This inspection was carried out on 14th May 2009.
CQC found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.
Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: St Georges Care Home Kenn Road St George Bristol BS5 7PD two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Grace Agu Date: 1 4 0 5 2 0 0 9 Information about the care home
Name of care home: Address: St Georges Care Home Kenn Road St George Bristol BS5 7PD 01179541234 01179542233 stgeorgecarecentre@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : St Georges Care Home Ltd care home 68 Number of places (if applicable): Under 65 Over 65 68 old age, not falling within any other category Conditions of registration: 0 Manager must be a RN on parts 1 or 12 of the NMC register. May accommodate up to 68 persons aged 50 years and over requiring nursing care. Staffing Notice dated 22/06/2001 applies Date of last inspection Brief description of the care home 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 Care Homes for Older People
Page 2 of 11 Brief description of the care home users areas. All parts of the home are accessible to the able-bodied as well as wheelchair users. Care Homes for Older People Page 3 of 11 What we found:
The reason for this inspection was to follow up the outcome of the Annual Service Review undertaken in April 2009. The visit was also undertaken as a part of the action plan agreed following a safeguarding strategy meeting in relation to various issues about the home to include, standard of care given to residents at St Georges Care Home, inadequate staffing levels, medication administration practices, poor heating, standard of food given to residents and general atmosphere at the home. To enable us to verify these concerns and to make a judgment we looked at following records; the rota, three care files, staff training, accident records and food menu. We spoke to staff and few residents and also observed how care was being provided at the home. We also looked at the complaints procedure and complaints record to help us determine how the home handles complaints made by the people living in the home or their relatives. Staffing. In relation to staffing levels we reviewed the staffing rota on the day; there were 66 residents on the day. The rota showed that there were three trained nurses from 8 am to 2 pm and eleven care assistants from 8am to 2pm excluding one new care assistant on induction. There were also two hosteses working from 8am to 1.30pm one on each floor helping out with meals. This was confirmed by staff. There were one activities person, three cleaners, one chef, one kitchen assistant, three administration staff and three maintenance personnel. The rota also showed that that there were two trained nurses from 2pm to 8 pm hours and seven care assistants from 2pm to 8pm. Also noted on the rota were two trained nurses from 8pm to 8am and four care assistants. We randomly reviewed the staffing levels on two weekends and the days that we were told that the home was short of permanent staff. Our findings were that the staffing levels on those days complied and in some occasions exceeded the staffing notice set out in the Avon Health Authority Inspection and Registration of Nursing Homes in 2001. However, we noted while touring the building that one resident was very agitated due to the individuals medical condition. What we observed led us to believe that this persons distressing condition impacts on the persons health and the health and safety of other residents. There was evidence that this person had been referred to appropriate health professionals and regular visits from the General Practitioner for medication reviews. There also evidence that the family had been involved in all the decision made in Care Homes for Older People Page 4 of 11 relation to the persons care. The manager stated that the Social Worker and family had been informed to consider alternative appropriate placement for the individual. We have issued a requirement for the home to undertake a risk assessment followed with a care plan to protect this person and those around them. We have also issued a requirement for the home to ensure that care plan is in place to meet the residents identified need. The manager informed the Commission that specific care plans had been written to meet the persons change in needs. Accidents Accident records show that there were 10 accidents to residents in April 2009, While there were risk assessments and care plans in place these have not been reviewed in order to minimize accidents. The home must ensure that that risk assessments and care plans are reviewed after accidents. Complaints Records kept at the home showed that nine complaints were received in January 2009 in relation to thefts of residents monies and jewelery. These have been reported to the police and the safeguarding team at the Bristol City Council The manager told us that the homes insurance company have been contacted and may replace the items stolen out of good will. Four other complaints had been investigated and responded to under the Homes complaints policy. Training There was enough evidence to suggest that staff have received training in area that safeguards the welfare of the residents. Call bells. We looked at the maintenance of the Nurse Call bell systems following the complaint which we received stating that Call bells were not being answered on time and in many instances not answered at all. This practice we believe put the residents at risk. The manager stated she audited the call bell system three weeks before the visit and had taken action in relation to the ones that were not working. We toured the building to identify the call bells that were out of action and we noted that some call bells had no leads to enable the residents to summon help, some had been deliberately removed for safety reasons. We saw evidence of the action that the manager had taken to rectify the situation. However there was no risk assessment undertaken to ensure that the residents were not at risk of isolation and neglect. There was no strategy in place of how the residents affected will be monitored to reduce risks. Risk assessments and monitoring charts were put in place as requested by the inspector before the inspection was completed. Care Homes for Older People Page 5 of 11 The manager informed the Commission before this report was completed that eight call bell leads which were missing at the time of the inspection arrived by post on Friday 15 May and were immediately distributed to the identified rooms. Staff have been told that a call bell must remain in place, and they and the maintenance personnel have been instructed to check, on a weekly basis as a minimum, that all leads are in place. Regulation 37 Notifications. We noted from our record that the Care Quality Commission had not been notified of the above incident as required by the legislation. This practice is unacceptable because we believe that the risk to Health and safety of the residents had been compromised. Environment. The home was well maintained, found warm tidy and comfortable. Service records and health and safety checks were up to date. However, one residents room was noted with unpleasant odour. We made a requirement for the room to be deep cleaned or the flooring replaced to ensure that the persons comfort and dignity is maintained. The manager informed us before this report was completed that the identified room had been deep cleaned and an odour neutralizer spray had been installed in the room. We will be monitoring this requirement at the next visit. Menu/Quality of food. We observed lunch; the food looked nutritious with two choices and other alternatives. There was a four week menu at the home with varied meals. The cook stated that the menu will be reviewed to offer more choices at supper time. residents we spoke with told us that they enjoyed their meal. Manager Helen Marshall is the new manager of the home. Staff stated that she is approachable and doing her best to give direction and leadership to staff in order to provide good care to the residents. What the care home does well: What they could do better: Care Homes for Older People Page 6 of 11 It could be better if the identified room is deep cleaned/ flooring replaced. This to ensure that the person is comfortable and dignified The home must ensure that action is taken to protect the residents from financial abuse and loss of personal belongings The home must ensure that care plans are in place to meet the assessed needs of people living at the home. The care plans must be reviewed regularly and as needs change. All residents must have risk assessments based on individual circumstance. Residents with recent falls must have risk assessments and same reviewed regularly. The home must notify the Care Quality Commission of circumstance that affects the health and safety of the residents. The home must ensure that appropriate strategy is in place to minimize the effect of one residents medical condition to the individual and other residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 38 Residents with recent falls 30/06/2009 must have risk assessments and same reviewed regularly. To meet the residents needs. 2 7 37 Notify the Care Quality Commission of circumstance that affects the health and safety of the residents To meet the regulation 30/06/2009 3 7 13 Ensure that appropriate strategy is in place to minimise the effect of one residents medical condition to the individual and other residents around them To protect the person and other people. 30/06/2009 4 7 15 The home must ensure that care plans are in place to meet the assessed needs of people living at the home. The care plans must be reviewed regularly and as needs change. To ensure that residents 30/06/2009 Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action needs are met 5 26 23 Deep clean/ replace the identified room This to ensure that the person is comfortable and dignified 6 35 13 Action must be taken to protect the residents from the financial abuse. To protect residents from financial abuse 7 38 13 All residents must have risk assessments based on individual circumstance. To protect the residents from injury. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 30/06/2009 30/06/2009 30/06/2009 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
