Inspection on 05/06/05 for St George`s (Wigan) Limited

This inspection was carried out on 5th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St George`s (Wigan) Limited 19/07/07

St George`s (Wigan) Limited 06/07/06

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

St George`s (Wigan) Limited 14/02/05

St George`s (Wigan) Limited 11/05/04

St George`s (Wigan) Limited 10/03/04

Similar services:

Chirnside House

Chirnside House

Keer Sands Residential Home

Rosehill Residential Home

Ruskin Lodge

Ruskin Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE St Georges Nursing Home Windsor Street, Wigan, Lancashire, WN1 3DG. Lead Inspector Lindsey Withers Second Inspector J. Stanley / Pharmacy Inspector S. Unannounced 4 & 5th June 2005 th 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 and Care Homes for Adults 18 – 65*. 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 Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Georges Nursing Home Address Windsor Street, Wigan, WN1 3DG 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) 01942 821399 St Georges Limited Ms Julie Melling CRH Care Home with Nursing 62 Category(ies) of Older People 38, Dementia over 65 12, Physical registration, with number Disability 6, Terminally Ill 6. of places St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum registered numbers there can be up to 12 DE(E), up to 38 OP, up to 6 PD and up to 6TI. 2. The service should at all times employ a suitable qualified and experienced manager who is registered with the National Care Standards Commission. Date of last inspection 14th February 2005 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 Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of St. George’s using both the National Minimum Standards for Older People (OP), and those for Adults under the age of 65 (YA). Previously the Home had been inspected only under the NMS for Older People. This unannounced inspection took place over a Saturday and a Sunday, and was carried out by two inspectors. Two immediate requirements were left as a result of the findings at the inspection. The Pharmacy Inspector called several days later and carried out her own inspection. Her comments are included in this report. The Inspectors looked at the paperwork that the Home must keep to show that it is providing a good service. The Inspectors also looked around the building, and spent time with residents, their visitors, and staff. 15 comment cards were given out, some during the inspection, and some posted out to residents’ next of kin and to health professionals. Only three of the 15 were returned. Comments received are included in this report. What the service does well: What has improved since the last inspection? What they could do better: Improvements within the Home for the benefit of residents are not initiated by the Manager but appear to be made only when suggested by a third party, such as a social worker or the CSCI. Because health and social care professionals and advisers from outside the Home are not routinely called in, residents cannot be guaranteed that they will receive a good standard of care that is based on their individual needs and preferences, or that is based on current good practice. The emphasis is on “nursing care” rather than anything else, and can only be as good as the nurses providing that care, one of whom said she did not want to do any more training and admitted that her moving and handling techniques were “old fashioned”. This is not, therefore, a “needs-led” service. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 6 In many respects, the management and leadership of the Home lies at the root of the issues identified during this inspection. The last two CSCI inspection reports record requirements and recommendations upon which action has been taken to some degree, but a number of the requirements and recommendations could easily have been identified and rectified by the Manager. The same can be said for this inspection. Staff have not consistently been properly trained and are not properly supervised. As a result, residents do not always receive good quality care from competent staff. The general view of residents and relatives who chose to speak about the quality of the service, was that they did not feel they could raise issues because they thought nothing would get done. This is not a service, therefore, that is open, respectful and inclusive, or that seeks opinions and makes it known that those opinions matter. The management of medicines must be improved: the records must be clear, the home’s written instructions must be followed when giving non-prescribed medicines bought from the chemist, all medicines must be stored correctly. 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 Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 4 )Older People), 1, 2 and 3 (Younger Adults) Residents thinking about moving into St. George’s do not receive sufficient information to allow them to make an informed choice about where they live. Residents cannot be assured that their assessed needs will be met. EVIDENCE: Although there was a Service User’s Guide (the Home’s Information Pack for residents) in the nurse’s office, it was not readily available as most visitors said they had not seen a copy, and none were seen around the Home. The Guide is aimed at relatives rather than service users and is not available in other forms, e.g. for those with dementia or visual impairment. A guide must be developed that clearly sets out how and what care will be provided to older people and younger adults. