Inspection on 25/09/07 for St Georges

This inspection was carried out on 25th September 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 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 Georges 11/04/07

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 10:00 25 September 2007 th 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.V351297.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.V351297.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.V351297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th February 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.V351297.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 30th July 2007. Site visits to the home form part of the overall inspection process and two inspectors conducted a visit during daytime hours on Tuesday 25th September 2007. The opportunity was taken to look at the core standards of the National Minimum Standards (NMS). This 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 talking to four people living in the home and a visiting relative. Discussions were held with the provider, three care assistants and the registered home manager. A telephone conversation was held with the son of a resident and the relatives of two residents completed and returned satisfaction surveys to the Commission. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. What the service does well: What has improved since the last inspection? Significant improvements had been made to the way medication was administered, stored and recorded to ensure that people living in the home were receiving their prescribed medication safely. An outstanding requirement had been addressed by undertaking a diabetic risk assessment for one of the people living in the home. The provider had failed to provide evidence that balances of personal monies he held on behalf of residents were accurate. Consequently, a safeguarding St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 6 adults referral was made to Manchester Social Services. The outcome of the investigation resulted in the management of finances for three residents being transferred to the local authority. This will mean that these three people will have access to accurate information in relation to their income and expenditure. Other people living in the home had their personal allowances managed by their relatives. Staff attended various training courses and had achieved National Vocational Qualifications in levels 2 and 3 in care in the previous twelve months. What they could do better: Ten requirements and eleven good practice recommendations were made during this inspection. This home has been inspected seven times since November 2006. It is of serious concern that during this time the standard of risk assessment and management has consistently failed to provide evidence that people living in the home are safe. Additionally, assessments of need and care plans do not contain current and accurate information to inform care staff of the tasks they must undertake to safely meet peoples assessed needs. Minor shortfalls were found in the way some medication was being administered and stored. This can be improved by consulting with the supplying pharmacist and residents’ general practitioners. Two people living in the home confirmed that they were able to engage in activities of their choice, although this was not evident for other people. A visiting relative said that she visited regularly and had never seen much in the way of organised activities apart from music and television. People living in the home should be consulted about how they like to spend their time and particular attention should be paid to involving people who have cognitive impairments, such as dementia. Staffing levels provided were adequate in meeting the assessed care needs of people living in the home. However, it was noted that care staff were expected to undertake the cleaning, laundry and cooking in addition to their caring duties. This placed care staff under pressure at key times of the day, such as mealtimes and left them little spare time to organise structured activities for residents. It is recommended that staffing levels be reviewed. The environmental health department had conducted a food safety inspection following this inspection visit and a warning had been issued in relation to the poor standard of hygiene and cleanliness in the kitchen. This must be addressed within the required timescale. Improvements were necessary to ensure that new staff were not confirmed in post until satisfactory pre-employment checks had been received. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 7 During this inspection visit serious concerns were identified relating to the management of health and safety within the home. The servicing and maintenance of gas and electric equipment was out of date and the storage of flammable materials in close proximity to the gas boiler was a particular cause for concern. Since the visit evidence was provided to the Commission that the gas equipment had received an annual service. Further health and safety concerns included inappropriate storage of a hoist and a mattress at the top of a staircase and cleaning equipment obstructing a fire escape route. There was evidence that staff had been smoking in three areas in the building despite the recent introduction of legislation banning smoking in the workplace. No risk assessments had been undertaken in relation to safe working practices as required by health and safety at work legislation and no assessment of the safe control of substances that are hazardous to health (COSHH). The homes fire evacuation procedure instructed staff to ‘remove non-ambulant residents from the building.’ During a conversation with the manager it was evident that this was meant in the best interests of people living in the home. However, the manager was unaware of the risks and dangers involved. Advice on the safe evacuation of people in the home should be taken from the local fire safety officer. The service did not have a quality assurance monitoring system in place. It is important that the views of people using the service and other stakeholders are regularly surveyed so that the necessary improvements can be made to the quality of service provision. 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.V351297.