Inspection on 29/11/06 for St Georges

This inspection was carried out on 29th November 2006.

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 11/04/07

St Georges 26/02/07

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 Helen Dempster Key Unannounced Inspection 29th November 2006 1:00 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.V303887.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.V303887.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 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.V303887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: No conditions. Date of last inspection 28th February 2006 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. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by gathering lots of information about how well the home was meeting the National Minimum Standards. This included the manager filling in a questionnaire about the home, which gave information about the residents, the staff and the building. Questionnaires about the service were sent to the home prior to the inspection and four residents completed questionnaires. The inspection also included carrying out an unannounced site visit to the home on 29 November 2006 from 1pm to 7:30pm. During this visit, lots of information about the way that the home was run was gathered and time was taken in talking with the residents, the manager and the staff team about the day-to-day care and what living at the home was like for the residents. A further site visit was made on the morning of 30 November to discuss concerns found during the site visit with the manager. Other information was also used to produce this report. This included reports about events affecting residents that the home had informed the Commission about. The main focus of the inspection was to understand how the home was meeting the needs of the residents and how well the staff were themselves supported by the home to make sure that they had the skills, training and support to meet the needs of the residents. There was also a themed part of the inspection, which was part of a national study, which is taking place at the moment. This themed part of the inspection focused on information given to people on admission, having a contract which records the terms and conditions of a resident’s stay, whether people had their needs assessed before admission and residents’ awareness of how to make a complaint. What the service does well: It was obvious when watching staff talking to and looking after residents, from their appearance, from the way that residents responded to the staff and from what they and their relatives said, that residents were well looked after and respected and that their privacy and dignity was maintained. Residents and their relatives said that visitors were made welcome at the home. The manager had made sure that all the residents were registered with “Ring and Ride” so that staff could take residents to the shops, local markets and to see Blackpool Lights. Some residents had also had a holiday to Wales. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 6 The home makes sure that residents can raise concerns and ensures that the residents at the home are safeguarded from abuse. Most of the staff at the home had NVQ Level 2 and the 2 managers are NVQ assessors. This is very good for the residents and exceeds the standard that 50 of staff are qualified to NVQ Level 2. Residents and their relatives said good things about the staff and manager. One resident said that the “staff are very good to us, they all are”. Residents’ relatives commented that the staff were “very nice” and “brilliant”. One resident said that the manager is “a good woman”. A resident’s relative said that she could approach the manager with a problem and that she is “trustworthy”. This is good for the residents. What has improved since the last inspection? What they could do better: The Service Users Guide needed to be updated to give residents up to date information to help them to make a choice about the home. The home needed to complete and record an assessment of residents’ needs on admission so that the home is confident that it can meet the residents’ individual needs. Residents’ rights need to be respected by providing residents with terms and conditions of their stay and information about the cost of their care. All residents needed to have an up to date care plan, which explained how their needs and preferences would be met. The home needed to complete risk assessments and nutritional assessments to try to reduce risk to residents e.g. the risk caused by smoking. The home needed to discuss food with each resident, to make sure that their preferences were being met. Residents said that the home was “alright”, “comfortable enough” and “not too bad” but one resident said that “the staff smoke and it smells”. A resident’s relative said that “everywhere is shabby” and that the home “needs money spending on it”. Not always making sure that the home is clean and having St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 7 damaged furniture, floor-coverings, equipment and fittings could put residents and staff at risk. Uncovered hot radiators and some windows in the home, which were not fitted with restraints, could put residents at risk. Staff needed to be provided with induction and supervision and poor recruitment procedures could put residents at risk. The home needed to take account of the views of residents and their relatives about how the home is run, what is good and what could be improved by completing quality assurance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Georges DS0000021580.V303887.