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 9 Care plans contained copies of assessments that had been done by staff prior to a resident moving in. Assessments completed by placing authorities were seen on file. However, this was not seen to be the same in relation to a person taking a short term placement. This person had been admitted as an emergency. The nurse on duty told the Inspectors that the resident’s needs were greater than what they had been told, and that they were finding it difficult to provide appropriate care. This is not acceptable. Had the Home done its own assessment, this situation might have been avoided. Although assessments formed the basis of the plan of care, based on conversations and observations, there was insufficient evidence to show that staff were meeting residents’ assessed needs. This was the same for both groups of residents. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 (OP) and 6, 7, 9, 18 and 19 (YA) Care plans are not routinely seen by care staff other than nurses. 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 to residents in such a way as to promote and protect residents’ privacy, dignity and independence. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 11 The Home’s medication policies and procedures and current good practice guidance was not always adhered to, potentially putting residents at risk. EVIDENCE: Older People Outcomes: Each resident had an individual plan of care that was designed to meet their health care needs. However, what was seen in the care plan was not always seen in practice. Care plans did not contain sufficient information about personal and social care needs e.g. likes, dislikes, hobbies, and interests, so that the resident’s lifestyle could 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. Three visitors said they did not know what a care plan was. Assessments had been done, some for all residents e.g. skin tissue viability and moving and handling, and some on an individual basis e.g. smoking. 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 current guidelines. There were no appropriate interventions for residents identified as being at risk of falling, except for moving furniture in the room of one resident. Staff were complacent about an injury that one resident had received when he had fallen, and, because he was “always falling”, did not respond and provide first aid until told to do so by the Inspectors. Care staff were not maintaining the personal hygiene of residents. Care plans identified where residents needed prompting in order to maintain their capacity to self-care, but it was observed that this was not being done. For example, on the first day of the inspection at 8.20 a.m., 13 residents were sitting in the ground floor lounge (and a further five residents in the first floor lounge), were dishevelled, were wearing stained clothing, and at least three residents were not wearing their glasses. One relative said that staff had to be reminded “all the time” about personal care issues, but other relatives appeared more accepting of the situation. 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 provided on a communal, rather than individual basis e.g. a wheelchair cushion for one person being used by someone else. 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 from health care professionals from Community Health Services e.g. dietician, continence adviser, and the tissue viability nurse. This is not to say St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 12 that referrals were not made. For example, on the first day of the inspection, several residents were seen by the visiting chiropodist in the treatment room on the ground floor. However, she did not know who she was due to see, and staff were also unsure who had appointments. What was clear, was that referrals were not routinely made by the Home. At least two residents said there were not enough opportunities to take exercise. One in particular was concerned about weight gain, and another spoke about missing the exercise regime he followed before he became ill. 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’ conditions and needs were discussed in public places (i.e. corridors and lounges), residents were spoken to inappropriately regarding the use of the toilet, there were no working locks on bathroom and toilet doors, and there was no privacy screening around the hand-basin in shared rooms. One resident commented that she did not like to be watched while she was having a wash. One care plan recorded that a resident was being allowed to use the staff toilet “to maintain her privacy”, which emphasises the need for locks on bathroom and toilet doors used by residents . The public telephone is located in a corridor, so residents could not make or receive calls in private. One resident had been told about the content of phone calls rather than being taken to the telephone to receive the call. A number of staff were heard to be speaking to residents in a disrespectful manner. Rather than these staff using an approach that was warm and sensitive, offering support and reassurance, they spoke in a way that was sometimes loud or severe. They could not demonstrate by their actions, therefore, that they were seeking to enhance the self-esteem of the residents, or make them feel valued. Residents were spoken about by groups, for example, “the feeders” or “the catholics”. Indeed, in one staff office the “Roman Catholics” were listed in a notice. During the inspection, post-it notes were stuck on lounge doors to identify people who were to be seen by visiting clergy. This does little to demonstrate that each resident is seen to have a unique, individual identity. Younger Adults The situation noted above was also reflected in the care planning for this group of residents. Furthermore, care planning for younger adults has not been developed in line with the National Minimum Standards. Interventions were led by social workers and other outside agencies, rather than by the Home. Residents could not, therefore, be sure that the care being provided would be sufficient to support their needs, including the opportunity to maintain a fulfilling lifestyle in and outside of the Home. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 13 Medication The medication administration records were generally up-to-date but there was, on occasion, lack of clarity where the reason for non-administration of medication was not indicated; the administration of nutritional supplements and of external preparations was poorly recorded. One resident had not received their ‘once weekly’ tablets on three occasions, including the inspection day; robust procedures must be implemented to address this omission. Records indicated that homely remedies were sometimes administered other than in accordance with the home policies and procedures. Medication was generally appropriately stored within the treatment room but some creams were stored in the sluice rooms (removed during inspection). During the inspection the treatment room was 28oC, this must be monitored and action taken if an appropriate temperature cannot be maintained. Medication is administered from an open trolley on one floor; this should be reviewed to ensure that security of medication is maintained. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 (OP), and 12, 13, 15, 16 and 17 (YA) 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. The Home does not routinely arrange access to advocacy services for residents. Food provided by the Home is plentiful and good quality, but 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 special diets. EVIDENCE: Older People Outcomes: Several residents expressed the view that they could not do what they wanted, when they wanted, for example, having to receive communion alone but in a lounge, rather than celebrating with others. From observation, it was seen that staff made choices on behalf of residents, rather than asking for their St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 15 views or permission, for example, by switching off the TV and turning on music because “it’s what we always do”. While residents’ interests may have been recorded, care staff did not have access to documentation and often could not say what the interests of a resident were, so activities – other than watching a programme on television that was not age appropriate - are not provided that are based on the knowledge of past-life and interests of individual residents. In a comment card, one visitor spoke about the lack of activities for residents living on the dementia unit. No activities were observed during the two days of the inspection. The Visitors’ Book showed that there were a lot of visitors to the Home, and that visitors call at all times of the day and into the evening. There were one or two examples of people establishing friendships within the Home. A small number of residents had some understanding or level of control over their financial affairs, but the majority had someone to manage finances on their behalf. There was evidence to suggest that residents and their supporters are not informed about how to contact an advocate, though it was clear from conversations with residents and visitors that support from an advocate might be beneficial. There was no evidence to confirm that residents are helped to look at their personal records. Food purchased by the Home is plentiful and is of good quality. Residents are offered three full meals each day. Staff said that new menus had been introduced during the week of the inspection and that they were being monitored for suitability and enjoyment. Written menus were not available from which residents could make their choice. A number of residents said they did not know what they would be having to eat. Meals that were taken by residents away from the main diningroom (on the lower ground floor), were not served quickly enough for them to be as hot as they should be. Staff said food is sometimes cold and they have to reheat it in the microwave. However, staff continued to serve breakfast eggs and porridge that had been standing for at least 30 minutes. Meals were seen to be delivered on trays so that hot, plated meals are positioned next to cold desserts. All meals were seen to be the same, i.e. same sized portions of the same food. This indicated that residents had no choice over the food they were to eat, or any consideration given to the portion they might prefer to be offered. Staff continued to serve food that they said was unsuitable for residents, for example, cornflakes for someone with swallowing difficulties, and made no effort to find something else that would have been suitable. Residents were not consistently offered a hot drink on rising, so some had to wait a long time to get a drink as they were not served breakfast until 9.30 a.m. One resident said that “It’s a long time from getting up till breakfast, St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 16 but staff are busy. They have a lot to do.” Tea was seen to be poured and left to stand in cups for some time before serving. Tea would not, therefore, have been served so that it was enjoyable for residents. Staff took no account of the way that residents preferred their drinks to be served, e.g. just a little milk, strong rather than weak, etc. There was strong evidence to suggest that the interval between the evening meal and breakfast was longer than 12 hours. One relative said that supper, which is served around 7 p.m., is usually tea and biscuits, or