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.V351297.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, 3 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Failure to monitor, review and update the assessed needs of people admitted to the home places their welfare, health and safety at serious risk EVIDENCE: The inspector chose to examine the care records belonging to two residents that had not been assessed during previous inspections. Both files contained care manager assessments of need. These documents clearly identified potential risks to the safe delivery of care. There was no evidence that assessments of need had been subject to in-house reviews to ensure that information was accurate and up to date. Care manager reviews were held in June 2007 for four people living in the home. These reviews identified that there had been significant changes to the needs of these four residents, yet no action had been taken to ensure that this information had been used to inform staff of the changes or to provide guidance on how residents’ current needs were to be met. Additionally, there was no evidence that residents or their St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 10 representatives had been consulted regarding their assessments or how they would like their needs to be met. Consequently, there was no evidence to demonstrate that the service was capable of meeting the needs of individuals admitted to the home. Two relatives that returned completed satisfaction surveys to the Commission said that they were given enough information to make a decision on whether the care home would be able to meet individuals’ assessed needs. One of these two relatives added, “I visited a number of residential care homes. My first visit to St Georges, I was impressed with the homely atmosphere and no foul smells. On the information from the management I chose St Georges.” A third relative was disappointed that information she had been given prior to admission had later proved to be inaccurate. (see the section of this report entitled, ‘Daily Life and Social Activities’) The home did not offer an intermediate care service. St Georges DS0000021580.V351297.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. Failure to adequately assess risks and keep care plans up to date places the safety of people living in the home at serious risk. EVIDENCE: Four people living in the home, two relatives spoken to and two relatives that completed satisfaction surveys confirmed that individuals’ needs were being met in a caring way. Additionally, observations of how staff interacted with residents during the inspection provided further evidence that people using the service were treated with respect. However, serious concerns were identified in the way that risks were being managed in the home. The records belonging to two residents were examined for evidence that care plans contained detailed instructions on the tasks that care staff would undertake to meet individual’s needs safely. The assesment of one of these residents detailed the following needs; cognitive and mobility impairments, at St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 12 risk of falling, assistance with continence, potential risk of self-neglect with personal care and eating and drinking and at risk of developing pressure ulcers. In particular, the care manager had recommended that this resident’s fluid and food intake should be monitored and a continence programme be implemented. The care plan in place stated that staff should monitor the resident’s eating and drinking. However, there was no evidence in the daily notes of the quantities of food or drink taken by the resident. When asked about this, a senior member of staff responded, ‘She is eating and drinking fine.’ Written evidence must be provided to ensure that this resident’s diet is being monitored in accordance with her assessed needs. Furthermore, there was no evidence that the resident had been weighed. In relation to a continence programme, no care plan was in place to ensure that the resident was prompted to use the toilet regularly. This was particularly important for this resident as she clearly needed staff to provide support with her mobility and in orientation of time and place. Although a falls risk assessment was in place this lacked detail to inform staff of the action they must take to minimise the risk of the resident falling. Of particular concern was the absence of a moving and handling risk assessment. During the inspection the resident was observed to move with difficulty with the use of a zimmer frame. This must be appropriately assessed and instructions provided for the support needed to keep the resident safe when moving about the home. The second care plan examined provided further evidence of serious concerns. Manchester Social Services Department had reviewed the resident’s care at the home on 5th June 2007. The review notes identified issues outstanding from a earlier review as follows: • • A moving and handling risk assessment was needed and the care plan needed updating. The resident had declined the use of a hoist for her moving and handling needs. Consequently, clear written guidance was needed to advise care staff on how to provide safe moving and handling support for the resident. The resident needed a risk assessment in relation to mobility. Scales needed to be purchased to weigh the resident monthly. The resident could not use the nurse-call system in her bedroom so an alternative means of summoning staff assistance was needed. The resident had delicate and fragile skin and needed ointment to be applied daily. There was no evidence in the care plan on how care staff were to safely provide care and no evidence of when ointment was being applied. Although the resident had been provided with a bed rail, no risk assessment had been undertaken to ensure its safe use. The resident’s bedroom carpet was badly fitted causing a tripping hazard. DS0000021580.V351297.R01.S.doc Version 5.2 Page 13 • • • • • • St Georges The care manager made further recommendations to review the resident’s prescribed medication annually, to record the outcome of medical appointments and to provide the resident with more than one shower per week. The resident’s care plan was dated 28th February 2007 and a separate sheet recorded that the care plan had been reviewed every month since the care managers review. However, an entry made on 23rd June 2007, after the care managers review, stated ‘care needs remain the same.’ This was clearly inaccurate as identified above. At the previous inspection on 30th July the manager gave her assurance that all care plans were being reviewed and brought up to date. This home has been inspected on five occasions since November 2006 and has consistenly failed to meet the standard of care planning and risk assessment required. If risk assessments and good practice guidelines are not carried out evidence cannot be provided that residents are being supported in a safe way. This places the health, welfare and safety of people living in the home at serious risk. Four residents and a visiting relative were spoken to during the visit. The residents confirmed that staff maintained their right to dignity and privacy. The relative commented that she was encouraged to become involved in her mother-in-law’s care by accompanying her to medical appoitments. The system for the adminstration of medication was assessed. Significant improvements had been made to medication recording and storage since the last inspection to ensure that residents received their prescribed medication safely. However, minor shortfalls were found as follows. A small, locked fridge in the kitchen was being used to store liquid diazepam, haloperidol and lactulose. Manufacturers’ instructions stated that these medicines must be stored below 25 degrees Celsius although it was not clear if the effectiveness of this medication would be compromised by being stored at colder temperatures. A recommendation was made to contact the pharmacist to clarify the situation. An opened tube of eye ointment was also stored in the fridge and the manufacturer’s guidance stated that the ointment should not be used longer than 28 days after opening. Staff had failed to mark the tube with the date of opening so that it could be discarded after 28 days. A newly admitted resident had been prescribed co-codamol, a painkiller to be taken ‘as required.’ There was no evidence of written instructions to guide staff in what circumstances they should administer pain relief. Also this medication was being recorded as if it had been prescribed to be taken four times a day. Staff stated that the resident was aware of when she needed to take this medication as she was in constant pain. It was recommended that the resident’s general practitioner is asked to review the resident’s need in relation to pain relief. A second resident had been prescribed laxative medicine to be taken ‘as required’ although there were no written guidelines for when this should be administered by staff. This should be clarified with the resident’s general practitioner and his instructions should be written down and made St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 14 available to staff administering medication. The member of staff responsible for monitoring and auditing the medication records understood the role of administration and recording and what equipment should be used to support people to take their medication safely. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 15 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 poor. This judgement has been made using available evidence including a visit to this service. Poor standards of hygiene and maintenance in the kitchen environment place the health and safety of people living in the home at serious risk. EVIDENCE: There was little evidence that residents had been consulted about or had access to regular activities that provided interest and stimulation. A visiting relative said that she visited at all times of the day and she had never seen much in the way of organised activities apart from music and television. She added that her mother-in-law becomes bored because she finds it difficult to engage in meaningful conversation with other residents. Another relative commented, “I would suggest that subtitles are put on the television. I do not think any of the residents can actually hear the sound.” Another comment made by a relative completing a satisfaction survey was, “On my first visit to the home (i.e. before I chose it) I was told that there were regular visits to Harry Ramsdens, Blackpool illuminations, Southport and Gorton market etc. As far as I can ascertain (and speaking to another relative of a resident) this has not been the case. I don’t think there have been any such visits in the past two years. My relative has no short-term memory so I cannot ask her.” St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 16 One of the residents said that he had recently been away on holiday with staff and other residents and a second resident enjoyed meeting up with his friends for a pint in the local pub. He added that staff arranged for him to travel to and from the pub by taxi. Although this was encouraging, evidence of these positive outcomes could not be provided for the other residents. Residents should be consulted about the programme of activities arranged on their behalf. The two care plans examined recorded residents likes and dislikes and their particular interests such as knitting, reading books, magazines and newspapers although there was no written evidence that residents were being encouraged and supported to maintain their interests and leisure pursuits. Daily records did not specify what people did with their time during the day or the outcomes of any activities they had engaged in. A typical entry in one of the daily records stated, ‘washed/dressed, slept well/ate and drank well. Family visited.’ It is recommended that a more person-centred approach is taken and that interest and stimulation is provided for people living in the home according to their individual choice and preferred lifestyles. Particular attention should be paid to providing meaningful activities to people with dementia and other cognitive impairments. The experiences of residents engaging in activities should be recorded in detail on a daily basis. Residents’ visitors were observed to come and go throughout the inspection visit. A conversation was held with one of the visitors. She said that staff were caring, friendly and approachable and always made her feel welcome. However, she thought that more could be done to provide interest for residents. She added, “Care staff have to look after residents and do the cooking and cleaning. This leaves them little time to organise activities and spend time with residents.” It is recommended that additional staff hours be provided for the purpose of providing structured activities for residents. The kitchen and food stores were examined during this visit and the home underwent an environmental health food safety inspection the following day. The environmental health department issued a warning letter in relation to poor standards of cleanliness and maintenance found in the kitchen environment. Additionally, records required under food safety legislation had not been completed. This placed the health and safety of residents at serious risk. The environmental health department will monitor the improvements required to ensure that food safety standards are met. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 17 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. Staff training and policies and procedures for safeguarding people from abuse afford protection to the welfare of people living in the home. EVIDENCE: Policies and procedures for dealing with complaints were in place at the home and four residents spoken to knew who to talk to if they had a complaint. Two satisfaction surveys completed by resident’s relatives also provided evidence that people knew how to make complaints. During a telephone conversation a third relative said that he was confident that the appropriate action would be taken if he had any concerns about his mother’s care. No complaints had been made in the previous twelve months. Policies and procedures for safeguarding people from abuse were in place at the home. Staff had received training in how to recognise the signs and symptoms of abuse and the action they should take to keep residents safe if abuse was alleged or suspected. The manager said that staff were due to have refresher training in abuse awareness and that this would be provided by Manchester Social Services. Since the inspection in July 2007 a safeguarding referral had been made to Manchester Social Services in relation to residents’ personal allowances managed by the homeowner. This was because the homeowner had failed to provide documentary evidence that individual balances were accurate. The investigation revealed that the homeowner held St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 18 appointee-ship for three people living in the home. It had been decided that the responsibility for managing these finances would be transferred to Manchester City Council and that individual bank accounts would be opened for each person. This will mean that these three people will have access to their money and accurate information of their income and expenditure. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in the maintenance and servicing of the building, equipment and fixtures and fittings place the health and safety of people living and working in the home at serious risk. EVIDENCE: A tour of the exterior and interior of the home was undertaken to assess if the environment was safe. Shortfalls were found that potentially placed people living and working in the home at serious risk. It was observed that some tiles on the roof edge above the access ramp had become dislodged and needed attention to secure them. As identified in a previous inspection report, a downspout near to the rear exit door was leaking. Several areas of guttering around the building and the chimney stack St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 20 showed evidence of weed growth and looked damaged. A ramp to the side door provided the only access for people that had restricted mobility or used wheelchairs. The ramp surface was cracked and uneven and had substantial weed and moss growth making access difficult and unsafe. This area was also infested with animal excrement. Furthermore, once inside the building the only access to the ground floor was via a short staircase. This would deny access to people whose mobility was impaired. Two single mattresses that were stained and unsightly had been laid against an outbuiilding near to the front of the house. A corridor that provided access to the emergency exit at the side of the building had furniture, vaccum cleaners and other items stored that partially blocked the way out. Access to the second floor landing and stairway was impeded by a mattress and a hoist. Placing obstacles in such situations impedes access in emergencies and creates serious hazards to the safe evacuation of the building in the event of a fire. The communal lounge was carpeted and the seating provided was a mixture of high backed chairs and domestic settees. A television and music system had also been provided for residents’ use. The home was generally found to be clean and hygienic. However, the stair carpet between the first and second floor was in need of cleaning along with the extractor fan in the kitchen and the grill covering the air vent in the laundry. The first floor shower room contained a variety of toiletries, which suggested that these were being shared by people living in the home. Residents should be provided with individual toiletries that meet their personal hygiene needs and these should be stored in their bedrooms. There was a loose tap on the wash-basin in the shower room that needed attention. Wall tiles in this room had been poorly repaired with excess grout and looked insightly. There was evidence of water damage to the ceiling and the toilet seat was loose and broken. Similarly a toilet next to the shower room had a loose seat. A fire door fitted to one of the bedrooms did not fully close within its rebate and another bedroom door was held open with a wooden wedge. Care staff said that they used laundry bags to transport soiled linen to the laundry and a washing basket to return clean laundry to residents bedrooms. The washing basket was broken, had sharp edges and was nearly falling apart. As the laundry was connected to the kitchen the staff on duty stated that they have to exit the main building and walk round to a separate entrance to access the laundry. This should be risk assessed to ensure that staff are safe, particularly during the evening and at night. These shortfalls place the health, safety and dignity of people living in the home at serious risk. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The number of staff deployed in the home and the duties expected of them potentially places residents at risk of not having their assessed needs met. EVIDENCE: The staff rota showed that there were two staff on duty at all times from 8am to 10pm. There is a waking and sleep-in staff on duty during the night. The manager was usually on duty during the day but was available at most times if required. On the morning of this inspection visit two care assistants and the registered manager were on duty. The staff on duty during the day and night are expected to undertake the domestic tasks of cooking, cleaning and laundry as part of their normal duties. It was noticed that at lunchtime a care assistant was doing the cooking and serving residents leaving just one care assistant to help people to the dining room. One resident was heard calling from her bedroom. The care assistant helping residents into the dining was asked about this and said that the resident always started calling out when she was on the toilet as she did not like being left on her own. Consequently, no member of staff was available to attend to the resident calling for assistance from her bedroom. The staffing complement should be reviewed to ensure that there are sufficient staff on duty at all times to meet the assessed needs of people living in the home. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 22 The registered manager said that the deputy manager and senior care assistant were due to start a National vocational Qualification (NVQ) in care at Level 4 along with the Registered Managers Award. This was in preparation for the retirement of the registered manager later in the year. The majority of staff have achieved the NVQ Level 2 in care. The staff team consists of the registered manager, deputy manager and nine care assistants working a range of hours. During the inspection visit, staff were seen working with residents in a very supportive and respectful way. A care assistant was supporting a resident to go into the dining room for a meal and spent some time encouraging the person to get there themselves and so maintain their strength and mobility instead of stepping in to help which would have been easier and quicker. This provided evidence of good practice. One of the residents had their meal in their bedroom. Staff were seen going into the room to see if the resident needed any assistance. The interaction between staff and the resident was friendly and respectful. Criminal Record Bureau (CRB) certificate numbers were seen for seven members of staff. Another member of staff had started work in August 2006 although her CRB was dated in June 2007. There was no evidence that a Protection of Vulnerable Adults check (POVA First) had been obtained before confirming her in post. The most recently employed staff had completed application forms and two written references had been obtained. Personnel files and training certificates displayed in the home provided evidence that over the last twelve months staff had accessed a range of training. This included adult protection, dementia awareness, infection control, medication administration, first aid and basic food hygeine. However, there was no evidence that staff had received induction in line with the standards of the Skills for Care Induction Programme. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 23 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, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Failure to effectively manage health and safety within the home potentially places the welfare of staff and residents at serious risk. EVIDENCE: The registered manager is suitably qualified and has several years experience of managing a care service for older people. The serious shortfalls identified in this and previous reports are a result of failed management systems and this has placed the health, safety and welfare of people living and working in the home at risk. Management systems must be developed to ensure that risks are minimised to afford protection to residents and staff. The home did not have a formal quality assurance monitoring system in place. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 24 The views of residents and their relatives should be regularly sought on the quality of the service provided. Details of the system in place to manage residents finances has been included in the section of this report entitled, ‘Complaints and Protection.’ Serious shortfalls were found in the servicing and maintenance of the homes equipment as required by health and safety legislation. The annual service for the gas bolier and other appliances was overdue. The manager said that she had spoken to the contractor that undertakes the servicing and they were going to service the equipment at the beginning of October. The manager forwarded a copy of the gas safety certificate to the Commission following the service. Electrical equipment in use had not been subject to portable appliance testing for over a year. It was not known when this was going to be carried out. The annual servicing for the fire equipment, emergency lighting and alarms was also overdue. The manager said that the contractor had been contacted and they would be coming later in the week. The public liability insurance certificate on display had expired. The manager stated that the new certificate was in the post. A copy of the current certificate was also forwarded to the Commission following the inspection visit. The fire evacuation procedure stated that non ambulant residents should be removed from the danger area to safety.’ The manager was asked what staff would do in the event of a fire and she said that they would try to get people out of the building. The manager did not appear to be aware of the risks and dangers involved in this. It was recommended that the manager contact the local fire safety officer for advice on safe evacuation procedures. Several hand-made no smoking signs had been posted at certain points in the home. Cigarette ash was found in the lower ground staff toilet, and there was further evidence that people had been smoking in the upstairs office and sleep-in room. The relative of one of the residents made the following comment in a satisfaction survey returned to the Commission, “In the interests of hygiene, I do not think that smoking should be allowed in the kitchen. The smell permeates into the lounge.” This places residents health at risk and contravenes food safety legislation and recently introduced legislation banning smoking in the workplace. The gas boiler was situated in a small room on the top floor of the home. Cardboard boxes and other combustible materials had been stored in close proximity to the boiler. Of particular concern was a plastic Christmas tree that had been placed on top of the boiler. This was potentially a serious fire hazard. A member of staff removed the Christmas tree during the inspection. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 25 The fire alarm panel at the top of the stairs was broken. Cleaning materials were stored in a cupboard in the laundry. The cupboard was not locked as required under the Control of Substances Hazardous to Health Regulations. Furthermore, this legislation requires that risk assessments be carried out on the safe use of chemicals used in the workplace. No evidence was provided that these risk assessments or other risk assessments had been undertaken in relation to safe working practices. There was no evidence that the home’s water system had been tested for Legionella bacteria. When talking to the manager about an incident that had affected a resident she stated that she was not aware that she needed to inform the Commission of incidents that affect the welfare of residents under Regulation 37 of the Care Homes Regulations 2001. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 26 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 1 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement People living in the home must have their needs monitored, reviewed and updated on a regular basis. Care plans must be reviewed regularly and updated as residents’ needs change. This will provide evidence that residents’ current assessed needs are being met. Timescale for action 25/10/07 2. OP7 15 12(1)(a) 25/10/07 3. OP7 13 (4) and 12 (1) (a) 23 (5) 4. OP15 5. OP19 16 (2) (j) Risks to residents’ health and 25/10/07 safety must be assessed and clear written guidance provided for care staff to ensure that care can be delivered in a safe way. The improvements required by 25/10/07 the Environmental Health Officer during a food safety inspection in September 2007 must be addressed within the time limit stated. The home must be subject to 25/10/07 regular maintenance to ensure that the buildings, fixtures and fittings provide safe access and accommodation for people living and working in the home. DS0000021580.V351297.R01.S.doc Version 5.2 Page 28 St Georges 6. OP22 23 (2) (n) The registered person must provide evidence that suitable provision, such as a ramp, has been made available, to ensure that people using the service have safe access to private and communal space. The registered provider must have regard for the safety of people living in the home by ensuring that newly recruited staff are not confirmed in post until the required preemployment checks such as Criminal Record Bureau disclosures and POVA First checks have been obtained. 25/10/07 7. OP29 19 25/10/07 8. OP31 13 (4) The registered manager must 25/11/07 submit an action plan detailing the management systems that will be implemented to ensure that risks are minimised and that the health, safety and welfare of people living and working in the home is protected. Risk assessments and risk management plans must be developed for all working practices in the home, including the Control of Substances Hazardous to Health. Accidents and incidents that affect residents’ health, safety and welfare, must be reported in writing to the Commission, as required by Regulation 37 of The Care Homes Regulations 2001. 25/11/07 9. OP38 13 (4) 10. OP38 37 25/10/07 St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 29 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 The home’s supplying pharmacist should be consulted to clarify if it is appropriate and safe to store diazepam, haloperidol and lactulose in the medication fridge. Medications, such as eye ointments, that carry manufacturer’s instructions on how long they can safely be used should be marked with the date of opening. Written guidelines should be provided to inform staff of the circumstances in which they may safely administer ‘as required’ medication. The general practitioner of the resident who experiences ‘constant pain’ identified in this report should be asked to review the resident’s medication. This will ensure that the resident is prescribed the right amount of pain relief. It is recommended that a more person-centred approach be taken in consulting residents about the activities to be provided according to their individual choice and preferred lifestyles. Particular attention should be paid to providing meaningful activities to people that suffer from cognitive impairments, such as dementia. The experiences of residents engaging in activities should be recorded in detail on a daily basis. It is recommended that staff be deployed in sufficient numbers to enable the provision of structured activities for residents. It is recommended that the registered person reviews and develops the quality assurance system to provide a verifiable method and evidence that the views of people living in the home are taken seriously and acted upon. The registered manager should develop a recording system to provide written evidence that she is undertaking regular audits to monitor the effectiveness of systems and procedures in place at the home. DS0000021580.V351297.R01.S.doc Version 5.2 Page 30 2. OP9 3. OP9 4. OP9 5. OP12 6. 7. OP12 OP12 8. OP33 9. OP33 St Georges 10. 11. OP38 OP38 The registered person should ensure that staff adhere to current legislation that bans smoking in the workplace. The registered person should contact the local fire safety officer for advice on the fire safety issues contained in this report. St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester 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. Extracts may not be used or reproduced without the express permission of CSCI St Georges DS0000021580.V351297.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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