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.V303887.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Failure to complete and record an assessment of residents’ needs on admission means that the home may accept a resident whose needs cannot be fully met. In addition, residents’ rights need to be respected by providing residents with terms and conditions of their stay and information about the cost of their care. EVIDENCE: Each resident had a copy of the Service Users Guide in their bedroom and there was also a copy of this information in the entrance hall of the home. The service users guide did not contain all of the information required. One example was that it did not include information about the staff team and their current training/qualifications. It was recommended that the Service Users Guide is updated. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 10 One of the 3 residents who were admitted to the home most recently could recall receiving a “little booklet” on admission, another of these residents knew that this information was in the hallway. The remaining resident was not able to remember seeing this information. These 3 residents were also asked whether they were told about any changes to the cost of there care. None of these residents were aware of the cost of their care when they were admitted or of any changes in costs since that time. The manager explained that none of the residents at the home independently managed their finances and she said that she held copies of all financial information, including the placing authority’s contract on a confidential file for each resident. Examples of the placing authority’s contracts and letters concerning residents’ pensions were seen during the inspection. The manager said that she discusses any changes to pensions or fee levels with the residents’ families. The 3 residents spoken to did not know whether they had received terms and conditions of their stay and were not aware of the contract held on their file between the home and the funding authority. The manager said that the home does not use a statement of terms and conditions for residents whose care is funded by the local authority or a contract for residents who are funding their own care. The need for this to be addressed was discussed so that residents are fully aware of the terms and conditions of their stay. At the previous inspection, a pre assessment document had been developed, to ensure that prospective residents were only admitted on the basis of a full assessment. However, this had not been used for any of the 3 residents who had been admitted to the home most recently. The manager stated that one of the managers always visited a prospective resident in his or her own home or in hospital prior to admission. One of the 3 residents spoken to said that they remembered this visit taking place. The other 2 residents were not able to recall this visit, but the manager said that the visits had taken place. A requirement was made that a full assessment must be carried out and recorded by the home for those residents who had not been assessed and funded by the local authority and it was strongly recommended that the home completes and records it’s own pre admission assessment for all residents so that the home is confident that it can meet the residents’ individual needs. St Georges DS0000021580.V303887.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 at least once during a 12 month period. 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. Although the manager and staff were able to demonstrate detailed knowledge of the residents’ needs verbally, failure to consistently record the residents’ needs in a care plan, consistently review needs, complete risk assessments and complete nutritional assessments has the potential to put residents at risk. EVIDENCE: The files of 3 of the residents who had been admitted to the home most recently were seen and the inspector met these 3 residents. As noted earlier, non of these 3 residents had an assessment of need recorded at the time of admission. One of these residents, who had been admitted on 20/10/06, did not have a care plan or the assessments of the placing authority. The only information about this person at the home was the care plan completed by the home that the person was living at prior to the move to this home. This care plan noted that the person was an “insulin dependant diabetic”, had “congestive heart failure”,” cervical and lumbar spondylosis”, St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 12 “emphysema”, “angina ” and “depressive symptoms”. The manager said that this care plan did not reflect this person’s needs. The fact that this meant that this person, who appeared to have extensive care needs, was being cared for without any needs and preferences being recorded for staff to follow was discussed. The manager rang the placing authority at the time of inspection to request their assessments for this person. The manager was able to describe what the home had learnt of this person’s needs during their time at the home. She agreed to record this information in a needs assessment and care plan without delay. The care plans for the other 2 residents were found to be vague and did not describe that person’s needs clearly and the way that person wanted to be cared for. Examples included a person who was said to need “assistance and prompting to bath”, but the plan of care did not state what staff