sometimes a sandwich left over from tea. Liquified meals were not served in a manner that was attractive or appealing. One visitor thought her relative had been served “just gravy”. One meal for someone requiring a soft diet was seen to have been mashed together: there was, therefore, no separation of flavour or colour. Meal supplements were provided for residents, but the decision for giving the supplement had been taken without reference to specialist advice. The methods used by staff for providing assistance in eating were unsatisfactory and insensitive. Staff were not present in one lounge where visitors were located, so visitors assisted residents with their meals. It was not clear whether this was custom and practice and acceptable to the visitors, or because there were insufficient staff on duty. In the main dining room, staff removed plates of food when it was clear that the resident had had little to eat. At least three residents in the upper lounges left their meals largely untouched. Staff explained this by saying that “they had had a good breakfast”, or said that this was what the resident “always did”. Staff were not equipped to recognise when the food provided for a resident was not presented appropriately or not liked, or that the resident may not be hungry when meals were served at the fixed times. A small, padlocked freezer and a very large dispensing machine for cold drinks are located in the residents’ dining room on the lower ground floor. Staff said the freezer contained special food for the provider which was prepared for him when he visited. Residents said the drinks machine was for the benefit of staff. One person said they could not afford to buy a drink from the machine, as it was too expensive. Staff were observed to be buying drinks over the course of the inspection. The dispensing machine is noisy and is located between residents’ dining tables. Younger Adults Outcomes: The situation noted above was the same for this group of residents. Furthermore, the Standards for Younger Adults were not reflected in the care being provided, so little thought had been given to the fact that the way they would wish to live their daily lives, and that social activities they would like, might be significantly different from the provision for Older People. For example, younger adults may value their independence and would appreciate support and assistance from care workers so that they can achieve a good St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 17 level. They might like to have a take away meal occasionally, or to see current movies. Or they may prefer to spend time with their peer group rather than with people who are considerably older than they, and with whom they may have little in common. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 (OP) and 22 and 23 (YA) The complaints process in this Home is poor with no complaints information available to residents, and no evidence that residents’ views are listened to or acted upon. Arrangements for protecting residents are not satisfactory, placing them at possible risk of harm or abuse. EVIDENCE: In this section, the outcomes were the same for Older People and for Younger Adults. Visitors and relatives spoken to during the inspection said they did not know how to make a complaint. In comment cards, one visitor said they were not aware of the Home’s complaint procedure, and one said they were aware. One relative said they had not made a complaint, but that they had made their concerns known to staff. One person said they did not make a complaint because they feared repercussions for their relative. One resident said that if you raised a concern “nothing would be done about it”. It was clear from conversations that residents and their supporters were not routinely helped to access independent advocacy. Poor practice was observed on a number of occasions throughout the period of the inspection, and there was significant evidence to suggest that the poor St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 19 staff practices and a lack of management supervision was potentially putting residents at risk. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 23, 24, 25 and 26 (OP), and 24, 25, 26, and 30 (YA). 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 was poor. Infection control procedures were not being followed, putting residents at risk of cross-infection. The low lighting levels posed risks for residents, particularly those with a visual impairment. EVIDENCE: In this section, the outcomes relate to both Older People and Younger Adults. The Home is in need of redecoration and repair throughout, though the lounge/dining room on the Dementia Unit was in the process of being redecorated at the time of the inspection. Walls and paintwork were chipped and dirty. Baths and toilets were stained. One tap would not turn off, and two St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 21 taps would not turn on. There was evidence to suggest that repairs were not being carried out, for example, damage resulting from a leak in the roof, at least three window panes were broken, and at least four windows had broken handles. While an attempt had been made to introduce additional dining space on one floor, the furniture used was seen to be chipped and unstable. Armchairs were still badly stained, despite assurances on previous visits that this matter would be attended to. The garden is not suitable or accessible for residents living at St. George’s, particularly those with dementia or physical or sensory impairment. Three residents expressed the wish to be able to go outside when they wanted to. The Fire Service reported that they had been satisfied with the premises at their