Inspection on 11/04/07 for St Georges

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

St Georges 25/09/07

St Georges 26/02/07

St Georges 29/11/06

St Georges 28/02/06

St Georges 30/06/05

St Georges 13/01/05

St Georges 25/08/04

St Georges 10/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE St Georges Abbey Hey Lane Gorton Manchester M18 8RB Lead Inspector Val Bell Unannounced Inspection 11th April 2007 10:00 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 Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Georges Address Abbey Hey Lane Gorton Manchester M18 8RB 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) 0161 220 8885 F/P 0161 220 8885 Mr Haile Kidane Ms Margaret Beech Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2007 Brief Description of the Service: St Georges is a privately owned residential care home providing accommodation for up to 10 people aged 60 and above. The home is situated in the Gorton area of Manchester, close to public transport links into Manchester City Centre and Hyde. The home is a three-storey property, next to a church, and was previously used as a rectory. The accommodation is provided in one double bedroom and eight single bedrooms located on two floors. Access to the first floor is via a passenger lift and a central staircase. The third floor provides office space and a staff sleep-in room. None of the bedrooms have en-suite facilities. All bedrooms have a washbasin and vanity mirror. Accessible toilet and bathroom facilities are provided on the ground and first floors close to the living accommodation. There is a lounge on the ground floor with a separate dining room. A kitchen and laundry are also located on the ground floor. The fee for living at the home is £373.83 per week. There are additional charges for hairdressing, toiletries, day trips, holidays and clothing. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 26th February 2007 and supporting information provided by the home prior to the visit to the home. Additionally, one of the people living in the home provided information by completing a satisfaction survey. The visit to the home forms part of the overall inspection process and the lead inspector and the Commissions pharmacist inspector conducted this during daytime hours on Wednesday 11th April 2007. The opportunity was taken to look at the core standards of the National Minimum Standards (NMS) The inspection will also be used to decide how often the home needs to be visited to make sure that the required standards are being met. During the visit time was spent with people living in the home and discussions were held with staff and the home manager. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. What the service does well: The home placed emphasis on valuing people as individuals and encouragement and support to maintain peoples independence through promoting good mobility and maintaining peoples capacity to follow their chosen lifestyles. There were certain identified risks associated with this and there was some evidence that risks were being managed well. However, the home had neglected to record how this was being done. Stimulating and interesting activities were being provided both inside the home and within the surrounding community. This was confirmed in conversation with a visitor and several people living in the home. Several people praised the standard of the food provided and added that second helpings were always available. Staff had a thorough understanding of peoples needs and were skilled at tempting people with poor appetites to eat. Staff had regular access to training opportunities, which ensured that they had the relevant skills and knowledge to meet the assessed needs of people living in the home. People living in the home were being afforded respect and their care and support was delivered in a private and dignified way. Staff worked hard to encourage people to take a pride in their appearance and one person commented that this was important to them. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home had made little progress in ensuring that identified risks had written assessments and management plans in place as required in the previous three inspection reports. A man admitted to the home the week before this visit had identified risks associated with diabetes, mobility and orientation, yet there were no risk assessments or risk management plans in place. The pharmacist inspector identified serious concerns, in the way medication was being administered by the home and two of these issues were outstanding from previous inspection reports. The shortfalls identified potentially placed the health and welfare of people living in the home at risk. The home must improve all the medication handling systems to ensure that the recording of medication is clear and accurate and that all medication is accounted for. It is very important that people are given their medication as prescribed and staff must have accurate information from the prescriber on how to administer prescribed medication safely. The system in place for the management of people’s personal monies did not have an audit trail in place. Consequently it was not possible to assess the St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 7 accuracy of balances held. A good practice recommendation was made for two signatures to be obtained on all recorded transactions. Health and safety shortfalls were found as follows; a leaking drainpipe, builders rubbish left on a path near the patio, the use of wedges to hold two bedroom doors open and failure to consistently undertake the required fire safety checks at the prescribed intervals. These shortfalls potentially placed the health, safety and welfare of people living in the home at risk. Nine good practice recommendations were made to improve standards in health and safety, medication administration, quality assurance and the décor in one of the bathrooms. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People admitted to the home could be confident that their support needs would be identified and recorded during the pre-admission assessment process. EVIDENCE: The registered manager said that two good practice recommendations made at the last inspection had been implemented. She confirmed that the service users guide had been updated and that people living in the home had been issued with written contracts detailing the conditions of their stay in the home. One of the people living in the home made the following comment in the satisfaction survey he completed, ‘The care and support are important and this is the main reason this home was chosen as the staff are very supportive and caring, which at the end of the day is very important at our time of life.’ The requirement made at the last inspection that the home must obtain care manager assessments of need for all people admitted had been met. The St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 10 manager said that these documents were not always available before people were admitted but care managers always provided a verbal summary of individual’s needs. It was pleasing to note that the homes in-house assessment of need had been developed to include the areas of need specified in Standard 3. This ensured that people moving into the home could be confident that they would receive a robust assessment that fully identified and recorded their support needs. The manager provided evidence that the home’s assessment of need recorded individual’s choices and preferences, such as favourite foods etc and again it was pleasing to know that these were being bought in on an individual basis. A man admitted to the home the previous week had signed his assessment of need. This provided evidence that he had been consulted throughout the assessment process. The home did not provide an intermediate care service. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provides a good standard of care and people are valued as individuals. Care is provided in private in a dignified way. However, the home’s failure to operate a safe system of medication administration potentially places the health and welfare of people living in the home at serious risk. EVIDENCE: It was pleasing to note that the home had complied with the requirement that all people admitted to the home must have up to date care plans. The care plan belonging to a man admitted the previous week had been drawn up from the care manager needs assessment together with the homes assessment of need. Other care plans were being reviewed and updated on a monthly basis. From conversations with staff and people living in the home and examination of the daily records it was evident that individual risks were being managed well. However, assessment of risks and how they were being managed had St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 12 not been written down. This was evident in the care plan belonging to the man admitted the previous week as his assessments of need identified risks associated with diabetes, mobility and orientation. Failure to provide staff with written instructions on how to provide the right level of support potentially places this person’s welfare and safety at risk. The manager gave her assurance that his key worker would implement the required documentation as soon as possible. Several examples of good practice were observed from staff encouraging people to maintain their mobility. It was noted that staff took care to provide support that was not rushed but consistent with an individual’s pace. The friend of a man living in the home said that prior to moving into St Georges her friend had lived in a nursing home, where he was being sedated and as a consequence had become immobile. She was delighted that only a few days after admission to St Georges, her friend had regained his mobility. She praised staff for taking the initiative to instigate a review of his medication and the support they provided to encourage his mobility. Medication continues to be handled poorly and the health of people living in the home is at risk of harm because of these poor practices. The standard of record keeping was poor. Staff administering medication failed to administer some of the medication, which they had signed for. An example of this was that staff had signed that they had administered a tablet that had been prescribed for once a week on four consecutive days. Staff failed to make accurate records when receiving medication and an audit trail could not be provided to show that all medicines were accounted for. The standard of medication administration was poor. People were not always given their medication as prescribed by the doctor. The day before the inspection new medication had been prescribed and delivered for two people although neither person had been given their new medication. This failure to administer medication properly potentially puts these peoples health at risk. Another person was prescribed a controlled drug patch for pain relief. There were a large number of patches in stock for this person. Staff said that the possible reason for this excess was that they must not have been applying them as prescribed. This failure to administer pain relief as prescribed by the doctor could put this person’s health at risk. There were also serious concerns that staff did not always have information on exactly how to administer some tablets. One person was prescribed Warfain but there were no directions from the prescriber as to the dose this individual was to have. This placed the individual’s health at significant risk. An immediate requirement notice was issued so that staff would take action to determine the correct dose of medication quickly. It was of further concern that no action had been taken on finding this information as required during the previous inspection. It was encouraging to note that the registered manager telephoned the pharmacist St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 13 inspector five days after the site visit to confirm that action had been taken to meet this requirement. Some medication was poorly stored and staff did not follow the manufacturers’ directions for storage. By storing medications at the wrong temperature their effectiveness could be changed and peoples health could be harmed. Throughout the site visit staff spoke to people in a respectful way using their preferred term of address. It was evident from observing interactions that staff had developed trusting relationships