had to do to help this person and what the person could do independently. Another person’s care plan talked about the need to “make sure” that this person got a “daily intake of food and drink”. However, this person’s preferred foods and specific dietary needs were not recorded. Another resident was said to have diabetes and the risk assessment stated the need to “watch intake of diet and fluids”. There was no specific information about this person’s dietary needs. The manager and staff were able to describe these residents’ preferences and needs and they agreed that they needed to record this information in the care plan. Advice was given about care plans and nutritional assessments and the manager and staff had a very open and professional attitude to the advice given and fully acknowledged the need to review care plans as soon as possible. A requirement was made about this. A review of one person’s care plan had been completed on 21/08/06. However, there was no evidence of regular reviews of the care plans and there were no risk assessments about aspects of residents’ day to day needs, which described risks and how risks could be reduced. Requirements were made about this as this could put residents at risk. One example was a resident who was said to need to be “supervised when smoking due to burning (themselves)”. There was no details of where this person smoked or how the staff could minimise risk. The manager said that this person had stopped smoking some months ago, but the care plan had not been reviewed to include this information. Clear risk assessments were not in place for the other residents who smoked. Overall, day to day records were detailed. However, one record noted that a resident had fallen, but there was no follow up in the resident’s notes of how they had been in the days following the accident. All 8 residents at the home had prescribed medication. This was kept in a locked cabinet, which was secured to the wall in the dining room. Overall, medication administration records were completed appropriately. However, staff were not signing the record to confirm that they had received medication, St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 13 they were using stick on pharmacist labels on the medication records and they were using an “x” to denote administration of one medication, rather than the initials of the staff who had administered it. A requirement was made about this. It was obvious from observing staff talking to and caring for residents, from their appearance and from the way that residents responded to the staff, that residents’ were well cared for and respected and that their privacy and dignity was maintained. One resident’s relative said that their relative was “well looked after”. This is good for the residents. St Georges DS0000021580.V303887.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 at least once during a 12 month period. 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. The home provides a homely environment for the residents with some activities and residents are able to exercise choice and control over their lives and to maintain contact with family and friends. This good practice could be extended by reviewing residents’ preferences about meals. EVIDENCE: The home had an open visiting policy and residents were able to receive visitors at reasonable times in the privacy of their own room or in the lounge or dining room. At the time of the visit, there were 2 residents’ relatives visiting the home. Both these people said that they were made welcome at the home. Residents spoken to said that they were able to have visitors when they wanted and one resident said that her daughters visit a lot. Residents were also able to use the office telephone to call friends and family. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 15 The manager had made sure that all the residents were registered with “Ring and Ride” and this service was used to enable staff to take residents to the shops and local markets. In November, this transport had been used to take residents to see Blackpool Lights. Three residents had enjoyed a holiday to Wales, accompanied by the manager and staff in September 2006. Activities in the home included dominos and videos. An entertainer had been booked for the residents’ Christmas party. The residents were offered three meals a day. Meals were served in the dining room adjacent to the kitchen. On the day of inspection the meal was lamb chops, broccoli, carrots, onions and potatoes followed by rhubarb pie and custard. The home does not have a formal method for offering alternative meal choices. However, the home was only accommodating 8 residents and the staff were able to describe residents likes and dislikes (although as noted earlier, these were not recorded) and said that they were able to offer alternatives to residents on a daily basis. Residents’ comments about food included that it was “good”, “alright” and “not bad”. It was recommended that the manager discussed food with each resident to make sure that their preferences were being met. St Georges DS0000021580.V303887.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 inspected at least once during a 12 month period. 