Inspection on 11/07/05 for St Georges Care Home

This inspection was carried out on 11th July 2005.

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 Care Home 10/08/10

St Georges Care Home 07/04/10

St Georges Care Home 14/10/09

St Georges Care Home 14/05/09

St Georges Care Home 08/04/08

St Georges Care Home 07/11/07

St Georges Care Home 06/03/07

St Georges Care Home 27/09/06

St Georges Care Home 20/03/06

St Georges Care Home 23/02/05

St Georges Care Home 20/10/04

St Georges Care Home 08/12/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE St Georges Care Home Kenn Road St George Bristol BS5 7PD Lead Inspector Jill Cornelius Unannounced 11 July 2005 09:30 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Georges Care Home Address Kenn Road St George Bristol BS5 7PD 0117 9541234 0117 9542233 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St Georges Care Home Ltd Ms Alexandra Crew N Care Home with Nursing 66 Category(ies) of OP Old age (66) registration, with number of places St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 66 persons aged 50 years and over requiring nursing care. May accommodate up to 3 persons aged 65 years and over requiring personal care. Staffing Notice dated 22/06/2001 applies Manager must be a RN on parts 1 or 12 of the NMC register. May accommodate one named person aged 34 years and over with severe multiple sclerosis. Home will revert when named person leaves. Date of last inspection 23-Feb-2005 Brief Description of the Service: St. George is registered as a Care Home for a maximum of 66 service users requiring nursing care. The home is situated in a residential area of St. George, with easy access to local community facilities and is less than 3 miles to the city centre. It can be accessed by car or bus, with a short walk.The home is purpose built, providing a mix of double and single en-suite rooms. Care is provided over two floors, the first being for the more dependent service users. Each floor offers bedrooms, communal lounge and dining room as well as bathroom facilities. There are also pleasant gardens to the rear and side of the property.There is a passenger lift providing access to all service users areas. All parts of the home are accessible to the able-bodied as well as wheelchair users. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day with a follow-up visit 10 days later in relation to the action needed on care plans. Opportunity was taken to tour the premises, examine records and policies and speak to staff and residents. Most of the residents were seen during the inspection and several were spoken with. Four of the residents had visitors who gave their views of the service provided to the inspectors. What the service does well: What has improved since the last inspection? The home has a relatively stable care team and supporting workforce. The residents and relatives spoken with during the inspection continue to express satisfaction generally about the home. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Prospective residents are given clear details of the services the home provides enabling them to make an informed decision about admission. The admission procedure generally ensures that there is a proper assessment prior to people moving into the service. EVIDENCE: The home’s Statement of Purpose and Resident Guide give residents and prospective residents details of the services the home provides in accordance with legal requirements and the expectations of the National Minimum Standards. Individual records are kept for each resident. The records for 2 rapid response residents did not have full assessment information. When discussed with the manager it was highlighted that the multi disciplinary staff hold all the care documentation, and only enter their attendance in the files that they have attended. There is no care plan for carers at the home to assist service users who are using the rapid response beds. On the 2nd visit, minutes were observed of a meeting which had taken place with the Rapid Response team. An agreement had been drawn up as a result of this meeting and this was formed into a policy for the home. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 9 Other residents had their assessments information completed. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 Residents are at risk of not having their health and personal care needs met. Further attention needs to be given to the revision and review of care plans and the quality of the record keeping so that staff are fully aware of how needs have changed and how care is to be given. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: The home utilises a core care planning system based on the Activities of Daily Living with a tick box approach to indicate the level of assistance required with meeting the individual’s needs. Ten service user care files were sampled from both floors. Most of the documentation viewed contained identification of a range of holistic needs, however the plans of care were not prescriptive of the interventions required to meet the identified needs. Most of the ADL assessments had either not been fully completed or reviewed for over 12 months. The care plans viewed showed gaps in the cross referencing from daily nursing records. Where this happened, there was no clear direction of detailed care to be provided in the care plans. These gaps were most evident in the case St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 11 tracking of pressure care assessments; wound care documentation; nutritional screening and management. Consent forms in relation to the use of bedrails were not completed. This does not provide staff with the information they need to satisfactorily meet residents’ needs. A discussion regarding the seeking of alternative documentation was held with the manager. The quality of record keeping does not reflect the actual quality of care being given, which residents said was really good. Re-assessments were viewed on the visit on 21st and some discussion with RN’s of their content took place. Observation during the inspection showed staff have a good awareness of how to protect residents’ privacy and dignity. They were seen to knock on doors and wait for responses before entering and spoke to the residents’ in a respectful way. Residents’ spoken with said this was normal practice. A visitor commented that their observations were always positive about this. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14 and 15 Residents are given meaningful opportunities to exercise choice and control over their lives in the home and to have their interests met. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: Visitors and relatives spoken with spoke of how they were happy with the standard of care given to their loved ones. Rising and retiring choices are documented during the assessment and referred to in the care plans. It was evident from the photographs displayed that friends and relatives are involved in the many social events in the home. During the inspection residents were observed in a reminiscence and general discussion group. One resident stated, “it is nice to be able to have a topical discussion, I enjoy it greatly”. Those unable to participate were observed having one to one involvement with carers at different times in the day. All had enjoyed a recent Sports Day event. One resident said how they had “enjoyed the games and the celebration tea2. Another resident said that “their family had come and they had enjoyed the atmosphere”. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 13 Everyone who commented on the food said how “good it was”. Menus are balanced and interesting, and are flexible enough to accommodate individual preferences. Staff see each person individually the day before, and ask for their choices. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 14 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 standard(s) 16, 17 and 18 Arrangements for protecting residents and responding to their concerns are satisfactory. Residents’ legal rights are promoted. EVIDENCE: Residents’, visitors and staff comments received during this inspection showed that people feel comfortable discussing any concerns with senior staff or management. A log of complaints and the outcomes is maintained. The Commission for Social Care Inspection has become involved with two recent complaints that were similar in nature. These have yet to be fully addressed by the manager. All residents are on the electoral roll and a number voted in the last inspection. The role of advocacy in facilitating resident’s rights to exercise their rights and details of an advocacy service were supplied. Adult Protection procedures are in place and staff attend Bristol City training on the Protection of Vulnerable Adults. Through this they are aware of their responsibilities in this area. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 15 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 standard(s) 19, 20, 21, 23, 26 A clean, comfortable and safe standard of accommodation where personalisation of rooms is encouraged is provided for the residents. Bathroom facilities are presently being compromised by the lack of storage space for equipment. EVIDENCE: The environment is well maintained and suited to residents needs. The home is decorated and furnished to a high standard that creates a comfortable and homely ambience. At the time of inspection the redecoration of communal lounges, halls and corridors was taking place. Replacement of carpets throughout the home was also planned. A risk assessment and action plan has been undertaken to reduce the risk of potential accidents for the residents and staff during this work. Residents confirmed that they felt well informed by the manager regarding the potential stress and upheaval this may cause to residents. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 16 There are an adequate number of bathing facilities: however during the inspection the inspector observed that two of the bathrooms on the first floor were being used to store excess equipment. Bathrooms should be available for use at all times. Discussion with the manager explored ideas for solving this area. The residents’ bedrooms looked very homely, as residents are able to bring in small items of furniture and personal possessions with them. All areas of the home smelled pleasant and were cleaned to a high standard. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staff at the home are well trained and supported. Some gaps in training regarding POVA (protection of vulnerable adults) were noted. The number of staff deployed to meet the needs of residents during the busy time of the morning and the way those staff are deployed needs to be reviewed. EVIDENCE: The staff-training plan was observed with tracking of 7 staff members. Training was undertaken with Palliative Care; Elder Abuse; Dementia Care; Care of the dying; Anxiety and Depression; Communicating in teams and Continence issues. Some gaps in training regarding POVA (protection of vulnerable adults) were noted. Staff spoken to related their role and responsibilities in supporting individuals with their care. The inspector viewed the duty rota for the month of July 2005 from the 14th to the 21st which was the date for the inspection; this evidenced the staffing notice was reached. It was noted during the inspection period there was a delay in answering call bells during the busy time of the morning. Staff informed the inspector that the home was very busy at times in the day causing some delay in answering call bells. Residents stated that they felt it St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 18 was “a long time in waiting for their call bell to be answered in the morning”. Discussion with the manager took place in relation to this. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 and 33 The manager has a good understanding of the areas in which the home needs to improve and considerable planning was in place indicating how this improvement was going to be resourced. EVIDENCE: The home is managed efficiently but attention needs to be given to improving care records used by the trained staff. At the time of inspection the manager was actively researching new documentation to aid care staffs documentation. There was also a planned week period for the deputy manager and an RN to undertake a complete review and assessment for all nursing placements. During this time they would be supernumerary. Contact with the rapid response team was also undertaken by the manager and a planned meeting to complete risk assessments / plan of care documents to be left in the home for St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 20 carers to be aware of residents’ needs. This had taken place on the 19th and minutes were observed on the second visit on 21st. Residents, their visitors and staff made positive comments about the manager of the home and gave examples of the ways they have been involved and consulted. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 2 x 3 x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x x x x St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 27 Regulation 18(1)(a) Requirement The number of staff deployed to meet the needs of residents during the busy time of the morning and the way those staff are deployed needs to be reviewed. Explore and provide a plan for the storing of excess eqipment Bathroome should be available at all times. Named care plans to be reassessed and written up to provide staff a plan of care enabling a consistent manner in meeting individuals’ needs. This is to be continued for all residents on the first floor. The records for rapid response residents require to be fully assessed with care plans and risk assessment documentation to be held at the home for carers to met individual needs. Timescale for action from 14th July 2. 21 19TH December 15th July(This was actioned by 2nd visit on 21stJuly). 15th July (This was actioned by 2nd visit on 21st July). 3. 7 14(2) 15(2)(b), (c) 4. 3 14(2) 15(2)(b), (c) St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 23 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 30 Good Practice Recommendations staff members to be updated with POVA training. St Georges Care Home D56_S20254_stgeorges_V235236_110705_stage2_UN.doc Version 1.30 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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