with people living in the home and all personal care was delivered in private and in a dignified way. Staff took care to speak to people by getting down to their eye level, which was particularly seen as an example of good practice for people who suffered from hearing impairments. The hairdresser was in attendance during the site visit and all the ladies living in the home had their hair set. Three of the ladies said that it was important to them that they looked nice. All people living in the home had been supported to look their best by wearing smart, clean and appropriate clothing. The friend of a man living in the home said, “Staff are very caring, they communicate well and will telephone me if they have any concerns about the welfare of my friend.” She added that staff treat people with respect as valued individuals and that privacy and dignity are maintained. This visitor said that she visits at all times of the day, mornings, afternoons and evenings. People living in the home are valued and treated as individuals and they are provided with full support to follow their chosen lifestyles e.g. attending religious services of their choice. The home ensures that routines are flexible and there is an emphasis on maximising individuals’ independence. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are able to make choices that affect their lives and are provided with a healthy diet and stimulating and interesting activities of daily living. EVIDENCE: A lengthy discussion was held with the manager regarding the activities provided by the home. It was evident that activities provided were relevant to the assessed needs of people living in the home. Written evidence of individuals’ experiences had been recorded on a daily basis. Additionally, it was pleasing to note that people living in the home enjoyed an annual holiday and regular trips out to markets and Harry Ramsden’s. Another pleasing point was that people were encouraged and enabled to follow their chosen lifestyle once they had moved into the home. For example, a man admitted to the home the previous week was receiving support to visit his local pub to socialise with his friends every evening. Additionally, he planned to continue to attend a drama group that he had been a member of for some years. This person suffered from memory loss and disorientation and the staff were working hard to support him to follow his chosen lifestyle in a safe way. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 15 The friend of a man living in the home was spoken to during the site visit. She confirmed that in-house activities such as karaoke, music, trips out and board games take place regularly and said that the deputy manager takes responsibility for arranging these events. Four people confirmed that daily routines were flexible and they could choose to join in or abstain from activities provided. All four people praised the level of care and said that staff were very kind to them. Two members of staff talked about how they enabled choice for people living in the home. This was observed in their practice and confirmed in conversation with several people. Four people living in the home said that the food provided was good, that they had a choice in what they wanted to eat and that second helpings were always available. During lunch one of the men said he had thoroughly enjoyed his meal. A member of care staff asked him if he would like some more, which he accepted. One of the ladies did not want to join other people for lunch in the dining room, as she was not feeling very well. Staff were overheard discussing what they could offer the lady to tempt her to eat. They debated which of this lady’s favourite foods would encourage her. Later on it was observed that the staff had managed to encourage the lady to eat yoghurt and some of her favourite biscuits. The home did not have a dedicated cook so care staff were responsible for cooking. This meant that from 8 – 11:00 they worked delivering personal care and from 11:00 a member of care staff started to prepare the midday meal. This potentially placed people at risk from contamination of food by crossinfection. A recommendation was made to seek guidance on this issue from the environmental health officer to ensure that people living in the home are safe from infection. Significant progress had been made to improve the standard of cleanliness and hygiene of the kitchen and food storage areas. This had been achieved by implementing cleaning schedules. Written evidence demonstrated that all areas in the catering section had been cleaned on a regular basis. Fridge and freezer temperatures had not been recorded on the five days prior to this site visit. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home can be confident that their concerns will be listened to and that policies and procedures in place will afford protection to their safety and welfare. EVIDENCE: The home had a complaints procedure and a system was in place to record complaints and the action taken to resolve them. No complaints had been made in the previous twelve months. Four people spoken to knew who to talk to if they had any concerns and were confident that staff would take the appropriate action to resolve them. A visitor to the homes confirmed that concerns were resolved immediately they were brought to the attention of staff. The home had adopted Manchester City Council’s policy and procedures in safeguarding adults from abuse. A copy of the procedure was available for staff to consult at all times. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Maintenance and redecoration work recently undertaken has provided people living in the home with safer and more pleasant and comfortable surroundings. EVIDENCE: Requirements relating to window restrictions, safety glazing, hot surfaces and hot water made by the environmental health officer in December 2006 had been met satisfactorily. Additionally, requirements made at the previous CSCI inspection had been met as follows: Food stored in the fridge was covered and date labelled. Chemical materials were stored securely by fitting locks to cleaning cupboards. Work had started on replacing broken wall and floor tiles in kitchen. All tripping hazards in the kitchen had been attended to at the time of the site visit. ReSt Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 18 decoration requirements had been undertaken. However, the standard of redecoration in one of the bathrooms was poor. Broken furniture had been replaced as required and all bathrooms and toilets were accessible to people living in the home. All areas of the home were found to be clean and hygienic and no offensive odours were present. The following comment has been taken from a satisfaction survey completed by one of the people living in the home, ‘There are never any bad smells. It is fresh and clean. The rooms are cleaned on a regular basis.’ Health and safety shortfalls were found in the environment at the time of this visit as follows: 1. The drainpipe at the side of the patio had a loose connection and water was pouring down the external wall. 2. A wrought iron gate on the patio had come away from its fixing. This had been leant against the gatepost. This was a potential hazard. Staff removed the gate before the end of the site visit. 3. Workmen had left rubbish on a path to the side of the patio. This needed to be removed to prevent tripping hazards. 4. Two bedrooms doors were propped open with wedges. The manager said that the people living in those rooms became anxious if their doors were closed. This needs to be risk assessed in line with advice taken from the local fire officer on the safe use of wedges. A laundry was sited next to the kitchen. Laundry facilities were appropriate to meet the needs of people living in the home. Colour coded bags were in use to separate soiled linen from other laundry. The manager assured the inspector that dirty laundry was not transported through the kitchen but though the external laundry door. Since the last inspection the patio area had been designated as the smoking area for people living in the home. The manager said that the owner proposed to build a shelter for this purpose to be used in inclement weather. People living in the home referred to the environment as homely and one person said the home was ‘cosy’. The home had been suitably adapted to meet the mobility needs of people living there, such as raised toilet seats, handrails, hoists etc. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of trained and skilled staff are deployed to meet the assessed needs of people living in the home. EVIDENCE: The inspector was provided with copies of the previous four weeks rotas. These provided evidence that sufficient staff were being deployed to meet the assessed needs of people living in the home. At the time of this visit staff were working towards NVQ level 3 in care and all staff, apart from 2 new staff, had achieved level 2 in care. The staff team had access to Manchester City Council training and the manager said they would be booked on relevant courses as they became available. Staff had accessed regular training opportunities in the previous twelve months including first aid, food hygiene, dementia, medication, infection control and fire safety training. Future planned training includes risk assessment, bereavement, first aid, safeguarding adults from abuse, and medication administration. At the previous inspection the manager was incorrectly advised that newly recruited staff could not commence employment following a POVA (Protection of Vulnerable Adults) First check. Staff can commence employment on receipt of satisfactory written references and a POVA First check pending receipt of a St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 20 satisfactory Criminal Records Bureau (CRB) disclosure. However, during this period staff must work under constant supervision. Consequently, the home was undertaking the required pre-employment checks to ensure that people with the right qualities were recruited to work at the home. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well managed. However, failure to provide evidence that essential fire safety checks are undertaken on a regular basis potentially places the welfare and safety of people living in the home at risk. EVIDENCE: From a conversation with the manager it was apparent that mitigating circumstances had not been identified when making the requirement at the previous inspection to undertake a review of the management arrangements in the home. The manager had been unwell at the time and should have been off sick. However, she had come in to cover a shift, as there were no available staffing resources. The home employs a manager, deputy and four senior St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 22 carers. This management structure provides suitable senior cover for the smooth running of the home. The manager stated her intention to retire in the near future but added that she would continue until a suitable replacement was found. The registered manager was present throughout the site visit and she presented evidence that confirmed the majority of previous outstanding requirements had been met. However, requirements will be reiterated in regard to medication and fire safety. The need to have written risk assessments and risk management plans has also been be re-iterated in this report. It was pleasing that nine of the ten good practice recommendations had been taken on board by the home. People admitted to the home were issued with satisfaction surveys following the admission process. The home should further develop this into a quality assurance system by issuing annual satisfaction surveys to people living in the home, their representatives and other stakeholders. It was pleasing to learn that the owner was making regular visits to monitor standards within the home. The registration certificate and public liability insurance were displayed, accurate and current. The manager was asked about appointee-ship. She stated that this was being managed for publicly funded people by the local authority. Individuals’ personal allowances were paid to the homeowner along with their care and accommodation fees. The owner held balances of personal capital in a bank account. It was not clear if people had easy access to their capital or if they had individual accounts that earned interest. Written records were held for all transactions undertaken but the balances could