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. The home has appropriate policies and procedures in place to ensure that residents can raise concerns and to ensure that the residents at the home are safeguarded from abuse. EVIDENCE: A copy of the complaint procedure was kept in a folder by the main entrance to enable all visitors to have access to it. There had been no complaints since the previous inspection and the manager had a record in which she could record any complaints. Of the 3 residents spoken to, when asked about whether they knew how to make a complaint one resident said they “think so”. Another resident said that they cold go to the manager with problems because she was “very good”. Residents’ relatives said that they knew how to make a complaint. Certificates were seen which demonstrated that staff had received training in the protection of vulnerable adults. The manager and staff were aware of the policies and procedures to follow and demonstrated knowledge of recognition of abuse and the protection of vulnerable adults. St Georges DS0000021580.V303887.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not maintaining appropriate hygiene arrangements and having damaged furniture, floor-coverings, equipment and fittings could put residents and staff at risk. EVIDENCE: Since the previous inspection, the carpet in the hall, stairs and landing had been replaced and the lounge and dining room had been painted. A resident’s relative spoken to during the inspection said that “everywhere is shabby” and that the home “needs money spending on it”. This person said that she was aware that the manager spent money on furniture for the residents personally. Residents comments included that the home was “alright”, “comfortable enough” and “not too bad”. One resident commented in a questionnaire when asked if the home was fresh and clean that “the staff St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 18 smoke and it smells”. There is no designated smoking area for residents and staff and they all smoke in the dining room. It was strongly recommended that this arrangement is reviewed so that the quality of life of residents who do not smoke is not affected. Communal areas, bathrooms, toilets, the kitchen and a sample of bedrooms were looked at. The lounge area, which had recently been decorated was warm and homely and the new hallway carpet had improved the environment. However, the home was very cluttered and many areas of the home were not clean or safe. This included the following specific issues which are of concern and needed addressing: There was an unlocked cupboard in one bathroom, which contained chemicals, including bleach. There was a towel in this room which was in a poor state and was not suitable for use by residents. There was no liquid soap and paper towels available. The deputy manager said that one resident was at risk through drinking liquid soap, but there was no risk assessment about this. The risks to this resident posed by the chemicals in the unlocked cupboard was discussed. This bathroom was not clean, there was an uncovered radiator, which could pose a risk to residents, damaged and missing tiles and damaged floor-covering on a ramp which could prove hazardous. Three bedrooms were seen. Although bedrooms were personalised by the resident and had photographs, statues, sweets etc near the beds, they were not clean and had many risks. Two of these rooms had rusty commodes, which could result in injury to residents. The furniture in rooms was damaged, and ill-fitting doors and broken drawers could put residents at risk. The danger of wardrobes being too heavily laden, resulting in a risk of them falling was also discussed. One room had new furniture. However, this furniture had not been fully assembled, including drawers not being assembled and glued, so that they were not fit and safe for use. One resident’s room had a bed rail between the wall and the bed. The manager said that it was no longer in use but that there was nowhere to store it. There was no risk assessment about this. Throughout the home radiators with hot surface temperatures were uncovered. There were no risk assessments about the risk this posed to residents. In bedrooms, the way that furniture was arranged near radiators could cause a resident to become trapped against the hot radiator if they fell, resulting in a burn. Some windows in the home, including the one on the staircase landing area, were not fitted with restraints and could pose a risk of residents falling from them. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 19 The kitchen area was very dirty and unsafe. The manager said that she was very worried about the kitchen. The manager stated “the kitchen is a mess” and added that it needed retiling and the floor replacing. She stated that “you’ll see it if you don’t break your neck going in it”. The kitchen walls, tiles, sinks, fridges and floors were greasy and dirty. The canopy over the cooker was very dirty with the risk that debris could fall in open pans. Floor and wall tiles were broken and some were missing. There was a dirty ashtray in the sink and a sock in the hand-wash sink. The storeroom was cluttered and dirty, and some food was stored on the floor. The laundry was accessed through the kitchen or through an outside door, which was not ideal. When these issues were discussed with the manager she said that the owner of the home had assembled the bedroom furniture. She added that a resident’s relative completed “DIY jobs” in the home for her free of charge and that recent decorating had been done by the staff, with the paint being supplied by herself. She talked about buying furniture herself and using her own money to buy things, including Christmas presents, for residents. The issue of financial viability of the home was also discussed. Manchester City Council’s Environmental Health Department was contacted about the dangers posed by the kitchen, uncovered radiators and unsafe windows and requirements were made about the above issues. 