last inspection in January 2005, but issues raised by the Environmental Health Officer at the 2004 inspection had not been attended to. The Home does not have a No Smoking policy but does not provide separate facilities for residents who smoke. Smokers are expected to sit to one side in lounges or dining rooms. They are not provided with ash trays and must put ash and cigarette ends into metal buckets. There is no system to extract the cigarette smoke. This is unsatisfactory as it may affect residents who have medical conditions that can be irritated by cigarette smoke, or it may simply annoy those who do not like it. There was limited privacy in shared bedrooms, which several residents commented about, and it was not clear that residents had made a positive choice to share or – except for one person - had been given the option to move to single accommodation when one became available. Two younger adults were experiencing difficulties in their shared accommodation: one wanted to sleep but the other wanted to listen to music. The positioning of furniture in one shared bedroom made it difficult for the wheelchair user to get about independently. Another resident spoke about the other person going through drawers and cupboards that did not belong to her. Several residents expressed the wish to move to single accommodation. There were five vacant rooms at the time of this inspection. Furniture in bedrooms was generally in poor condition, with chipped and broken veneer, broken drawers, and stained or dirty bedheads. Several residents expressed a wish to have a lock of their bedroom door and lockable storage space. Two ladies said they did not like it when other people, particularly men, “wandered” into their rooms. There was insufficient storage space for residents’ belongings. These were seen to be piled up on top of wardrobes, often in black plastic bags. This gave an air of people ‘passing through’, rather than moving in. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 22 The lighting throughout the Home, though domestic in character, was below the recognised standard (lux 150). A number of light bulbs were only 40 watt and did not give off sufficient light, particularly in those bedrooms that had low levels of light coming in from the outside. In corridors, main lights and wall lights had to be turned on all day in order to provide sufficient light. In at least one bedroom the overbed light (that was not located over the bed) was not working. 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, and there were areas of the Home where strong odours were present. The Home’s policies and procedures in relation to the hygiene and the control of infection were not being followed at all times. This is discussed further in the Management section of this report. At the last inspection it had been noted that commode pans were being washed in a bath which residents had access to. Following the inspection, a lock had been placed on the door to this bathroom, but was seen not to be being used on the weekend of this inspection. The sluice is located next door but is reported by the Manager not to clean commode pans effectively. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 (OP) and 35 (YA). The Home employs insufficient staff who have been appropriately trained and skilled to meet the needs and expectations of residents. Although staff morale did not appear to be low, there were high levels of short term sickness and a frequency of late arrivals for work. This situation is having a detrimental impact on the standard and consistency of care within the Home. EVIDENCE: It was evident from observations and conversations that, during the period of this inspection, there were insufficient staff on duty who were properly trained and competent to do their jobs so that the needs of residents could be met. An immediate requirement was left for this matter to be addressed. Responding to the immediate requirement, the Manager failed to see the difference between numbers of staff, and effectiveness and competence of staff. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 24 Observations indicated that the principal characteristic of the staff group was that they were disinterested and, because of this, they failed to recognise the health and social care needs of residents. Part of this problem could be attributed to the fact that care assistants were working on floors where they did not know the residents or the general routines. One member of staff was clearly unwell and taking medication. Her condition could potentially have put residents at risk, but the person in charged failed to recognise this. Staff were task orientated i.e. looking to get jobs done rather than thinking about the experience that the resident might be having. The majority of staff on duty were not considering how they could enhance a person’s well-being but demonstrated a level of complacency i.e. “this is what he always does”, “she’s always like that”. This was frustrating for those members of staff who were actively seeking to provide good care. One senior member of staff was rude and unco-operative during the inspection, which is against the Code of Conduct set by the Nursing and Midwifery Council. In a comment card, one visitor said that the anti-social behaviour of one resident affects her relative, but that staff were not equipped to manage the situation. In a telephone conversation, one relative described the manner in which a senior member of staff reacted to an incident, which was less than adequate. There is a high incidence of short term sickness and lateness. Staff arriving late for work seemed amused and untroubled by their action. Insufficient staff had stayed behind from the previous shift to cover the gap in the rota. Senior staff commented on the ‘usualness’ of the situation. A number of residents spoke about “having to wait” for assistance. Several residents and relatives spoke about the frequency of the Home being short-staffed. Four relatives said they “helped out” by sitting with residents when staff took a break or were busy elsewhere. One relative said staff took breaks during peak periods of activity so that, for example, only one member of staff remained on duty on the Dementia Unit. This might leave one member of staff providing assistance during a meal time. Staff confirmed that, sometimes, there was only one member of staff on duty to cover the Dementia Unit. Having only one member of staff on duty is unsatisfactory, and offers the opportunity to put the member of staff and the residents at risk. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 and 38 (OP) and 39 and 42 (YA) The Home is not managed and run in the best interests of residents. Openness (and, therefore, inclusiveness) is not encouraged, so residents and relatives do not feel that their opinions are of value. Staff are deficient in their knowledge of current good practice so residents cannot be assured that they are cared for by people who know their jobs. EVIDENCE: It was clear from observations, and from conversations with relatives, residents and staff, that the day to day operation of the Home is failing to meet the National Minimum Standards for both Older People and for Adults St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 26 under the age of 65. The Manager is a Registered General Nurse but she has no recognised management qualification. This is a significant shortfall as good management strongly influences the quality of care provided in a care home. Outcomes for residents, therefore, are limited by this. Staff spoke about what they knew about residents’ conditions, but in conversations about their skills and training, they indicated that their knowledge was more likely to have been obtained through information sessions held within the Home, lead by senior staff, rather than from training that was up-to-date, and provided by external providers. The methods for monitoring the quality of the service were not working effectively. Residents and relatives spoken to during the inspection indicated that their views were not listened to. Four relatives spoke about being reluctant to come forward with opinions or questions. One relative said that there had not been relatives meetings “for years”. Previously, the Manager had said this was because there were not many visitors to the Home, but this is not the case. The Home receives a good number of visitors. Relatives spoken to confirmed that the CSCI inspection reports are not made readily available at the Home, so residents and relatives are not aware of issues that have been raised. However, in a comment card, one relative said they had seen the reports on the CSCI’s internet website. At a meeting subsequent to the inspection, both the owner, Mr. Shah, and the Manager said that they did not visit the Home outside of the normal working day, Monday to Friday. One relative said that although he had seen the owner, he had not been acknowledged, nor had he been asked for his views or opinions. Three people said the Manager was never at work at times when they visited. From observation and written information in residents’ care plans, there was insufficient evidence to confirm that procedures and practices are being reviewed in light of changing legislation and good practice advice, for example, in relation to the use of restraint to prevent falls. Staff were observed to be using protective gloves and aprons, but there were instances where staff, for example, carried cups for residents by placing the fingers inside the cups (rather than using the handles), and wiped the face of a resident with a dishcloth (following which the dishcloth was used to wipe tables). Tables being used for dining on the Dementia Unit were cleaned before use, but not those on the ground or upper floors. The carpet was not cleaned following an episode of incontinence. A relative said that he had had to stop a carer serving biscuits directly onto a dirty table rather than cleaning the table or using a plate. A number of residents have MRSA. Good infection control and general hygiene procedures would, therefore, be doubly important. In the main, moving and handling techniques appeared satisfactory. However, one member of staff said that her techniques were “old-fashioned”. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 27 Accidents are now recorded on the appropriate document but there is insufficient evidence to confirm that accidents are audited. The Home does not report accidents and incidents that affect a resident’s well-being to CSCI as they should. Reports are only forwarded following the death of a resident. An immediate requirement was left with the Home for them to contact the Environmental Health Officer in relation to food hygiene, and an inspection was subsequently conducted. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 28 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 2 x 3 2 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 1 x 2 x x 2 1 2 Score Standard No 7 8 9 10 11 Score 1 1 2 2 x Standard No 27 28 29 30 1 x x x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 1 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 2 x 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 x 33 1 34 x 35 x 36 x 37 x 38 2 St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 29 NO 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 1 Regulation 5 Requirement A service users guide must be developed that identifies the difference between the care being provided for Older People and that for Younger Adults. Assessments must be carried out for all prospective residents, including those accessing respite care. All care staff must be made aware of the content of care plans. Care plans must contain sufficient information about personal and social care needs, in line with Standard 3. 