not be confirmed as accurate because bank statements were not available at the time of the visit. It was recommended that two signatures be obtained for all transactions undertaken on behalf of people living in the home and the provider must provide written evidence to the Commission that the personal monies held on behalf of people living in the home are accurate. A supervision and performance strategy was being developed at the time of the site visit. Safe working practices were assessed during the visit to this home. On two occasions staff were observed to use correct moving and handling techniques with two different people. One member of care staff confirmed that she had signed to say that she had been involved in a fire drill approximately six weeks ago. However, the manager could not find these records during the site visit. It was disappointing to find that essential fire safety checks were two weeks out of St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 23 date. Consequently the requirement made at the last inspection has been reiterated in this report. During a discussion regarding health and safety with two care staff in the kitchen it was noticed that there was an old bin in the kitchen that was dirty inside and not in use. One of the carers immediately removed the bin for disposal. That day’s kitchen waste was being deposited in a bin bag in the kitchen area. One of the carers said that the environmental health officer had stated that kitchen waste bins no longer needed to be covered. However, a recommendation had been made for bin bags to be placed inside a receptacle bin to avoid spillage of waste onto the kitchen floor. Two staff confirmed that they attended regular health and safety training updates and this was confirmed by sight of training certificates held in their personnel files. St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 2 X X 2 St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (4) Requirement Risk assessments must be in place to assess all risks applicable to people living in the home. These must be subject to regular review to ensure that people continue to be safe. Previous timescales of 05/01/07, 05/02/07 and 09/04/07 not met.) The registered manager must confirm the date of the next blood test and the correct dose and regime of warfarin prescribed to the person identified during the site visit. This is to ensure that this person’s health and welfare is not placed at risk. (Previous timescale of 05/02/07 and 09/04/07 not met) The registered manager must ensure that medication records are clear and accurate and that stocks of medication held are accurate to provide evidence that people receive their medication as prescribed. (Previous timescale of 05/02/07 and 09/04/07 not met) DS0000021580.V334532.R01.S.doc Timescale for action 11/05/07 2. OP9 13 (2) 13/04/07 3. OP9 13 (2) 11/05/07 St Georges Version 5.2 Page 26 4. OP9 13 (2) 5. OP9 13 (2) 6. OP19 23 (2) 7. OP35 20 8. OP38 13 (4) The registered manager must ensure that medication is administered to people in strict accordance with the prescriber’s instructions at all times so that people’s health is not placed at risk. The registered manager must ensure that all medication is stored safely and at the correct temperature so that people’s health is not placed at risk. The registered person must ensure that the environmental risks identified in this report are addressed to prevent harm to people living in the home as follows: 1. Repair of the leaking drainpipe near the patio. 2. Removal of the builders rubbish from the path adjacent to the patio. 3. Undertake risk assessments and risk management plans on the use of door wedges in line with advice from the local fire officer. The registered person must submit written evidence to the Commission that the personal monies held are accurate and that the system in use protects the financial interests of people living in the home. The registered person must consistently undertake fire safety checks at the prescribed intervals to promote the safety and wellbeing of people living in the home. (Previous timescale of 09/04/07 not met) 11/05/07 11/05/07 11/05/07 11/05/07 11/05/07 St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that controlled drugs are stored in a controlled drug cabinet and that a separate record of controlled drug handling is made in a controlled drug register to maximise the safety and welfare of people living in the home. It is recommended that handwritten entries on the medication records are signed by the person making the entry and then countersigned by a second person to ensure accuracy of the information and protection to the health and welfare of people living in the home. The registered manager should obtain advice from the environmental health officer on how to prevent contamination of food being prepared by carers following the delivery of personal care tasks. This will afford protection to people living in the home from the potential risk of infection in caused by eating contaminated food. The registered manager should ensure that fridge and freezer temperatures are recorded on a daily basis to make sure that the food people eat is safe. The bathroom that has been decorated to a poor standard should be re-decorated to a good standard so that it is a pleasant environment for people taking a bath. The registered manager should seek advice from the local fire officer on the safe use of door wedges on people’s bedroom doors. It is strongly recommended that the registered person reviews and develops the quality assurance system to provide a verifiable method and evidence that the home takes the views of people that live there seriously. The registered manager should consider getting two people to sign all transactions undertaken with money belonging to people that live in the home. This will ensure that their financial interests are protected. The registered manager should ensure that kitchen waste is deposited in a suitable bin fitted with disposable bin bags to maintain safe working practices in health and safety. 2. OP9 3. OP15 4. 5. 6. 7. OP15 OP19 OP19 OP33 8. OP35 9. OP38 St Georges DS0000021580.V334532.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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