5he Commission will meet with the owner of the home to discuss all the concerns. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Well-trained staff in sufficient numbers met the needs of the residents. However, poor recruitment practice could put residents at risk. EVIDENCE: There are 9 staff at the home and a deputy manager and manager. The manager and deputy manager are NVQ assessors and all but the 2 newly recruited staff had NVQ Level 2. The 2 newly recruited staff were about to commence studying towards NVQ Level 2 on 07/01/07 and 2 of the other staff were about to commence studying towards NVQ Level 3 on the same date. This is very good for the residents and exceeds the standard that 50 of staff are qualified to NVQ Level 2. The manager was committed to ensuring that staff had good access to training and copies of various training certificates were held on staff files or were displayed at the home. As training certificates were held in a number of places, the manager wasn’t able to quickly check who had done what training when. It was recommended that a training audit is done for ease of planning of training. Staff files did not contain records of induction or formal supervision. The manager said that she hadn’t been providing these. It was recommended that staff are provided with induction and supervision. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 21 Residents and their relatives were very positive about the staff. One resident said that the “staff are very good to us, they all are”. Residents relatives commented that the staff were “very nice”, “brilliant” and “always seemed busy”. Eight residents were accommodated at the time of the visit. The staffing levels were 2 staff and a manager from 8am until 4pm, 2 staff (including a senior) from 3pm until 10pm and 1 staff member on waking duty and another staff member sleeping in on call at night. This level of staff was meeting residents’ needs. The files of the three staff who had been most recently recruited were seen. The manager had not obtained a POVA First check or CRB check for any of these staff and the application form template did not have a criminal declaration. Two of the staff had application forms and one had one which was incomplete with no employment history and no references. The other application forms did not appear to have complete employment histories. One example was a staff member who only had one previous job specified on the application form and that was “casual work”. The source of references and level of relevant information was poor. This included a reference from a staff member’s “friend” who commented on staff communication skills. A requirement was made about the need to ensure that recruitment and selection of staff was appropriate, included obtaining a complete application form, making POVA First and CRB checks and obtaining appropriate references, so that residents were not put at risk at risk. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 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 manager worked hard to promote the health, safety and welfare of the residents living there but the owner needed to support the manager by investing in the environment. EVIDENCE: The manager had undertaken the Registered Managers Award and was an NVQ Assessor. Staff said that they were “happy” at the home and that they were “well supported” by the manager. One resident’s relative said that she “likes” the manager and that “she is fine” and that she feels that she could approach her with a problem and that she is “trustworthy”. Residents were also positive about the manager. One resident said that the manager is “a good woman”. St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 23 The manager expressed her regard for the residents and was seen to be kind, patient and respectful in her interactions with residents. This included reassuring a resident who was anxious. The manager said that she obtained residents’ views about the home verbally and she had not developed an effective Quality Assurance monitoring system. The need for the home to take account of the views of residents and their relatives about how the home is run, what is good and what could be improved was discussed. A recommendation was made about this. At the time of this visit, the Commission had not received any Regulation 26 reports from the homeowner. The manager said that the one report completed, had been completed by her personally. It was stressed that the owner must monitor the standard of the home and report on his findings to the Commission. In the light of the fact that many problems of a serious nature were identified during this visit, it was vital that the owner monitors the home. The manager was keeping records of money held on behalf of residents, which included receipts. The manager stated that families supported most of the residents with the management of their finances. However, the pre-inspection questionnaire stated that the manager was acting as the appointee for financial affaires of 5 residents. It was strongly recommended that the manager contacts these residents’ care managers to review the management of their financial affairs. The pre-inspection questionnaire listed those safety tests, including the tests of the gas system and electrical items, which had been completed. The manager stated that outstanding tests had been completed since the questionnaire was forwarded with the exception of COSHH assessments, which remained outstanding. The manager had COSHH guidance and said that she would complete these assessments without delay. St Georges DS0000021580.V303887.