent contamination of the food preparation areas. The manager said that the home employed people to look after the garden and the fabric of the home and they came twice a day to check on the home. The inspector met them at the end of the day and they confirmed this. St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x x x 3 St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? 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 7 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 The registered person must ensure that all controlled drugs are accounted for correctly The registered person must ensure that all of the staff team undestand not only the nature of abusive practice but also how to manage adult protection issues. Timescale for action 31st October 2005 15th September 2005 31st October 2005 2. 3. 9 18 13 (2) 13 (6) 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 Good Practice Recommendations St Georges Residential Home F58 F10 s22666 st georges millom v240825 260705 ui stage 4.doc Version 1.40 Page 21 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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