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Inspection on 28/11/05 for St George`s (Wigan) Limited

Also see our care home review for St George`s (Wigan) Limited for more information

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home buys good quality food from reputable suppliers. Some members of staff are keen and willing to provide a good standard of care.

What has improved since the last inspection?

A Deputy Manager and a Registered Mental Nurse (RMN) have been recruited. The RMN will work primarily with those residents who have dementia or other mental health condition. Both members of staff were working together to identify where they could make changes quickly that would make life better for residents living at the home. The Manager from the home in Liverpool had carried out an assessment of needs for all residents. The Deputy Manager was using this information to help her understand the type of care residents needed, and, therefore, the experience and qualities that staff would need in order to provide that care. Sluice rooms are now being used for their proper purpose. Several armchairs have been purchased, and some redecoration has been done in bathrooms. Residents have been provided with extra storage for their personal items in the form of plastic boxes.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE St George`s (Wigan) Limited Windsor Street Wigan Lancashire WN1 3DG Lead Inspector Lindsey Withers Second Inspector Judith Unannounced Inspection 28th November 2005 09:25 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 (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 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 (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St George`s (Wigan) Limited Address Windsor Street Wigan Lancashire WN1 3DG 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) 01942 821399 wigan@stgeorgescarehomes.co.uk St George`s (Wigan) Limited Ms Julie Melling Care Home 62 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (38), Physical disability (6), Terminally ill (6) St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 62 service users to include:up to 38 service users in the category of OP (Older People) up to 12 service users in the category of DE(E) (Adults with Dementia over 65 years) up to 2 service users in the category of DE (Adults with Dementia under 65 years) up to 6 service users in the category of PD (Physical Disability under 65 years) up to 6 service users in the category of TI (Adults with Terminal Illness) The service should employ a suitable qualified and experienced manager who is registered with the Commission for Social Care Inspection. Two named service users in the category of DE (Adults with Dementia under 65 years) may be accommodated within the overall number of registered places Sufficient staff must be on duty at all times who are trained and competent to meet the needs of service users, taking account of changing dependency levels and special needs. 5th June 2005 2. 3. 4. Date of last inspection Brief Description of the Service: St. Georges Nursing Home is situated within walking distance of Wigan town centre and is close to local shops and other facilities, including a large superstore. Public transport is easily accessible. The Home is a ten to fifteen minute walk from the bus terminal and the railway station. Access to the motorway network is also nearby. St. Georges has been operating as a care home since 1990 and has facilities to provide nursing care for up to 62 residents in a range of accommodation, including single and shared rooms. The building is Grade II listed and was previously a school before being converted to its present use. The Home is registered with the Commission for Social Care Inspection to provide nursing and personal care. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection by two Inspectors took place over 6.5 hours on one day. Since the last inspection a total of seven visits have been made to the home by CSCI Inspectors, and four meetings have taken place at the CSCI offices attended by the owner, Mr. Shah, and the Manager. Following visits to the home, letters were sent to Mr. Shah and the Manager providing details of any action they must take. Mr. Shah and the Manager had given reassurances that standards would be improved at the home. Copies of correspondence is available to members of the public or other enquirers on request to CSCI. Mr. Shah had asked the Manager from his home in Liverpool to provide assistance and guidance to the Manager at St. George’s Wigan. For the purposes of this inspection, because there are only a small number of people living at the home who are under the age of 65, the National Minimum Standards for Older People formed the basis for measuring the standard of care provided. The Pharmacy Inspector will undertake a separate unannounced inspection to follow up at the requirements she made at the last inspection. She will make her own report. Copies of correspondence between the Pharmacy Inspector and the owner is available to members of the public or other enquirers on request to CSCI. In a letter to the CSCI dated 24th November 2005, Mr. Shah confirmed that the Manager, Julie Melling, had resigned and would be leaving the home on 12th December 2005. What the service does well: What has improved since the last inspection? A Deputy Manager and a Registered Mental Nurse (RMN) have been recruited. The RMN will work primarily with those residents who have dementia or other mental health condition. Both members of staff were working together to identify where they could make changes quickly that would make life better for residents living at the home. The Manager from the home in Liverpool had carried out an assessment of needs for all residents. The Deputy Manager was using this information to help her understand the type of care residents needed, and, therefore, the experience and qualities that staff would need in order to provide that care. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 6 Sluice rooms are now being used for their proper purpose. Several armchairs have been purchased, and some redecoration has been done in bathrooms. Residents have been provided with extra storage for their personal items in the form of plastic boxes. 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 George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 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 the following standard(s): 1, 3, and 4 When it has been amended, the service user’s guide will give prospective residents the information they need to make an informed choice about where they live. Residents cannot be sure that their assessed needs will be met. EVIDENCE: The service user’s guide had been re-drafted in the week leading up to this unannounced inspection. Copies had been printed and were made available to visitors in the main reception as the inspection progressed. Copies of the document will also be made available in large print. The newly-appointed Deputy Manager said that she would be involving the Registered Mental Nurse responsible for the dementia unit in looking at a guide that will be applicable to those residents with dementia. She said this would be a blend of words and pictures. The Manager gave a copy of the service user’s guide on CD to the Inspectors for evaluation. The service user’s guide does not yet distinguish between care for older people and for younger adults. The registration categories listed under “Admission Criteria” are incorrectly stated: respite care is not a registered category but fits within the overall 62 registered places. Despite having been re-drafted recently, the document still refers to the St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 9 National Social Care Commission rather than the Commission for Social Care Inspection. Those pre-admission assessments that were looked at on this occasion were fully completed. However, one person had been admitted from hospital and a copy of her ward assessment was included on the file. Elements of the ward assessment had not been included in the pre-admission assessment information. Staff were finding it difficult to meet the person’s needs. A sixweekly review had been scheduled but it was clear that this should have been brought forward. Care staff could not categorically say that they understood the mental- or health-care needs of the residents to whom they were providing care. As one member of staff put it, “I just do as I’m told.” A Registered Mental Nurse has been recruited, primarily to work with the residents who have dementia or other cognitive impairment. The Deputy Manager has experience at Manager level in a care home and as a Registered General Nurse in hospitals and care homes. A Registered General Nurse, experienced in elderly care, has also been recruited. Care assistants were being recruited at the time of the inspection. This recruitment drive brings with it the promise of enhancing the collective skills and experience of the staff group, which, in turn, should bring benefits to the residents living at St. George’s. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 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, and 10. Care staff other than nurses do not routinely see care plans. As a result, staff do not have the information they need to satisfactorily meet the needs of residents. Residents are not included in the care planning process, so are not able to influence the care that they would wish to receive. The health needs of residents are not well met because decisions tend to be taken by staff at the Home, rather than by a multi-disciplinary approach including external health care professionals. Support is not offered consistently to residents in such a way as to promote and protect residents’ privacy, dignity and independence. EVIDENCE: The judgements noted in the last inspection report in relation to Standards 7, 8 and 10 are unchanged. No progress had been made towards improvement. Each resident has a plan of care that sets out the action that staff need to meet the resident’s health care needs. However, what was seen in the care plan was not always seen in practice. Care plans do not contain sufficient information about personal and social care needs e.g. likes, dislikes, hobbies, and interests, so that the resident’s lifestyle can be maintained or improved upon. There was little evidence to confirm that residents and their supporters were involved in the care planning process on a regular basis. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 11 Assessments had been done, some for all residents and some on an individual basis. Assessments in relation to the prevention of falls were also in place, but there was no evidence to show that there had been any advice sought from health professionals outside of the Home. As a result, methods for securing a person’s safety were not in line with the recognised best practice that all residents are cared for in the least restrictive environment. There was the potential for people to have their liberty restricted. There were no appropriate interventions for residents identified as being at risk of falling, except for moving furniture in the room of one resident. One person’s care plan stated that she must wear hip protectors – yet the resident was not wearing them. Similarly for this person, the pre-admission assessment had suggested the use of a recliner chair for the resident’s comfort and safety. No such chair had been provided. For another resident, the Manager had arranged for a recliner chair to be delivered. The chair was not suitable for the resident who found it uncomfortable. The resident had been charged for the cost of the chair. No consideration had been given to assessing the height and width of the seat, angle of the seat, etc. so that the person could sit comfortably and without undue pressure being placed on her body. Residents again were seen to be wearing clothes that had not been ironed, were too small, or were stained and dirty. Residents had not had their hair brushed or combed. Male residents were unshaven. A number of residents had finger nails and (in one case) toe nails that had not