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. Care practice must meet current legislation and good practice guidelines, e.g. in relation to the prevention of falls. The personal and oral hygiene of each resident must be maintained. Residents who have F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Timescale for action 1st September 2005 1st July 2005 1st July 2005 31st July 2005 1st July 2005 2. 3 14 3. 4. 7 7 12 12 5. 7 15 6. 7 12 6th June 2005 1st July 2005 7. 8 12 St Georges Nursing Home Version 1.30 Page 30 8. 8 13 9. 9 13 10. 9 13 11. 12. 13. 9 9 10 13 13 12 14. 12 16 15. 15 16 16. 16 22 17. 18 13 the capacity to self-care must be supported. Residents must have access to any health care professional from outside of the Home or treatment or advice, e.g. continence adviser or physiotherapist. Medication records must be maintained, including those for administration, disposal, medication supplied for administration outside the home, leave medication. Records must be complete, clear, accurate and up-to-date. Procedures must be followed during the medication round to ensure that the security of medication is not compromised and doses of medication are not missed. Homely remedies must be administered in accordance with the Homes written policy. Medication, including medicinal oxygen, must be appropriately and securely stored. The Home must be conducted so that the privacy and dignity of residents is promoted and maintained. Residents must be consulted about the programme of activities they would like, including activities in relation to recreation and fitness. Food must be provided that is suitable for residents to eat, that is properly prepared, and at times when they want to eat it. The complaints procedure must be made available to all residents or their supporters, in forms that are appropriat4e to the needs of the residents. All staff must receive training in F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc 1st July 2005 15th July 2005 15th July 2005 15th July 2005 15th July 2005. 1st July 2005. 15th July 2005 15th July 2005 31st July 2005 31st August Page 31 St Georges Nursing Home Version 1.30 18. 19. 19 19 23 23 20. 21. 22. 19 19 21 23 23 23 23. 24. 25. 22 24 24 23 23 23 26. 27. 25 25 23 23 28. 29. 26 27 23 18 30. 31 9 the protection of vulnerable people. The freezer and the vending machine must be removed from the residents dining room. A programme of repair, redecoration and refurbishment must be drawn up, together with timescales for completion. The garden must be made accessible for residents living at the Home. The Home must be made clean and free from offensive odours throughout. Bathrooms and toilets must be reviewed and updated so that they are clean and in good working order. The nurse call system must be reviewed so that all call cords are accessible. Residents must be provided with adequate storage. Residents must be provided with lockable storage space, and locks to bedroom doors, subject to risk assessments. Window panes and window handles must be repaired. Lighting must be provided throughout the Home that is suitable and meets recognised standards. The sluicing facilities must be upgraded to meet current demands. 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. The Manager must register on a course to undertake training in relation to the management of staff, as well as training to F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc 2005 15th July 2005 8th July 2005 31st August 2005 8th July 2005 31st August 2005 8th July 2005 31st July 2005 31st July 2005. 31st July 2005 15th July 2005 31st July 2005 6th June 2005 31st July 2005 St Georges Nursing Home Version 1.30 Page 32 31. 33 24 32. 33 24 33. 38 37 34. 38 13 update her knowledge, skills and competence. A system must be established for reviewing and improving the quality of care at the Home, including the quality of nursing. Policies, procedures and practices must be reviewed to meet current legislation and good practice advice. Notifications must be made to the CSCI and other relevant agencies in relation to accidents, incidents and significant events. Staff must be trained and supervised so that they achieve acceptable standards of food hygiene and infection control. 31st July 2005. 31st August 2005 15th July 2005 31st July 2005. 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. 4. 5. 6. 7. Refer to Standard 1 9 9 9 9 13 19 Good Practice Recommendations The service users guide should be made available in different formats. Covert administration should be recorded and reviewed strictly in accordance with the NMC guidelines. The dividers with residents photographs and administration information should be used between individual MARs. A list of registered nurses and their MAR initials should be maintained. Care staff application of prescribed creams should be formally delegated by the nurse-in-charge and recorded. Residents and their supporters should be advised about how to contact an advocate. Consideration should be given to providing separate facilities for residents who smoke. St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI St Georges Nursing Home F06 F56 S55720 St Georges V228201 4 5.06.05 Stage 4.doc Version 1.30 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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