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 2 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 X X X X X 2 1 STAFFING Standard No Score 27 3 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 2 St Georges DS0000021580.V303887.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 OP3 Regulation 14(1) (a) Requirement For residents that are self funding and do not have a care manager’s assessment, a full needs assessment must be carried out and recorded by the home so that the home can demonstrate that it can meet the resident’s individual needs. All residents must have a care plan and care plans must be reviewed when residents’ needs change taking account of their views Risk assessments must be in place to assess all risks applicable to an individual resident. This must include nutritional assessments. These must be subject to consistent review to take account of any changes. Version 5.2 Page 26 Timescale for action 05/01/07 OP7 15. (2) (b) (b) 13. (4) (b) and (c) (c) St Georges DS0000021580.V303887.R01.S.doc 2. OP9 13. (2) 3. OP19 The registered person must make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medication. 13. (4) The registered person must and 23. make sure that the premises is (2) (b). safe and well maintained. This includes minimising risks to 13. (4) (c) residents by: Locking cupboards which contain 13. (4) (c) chemicals. Completing risk assessments about the risk to residents posed by uncovered radiators with hot surface temperatures and covering those radiators where the risk of entrapment, and consequent injury through 13. (4) (c) burns, cannot be minimised. Replacing damaged and missing tiles and damaged floorcoverings in bathrooms and 13. (4) (c) toilets. and 16.(2) (c ) Replacing rusty commodes, which could result in injury to 13. (4) (c) residents. and 16. (2) (c ) Repairing or replacing damaged furniture and securing wardrobes that are too heavily laden, 13. (4) (c) resulting in a risk of them falling. and 23. Providing appropriate storage for (2) (l). equipment, including bedrails, 13. (4) (c) which are not in use. Completing risk assessments concerning the risk posed to residents by windows in the home, including the one on the staircase landing area, which are not fitted with restraints so that there may be a risk of residents 05/01/07 05/01/07 St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 27 falling from them. 4. OP26 16. (2) (j) and 13. (3) All areas of the home must be kept clean and hygienic and systems must be in place to control the risk of infection. This includes: The home must consult with the local Environmental Health Department concerning hygiene in the home, and in particular in the kitchen. A risk assessment must be completed concerning the access to the laundry through the kitchen, or through an outside door and the associated risk of cross infection. 05/01/07 The registered person must ensure that the recruitment and selection of staff is appropriate and in line with the requirements of Schedule 2 of the Care Homes Requirements 2001. This includes obtaining a complete application form, making POVA First and CRB checks and obtaining appropriate references, so that residents are not put at risk at risk. The registered person must visit 05/01/07 the home on a monthly basis to establish the standard of care provided and inspect the premises. 05/01/07 16. (2) (j) 16. (2) (j) and 13. (3). 5. OP29 16 Schedule 2. 6. OP36 26 St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP2 Good Practice Recommendations It is strongly recommended that the service users guide is updated to include all the information specified in Standard 1. It is strongly recommended that each resident is provided with a statement of terms and conditions of their stay and that contracts are used for residents who fund their own care, so that all residents are fully aware of the terms and conditions of their stay. It is strongly recommended that the home completes and records it’s own pre admission assessment for all residents, including those who have received a care managers’ assessment, so that the home is confident that it can meet the resident’s individual needs. It is recommended that the manager discuss food with each resident, to make sure that their preferences are being met. It is strongly recommended that liquid soap and paper towels are provided in bathrooms and toilets to minimise the risk of cross infection. It is also strongly recommended that a designated smoking area, other than the dining room, is provided so that the quality of life of residents who do not smoke is not affected. It is recommended that a training audit is completed for ease of planning of training and that staff are provided with induction and supervision. It is strongly recommended that the home reviews and develops their quality assurance system to provide a verifiable method, which involves residents, to audit the service and report on the findings. It is strongly recommended that the manager contacts the care managers of the residents for whom she is appointee for their financial affairs to request a review of the management of their financial affairs. 3 OP3 4. 5. OP15 OP26 6. 7. OP30 OP33 8. OP35 St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Georges DS0000021580.V303887.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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