been trimmed or cleaned. Records showed that residents had been assessed in relation to the prevention of pressure sores. There was some evidence to demonstrate that pressure relieving equipment was still being used on a communal, rather than individual basis. There was strong evidence to suggest that many decisions about health care needs were being made within the Home, and without advice and support being sought – with any consistency - from health care professionals from Community Health Services e.g. dietician, continence adviser, and the tissue viability nurse. It was observed that a high number of staff did not maintain the privacy and dignity of residents. This was demonstrated in a number of ways. Residents were spoken to inappropriately in relation to personal care. Members of staff were observed entering residents’ rooms without knocking or announcing themselves. Some residents were in bed with their door wide open so that they could be seen by anyone working in or visiting the home. In a shared room, one resident was still in bed, yet his room-mate was entertaining a visitor. These people were not, therefore, “free from public attention” – which is a stated aim in the Service User’s Guide. Continence products were on view throughout the home, rather than being appropriately stored. Lids were not consistently replaced on commode chairs once the commode pan had been emptied and cleaned. Much of the bed linen – and some pillows, blankets, and covers – belong to hospital trusts. A member of staff said that some St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 12 residents were still in nightwear in the afternoon because “they would be having a bath”. All this does little to enhance the value of people living at St. George’s and makes to create an institutional environment. Furthermore, it does not demonstrate that the stated aims of the home (as set out in the Service User’s Guide) are being met. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 13 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, 14, and 15. Residents have insufficient opportunities to make choices about how they spend their daily lives. Staff do not have the capacity to present choices to residents in a way that can be understood by residents. Food provided by the Home is plentiful and good quality. However, not all of it is properly stored. Residents are not offered sufficient choice. Residents are not offered appropriate assistance so that they take sufficient nourishment. The methods used for delivering meals away from the main dining room are poor, as is the presentation of meals, including special diets. EVIDENCE: In the week of the inspection, the Activities Organiser was on holiday. There were, therefore, no planned activities. Nothing had been scheduled to take place, and no staff had been included on the staff rota to provide cover for the Activities Organiser. One resident said there was often little to do. Mostly they “watched TV or looked at newspapers”. No activities were in progress on the dementia unit because staff time was taken up with caring for one particular person. In the week leading up to this inspection, the Deputy Manager had made arrangements with Age Concern for them to provide information on Advocacy Services for residents and their supporters. The Deputy Manager will make sure the information is widely advertised. This information will be particularly St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 14 important to those residents and their families who need help in ensuring that the resident’s best interests are looked after. There was still no evidence to confirm that residents are helped to look at their personal records. The food supplied to St. George’s is plentiful and of good quality. However, the way it is presented and served is not satisfactory. The poor standard of food hygiene is discussed further at Standard 38. The Inspectors saw some breakfasts being served and some of the lunch-time serving. One lady said she had difficulty eating her meals from a tray in her bedroom because she was not assisted to sit upright. This person said the chair was not the right size for her. Her melamine cup was stained and was chipped at the drinking edge. Other residents taking breakfast meals from trays appeared to manage sufficiently well. Residents were seen to be taking a range of breakfast foods, though it was not clear that it was they who had chosen what they were eating because they are not given information about the choice of meals available to them. One resident was still being served milky tea despite the Inspector having discussed this with the Manager at the last inspection: this person does not like milky tea. Cheese on toast had been sent from the kitchen for one person. The plate of food was still on the serving shelf in the corridor at lunch-time. It was not clear, therefore, that that person would have had sufficient to eat. At lunch-time, on the ground floor care assistants were serving food to residents even though the meals were cold. When the Inspector alerted the Deputy Manager to this, she returned the food to the kitchen and for arranged for hot food to be served. Food was not served hot enough for those who eat quickly, let alone those who eat slowly. No-one was making sure food was being properly served. The Inspectors noted that the tea-time sandwich meal had been prepared long before lunch-time and that it had been refrigerated. The dessert was portioned out. Some dishes were not suitable for residents with dexterity problems or who were visually impaired. The dessert had been carelessly served and so looked unattractive. Some people choose to eat their meals at a small table in the first floor lounge. The temperature here at breakfast time was 65o. Therefore, food had not been served with the room temperature at a comfortable level. The temperature had risen to 72o by lunch-time, which was satisfactory. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 15 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 and 18 The complaints procedure is included in the service user’s guide. At this time, however, residents cannot be sure that their complaints will be listened to. Arrangements for protecting residents are not satisfactory, placing them at possible risk of harm or abuse. EVIDENCE: The complaints procedure has been included in the service user’s guide, which was made available at the reception desk during the course of this inspection. The information will need to be amended when the service user’s guide is revised so that the correct title of the Commission for Social Care Inspection is included, as well as contact telephone numbers for the Local Authority and CSCI. One or two issues that had been raised at the last inspection by residents had still not been attended to. For example, the repeated requests for one person for a private telephone. These were discussed with the Deputy Manager for her to take any necessary action. Although the Manager had reported formally to the CSCI that she had delivered training to all staff in relation to the Protection of Vulnerable Adults (PoVA), two members of staff on duty during this inspection were unable to confirm that they had attended the training. This, therefore, raises concern about the quality of the training and doubts about whether members of staff were tested about their level of understanding of the subject. Observed poor staff practices and a lack of management supervision continues to potentially put residents at risk. This evidence is particularly worrying when an investigation had taken place under the Wigan Social Services’ Protection of St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 16 Vulnerable Adults procedure. The investigation upheld that the home was at fault and a person had been placed at risk. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 17 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, 21, 22, 24, 25, and 26. The standard of the décor within this Home is poor. It does not, therefore, present as a homely and comfortable environment for residents. The standard of cleanliness is also poor. The low lighting levels pose a risk to residents, particularly those with a visual impairment. EVIDENCE: Since the last inspection, the redecoration of the lounge in the dementia unit has been completed and the room is now back in use. Armchairs on this unit are stained and dirty. Walls and paintwork throughout the rest of the home are chipped and dirty. The water has been turned off completely in one bathroom. The chipped and unstable furniture in the small dining room (top floor) has not been attended to. Some new armchairs have been purchased for the lounges. The Manager said that different sizes and heights had been purchased but those seen were all the same. Some old furniture remains. The garden had not been improved over the summer and it was unlikely that anything would be done through the winter months. A visitor expressed the wish to be able to take his relative outside in fine weather. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 18 The Deputy Manager reported that the smoking policy at the home was being reviewed and that smoking areas were to be redefined, so as to make the environment more comfortable for those people (staff and residents) who do not smoke, and to reduce the risk of fire. Residents are still being accommodated in shared rooms when single rooms are available. Some improvement had been made in one shared room to make it safer to use for an independent wheelchair user. However, privacy issues remain a concern. Furniture throughout the home was still generally in poor condition, being chipped or broken. Some storage space has been provided to residents in the form of brightly coloured plastic tubs. However, clothing was found to be piled up rather than being put away. Suitcases were still in evidence on the tops of wardrobes. Some residents’ belongings were still stored in black plastic bags, but these bags had now been placed within their wardrobe. Some residents have lockable storage space. At the instruction of the Deputy Manager, the handyman was beginning to fix locks to those doors where residents had expressed a wish to have a key. This would benefit resident because it would improve their right to privacy. The lighting throughout the home was still below the recognised standard (lux 150). The quality of lighting was further hampered because light bulbs had not been replaced. As recorded at the last inspection, the low lighting in the Home will contribute to the difficulties experienced on a daily basis by those residents with a visual impairment or poor mobility. The premises were not clean: for example, some bedroom carpets were stained and dirty, some had not been vacuumed; skirting boards and paintwork were dusty and dirty. There were areas of the Home where very strong odours were present – both in personal rooms and in communal areas. These odours emanated from poor continence management or from inadequate attention to the personal hygiene of residents. The Home’s policies and procedures in relation to the hygiene and the control of infection were not being followed at all times. For example, items for one resident were seen in the sluice room in a correct red bag, but the bag had not been sealed. Staff had been instructed by the Deputy Manager to wear protective clothing when serving food. At the request of the Inspectors, staff were asked to wear protective gloves when handling food, if serving tongs were not available. Infection control is discussed further at Standard 38. The laundry assistant said that she washed “lots of sheets” during the day because “they are always short” of sheets. New linen will need to be purchased to replace that returned to the hospitals so that there is sufficient. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 19 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, and 30 The Home employs insufficient staff. Staff are not appropriately trained and skilled to meet the needs and expectations of residents and to keep the home clean. Residents cannot be assured that they are looked after by people who have been recruited properly and who are deemed safe to work with vulnerable people. Residents cannot be confident that staff are properly trained to do the work they are employed to do. EVIDENCE: As at the last inspection, it was again evident that the home had insufficient staff on duty that were properly trained and competent to do their jobs so that the needs of residents could be met. Three staff had not attended for work on this Monday morning. Staff brought in to provide some of the cover were unclear what they were supposed to be doing, and where in the building they were to work. One person was late for her shift in the afternoon. She displayed a casual attitude to her lateness. The standard of attendance at work by staff has not, therefore, improved since the last inspection. Two residents spoke about having to wait for assistance. One Inspector sat in the first floor residents’ lounge for 23 minutes without any member of staff coming to provide assistance to residents. Two residents who use that room are known to be at risk of falling. One resident was becoming agitated because she wished to leave the room, another resident told the Inspector that he was feeling unwell, and another was asking for his morning medication. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 20 Staff were still task orientated i.e. looking to get jobs done rather than thinking about the experience that the resident might be having, the best example perhaps being when residents were served cold food. Staff were still not clear about the assessed needs of the residents for whom they were providing care. For example, speaking about one resident who has a high level of agitation, a care assistant described the resident as “attention seeking”. There is also a culture of blame in this home, where staff do not take responsibility, saying something is someone else’s job or fault. The home was not being maintained in a clean and hygienic state nor was it free from dirt and unpleasant odours. The numbers and capabilities of the domestic staff will need to be reviewed if this situation is to be improved upon. An immediate requirement was left for staffing matters to be addressed. A recruitment drive was in progress. The Deputy Manager had been in post for five days, and the RMN for a few weeks. An RGN had been recruited. One RGN had left, and another was leaving mid-December. Two members of staff had been dismissed: CSCI had not been informed about this. The Deputy Manager was recruiting care assistants. It is the expectation that new staff will be appropriately trained to meet the assessed and recorded needs of the residents at all times. The personal files were looked at for four members of staff. Two showed that the person had started in employment without satisfactory Protection of Vulnerable Adults or Criminal Records Bureau checks having been received prior to commencement. One person had not been taken through a reinduction programme following her return to work from maternity leave. This is unsafe practice and has the potential to put residents at risk. A list of staff training had been provided to CSCI prior to this inspection. It was evident that some care assistants did not understand the basic principles of care, a topic that should be covered at induction and periodically throughout their employment. Observations of poor practice during this inspection calls into question the quality of the training delivered in the home. For all staff appointed after 1st April 2002, each must have a full, satisfactory PoVA First check and must have applied for an enhanced Criminal Record Bureau disclosure before starting work in the home. An appropriately qualified and experienced person must supervise employees who start work without full CRB disclosure. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 21 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): 30, 33, and 38 At the time of this inspection, the home was not being managed and run in the best interests of residents. Openness (and, therefore, inclusiveness) was not being encouraged. Staff are deficient in their knowledge of current good practice so residents could not be assured that they are cared for by people who know how to do their jobs. EVIDENCE: The Manager had advised the CSCI that she was stepping down from her post. The owner, Mr. Shah, subsequently advised the CSCI that the Manager was leaving the home. Mr. Shah had asked the Manager at his home in Liverpool to undertake some of the tasks that should have been done at St. George’s, including a full re-assessment of residents’ needs, an overview of training, and a review of staffing levels. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 22 The newly-appointed Deputy Manager will be responsible for the home until such time as a Manager is appointed. The Deputy Manager has the relevant experience to undertake this role. She is aware that if she were to be appointed as Manager, she would need to take the Registered Managers’ Award (or equivalent management qualification). The methods for monitoring the quality of the service provided by the home showed no improvement since the last inspection. Two residents still had requests outstanding. No formal meetings had taken place with residents or relatives. The food hygiene systems in place in the kitchen must be improved to avoid contamination and prevent illness. Dried food, such as sponge mix was found to be opened and the contents exposed to the air. Dry goods such as flour, oats, and cereal had been decanted but they were not labelled with the opening date, or the use by date. Several packs of meat in the freezer had use by dates that had expired or that would expire on the day of the inspection. Some labels had come off the freezer packs. The cook on duty could not satisfactorily explain the system for stock rotation and control. The sandwich tea had been prepared before lunch time. The food had been covered and placed in the bottom of a refrigerator. However, the dessert, which was decorated with cream, was not covered. Such food should not be stored uncovered or in the bottom of the refrigerator. Milk was left out on a counter top rather than being replaced in the refrigerator. Staff touched food, for example, bread and butter, instead of using tongs or instead of wearing protective gloves. The Deputy Manager attended to the labelling of frozen meat and disposable gloves at the time of the inspection. Kettles were in evidence around the home. The Manager said these were for night staff to make drinks for residents. While it is good that residents can have a drink when they would like one, leaving kettles unattended in communal rooms is unsafe practice and puts residents at risk. Either kettles should be put away or should be used only in a designated place away from residents. Accidents had been recorded on the proper documentation. However, information is still not being forwarded to CSCI, as it should. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X 2 2 X 2 1 1 STAFFING Standard No Score 27 1 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 1 St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 24 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 OP1 Regulation 5 Requirement A service users guide must be amended to provide correct information and to make note of the difference between the care being provided for Older People and that for Younger Adults. Timescale 1/9/05 not met. Assessments must be thorough and take into account the views of other health professionals. All care staff must be made aware of the content of care plans. Timescale 1/7/05 not met. Care plans must contain sufficient information about personal and social care needs, in line with Standard 3. Timescale 31/7/05 not met. Residents and their supporters must be involved in the development of the care plan and its subsequent reviews. Changes must be made only after consultation, unless it is impracticable to do so. Timescale 1/7/05 not met. Timescale for action 28/02/06 2. 3. OP3 OP7 14 12 31/12/05 28/11/05 4. OP7 12 28/11/05 5. OP7 15 28/11/05 St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 25 6. OP7 12 7. 8. OP7 OP8 16 12 9. OP8 13 10. OP10 12 11. OP12 16 12. OP15 16 Care practice must meet current legislation and good practice guidelines, e.g. in relation to the prevention of falls. Timescale 6/6/05 not met. Equipment must be provided that is appropriate to a person’s nursing needs. The personal and oral hygiene of each resident must be maintained. Residents who have the capacity to self-care must be supported. Timescale 1/7/05 not met. Residents must have access to any health care professional from outside of the Home or treatment or advice, e.g. continence adviser or physiotherapist. Timescale 1/7/05 not met. The Home must be conducted so that the privacy and dignity of residents is promoted and maintained. Timescale 1/7/05 not met. Residents must be consulted about the programme of activities they would like, including activities in relation to recreation and fitness. Timescale 15/7/05 not met. Food must be provided that is suitable for residents to eat, that is properly prepared, and at times when they want to eat it. Timescale 15/7/05 not met. All staff must receive training in the protection of vulnerable people. Timescale 31/8/05 not met. A programme of repair, redecoration and refurbishment must be drawn up, together with timescales for completion. Timescale 8/7/05 not met. DS0000055720.V266732.R01.S.doc 28/11/05 31/01/06 28/11/05 28/11/05 28/11/05 31/01/06 28/11/05 13. OP18 13 31/01/06 14. OP19 23 31/01/06 St George`s (Wigan) Limited Version 5.0 Page 26 15. OP19 23 16. OP19 23 17. OP21 23 18. OP22 23 19. OP25 23 20. OP27 18 21. OP29 19 22. OP29 18 23. 24. 25. OP30 OP31 OP33 18 8 24 The garden must be made accessible for residents living at the Home. Timescale 31/8/05 not met. The Home must be made clean and free from offensive odours throughout. Timescale 8/7/05 not met. Bathrooms and toilets must be reviewed and updated so that they are clean and in good working order. Timescale 31/8/05 not met. The nurse call system must be reviewed so that all call cords are accessible. Timescale 8/7/05 not met. Lighting must be provided throughout the Home that is suitable and meets recognised standards. Timescale 15/7/05 not met. Sufficient staff must be on duty at all times who are appropriately trained and experienced. Numbers must be determined according to the assessed needs of residents. Timescale 6/6/05 not met. Staff must not be employed without two satisfactory references, PoVA and CRB checks. Sufficient domestic staff must be employed so that the home is clean and free from offensive odours. A programme of staff training must be devised, based on meeting the needs of residents. A suitably experienced and competent manager must be employed. A system must be established for reviewing and improving the quality of care at the Home, including the quality of nursing. Timescale 31/7/05 not met. DS0000055720.V266732.R01.S.doc 01/05/06 28/11/05 31/01/06 31/12/05 31/12/05 28/11/05 01/12/05 28/11/05 31/01/06 31/01/06 31/01/06 St George`s (Wigan) Limited Version 5.0 Page 27 26. OP33 24 27. OP38 37 28. OP38 13 29. OP38 13 Policies, procedures and practices must be reviewed to meet current legislation and good practice advice. Timescale 31/8/05 not met. Notifications must be made to the CSCI and other relevant agencies in relation to accidents, incidents and significant events. Timescale 15/7/05 not met. Staff must be trained and supervised so that they achieve acceptable standards of food hygiene and infection control. Timescale 31/7/05 not met. Kettles must only be used in safe, designated places. 28/02/06 01/12/05 31/12/05 09/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP4 OP10 OP16 Good Practice Recommendations The recruitment drive should continue in order to enhance the collective skills and experience of the staff group. Hospital linen, pillows, etc. should be returned. The complaints procedure should be brought up to date. St George`s (Wigan) Limited DS0000055720.V266732.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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. 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