Inspection on 27/09/06 for St Georges Care Home

This inspection was carried out on 27th September 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 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 20/03/06

St Georges Care Home 11/07/05

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 Inspection 10.00 18 20 & 27 September 2006 th th 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 Care Home DS0000020254.V311990.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 Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Georges Care Home Address Kenn Road St George Bristol BS5 7PD 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) 0117 9541234 0117 9542233 St Georges Care Home Ltd Ms Alexandra Crew Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 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. May accommodate one named service user aged 47 years requiring nursing care. Condition of registration will lapse when service user leaves the home. 20th March 2006 Date of last inspection 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 DS0000020254.V311990.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was conducted unannounced over 2.5 days and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the residents, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined, a tour of the premises conducted and feedback sought from residents; staff and visiting health professionals. In addition to key records, surveys were sent to residents in advance of the inspection. Comment cards for relatives and visitors who visit the care home were also received. A number of residents and visitors were also spoken with about the quality of care provided at the home. The Commission for Social Care Inspection’s Pharmacist Inspector also examined the arrangements for administering and managing of medication. What the service does well: Residents spoke of St. George Care Home as a “caring place” “relaxed and friendly”. The home’s staff team have received a number of thank you letters from relatives praising the care provided and the dedication of the staff team. One of these highlighted ‘Our loved one is very happy here and her health and well being has improved considerably’. Prospective residents continue to receive clear details of the services the home provides enabling them to make an informed decision about admission. It is clear that opportunities exist for residents to participate in a wide range of meaningful activities. Residents were positive about the recreational activities on offer. Visitors are made very welcome and meals are well managed and provide daily variation, nutrition and social contact for people. St. George remains a well equipped home with a safe standard of accommodation provided for the residents. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 6 Homeliness in communal areas and personalisation of individual rooms are both well promoted. Residents are supported and protected by the home’s recruitment policy. Staff at the home continue to be well supported with their training. What has improved since the last inspection? 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 DS0000020254.V311990.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 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 the following standard(s): 1, 3, 5 The overall quality in this outcome area is good. Prospective residents continue to receive clear details of the services the home provides enabling them to make an informed decision about admission. The admission procedure ensures that a relevant assessment is undertaken prior to people moving into the home. Prospective residents are encouraged to visit the home. 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. These have been updated since the last inspection of March 06. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 9 There is no change in pre-admission assessment practice. The inspector was informed that the manager or deputy visits all prospective service users’ prior to admission to access their needs, however in exceptional circumstances emergency admissions are accepted after completion of a telephone assessment. A pre-admission form is completed, which forms the basis of the subsequent care plan. In addition all social service placed residents’ placed have a completed CM4 and CM7 assessments from the community services. The inspector reviewed the care documentation of 3 most resent residents to the home. There was evidence of the pre-admission assessment of residents having being carried out, including the liaison with relevant health professionals, these records had been signed by the assessing RN. Assessment is an ongoing process and following admission to the home a full detailed assessment of the residents care needs has to be established over the initial few days and regularly reviewed. This information forms the basis of the Care Plan (see Standard 7). Prospective residents are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. One new resident and their representatives were consulted and they said that they received a warm welcome. One family member said how “they had been involved in the gathering of information regarding the care planning of their loved one”. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10 The overall quality in this outcome area is poor. Care planning, risk management and medication procedures are not demonstrating that all of the residents’ health and personal care needs are being met. Staff treat residents in a warm and respectful manner, which means that residents can expect to receive care and support in a sensitive way. EVIDENCE: The home has care planning documentation for assessing, planning and evaluating care. Significant deficiencies were found in care planning that could lead to residents’ needs not being monitored or met. The standard of information was higher for the residential residents compared to the nursing residents, where some information was not cross-referenced. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 11 Three of six care plans examined were not up to date and did not reflect the residents changing or current needs or fully demonstrate how all of their assessed needs were being met. More detailed care plans are required for these residents (these were named during the inspection), in order to give a more prescriptive approach to how the identified needs should be met. Of the six viewed there was only one residents’ signature of involvement. There are risk assessments for some eventualities. However, there was a lack of identified risks for one resident who was observed and case tracked. An immediate requirement was made in relation to this. In general the risks identified need to be formulated into an action plan via the care needs assessment process to identify the care / management required to reduce risks identified. Specialist equipment being used for individual residents’ i.e. alternating pressure relief mattresses / seat cushions needs to be recorded in the care plan. This information must be updated; as equipment needs change in relation to assessed need and must be evidenced in the risk assessments. If any form of restraint is used to minimise risks (for example, a lap belt or bedrails used for personal safety) a signed consent form must then support this. On the documents observed there was one signed and two not signed. An immediate requirement was made in relation to this. Nutritional and fluid intake need improved monitoring to ensure frail residents receive sufficient fluids and an adequate diet. Goals for the daily fluid intake of residents who are at risk of dehydration or urinary tract infections are set or their fluid intake recorded. It appeared that one bed bound resident was not given a drink throughout the morning of day one of the inspection. Beakers of drink and a water jug were out of reach. Staff were unable to confirm what the resident had had to drink that morning. This was actioned during the first day of inspection. Another resident’s’ care plan indicated that he/she had not been weighed for 3 months even though an assessment indicated that this was undertaken with regularity. On questioning staff regarding this shortfall their reason for this was that he/she refused to be weighed. Discussion regarding other ways to monitor weight was then undertaken. Nutritional risk assessment for at risk residents’ should be considered, together with weight monitoring to act as a nutritional guide. When reviewing the wound care documents there was a shortfall in the recording of information. Of the ones viewed none evidenced the assessment of wound type or gave specific dimensions. This practice needs to be improved, St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 12 as the improvement, deterioration or time scale of any of the wounds from the information recorded could not be tracked. The registered nursing staff on duty said the home has adequate supplies of equipment but there are problems with the availability of hand gloves at the weekends. This was highlighted to the manager who actioned immediate reviews of supplies, to cover both floors for the weekend cover. All residents can remain with their own GP if they wish and if the GP consents to visit them at St. George. GPs visit the home upon request from the home or resident and the main GP practice (Air Balloon Surgery) visits most mornings. A comment card from a Social Care Professional said, “They provide a good service”. Another said, “ Any issues are addressed promptly”. Arrangements are made when requested for residents to attend their own or local dentist / optician. Domiciliary optical services are provided annually and dental services are also provided in the home on request for residents who are unable to access the community facilities. Records are kept of visiting dentists and opticians these were observed. All other specialist services are accessed by referral if there is a need. The ‘Homeward’ service supports people who require tube feeding. Standard 9 was inspected by the pharmacist inspector on 14th September 2006. A doctor from the nearby medical centre visits St Georges regularly, seeing residents as needed. Medication is supplied from a local pharmacy using Nomad boxes, a weekly monitored dosage system. Prescriptions are requested by nursing staff and sent directly from the doctors to the adjacent pharmacy. There have been some difficulties with this system resulting in residents missing doses of their medication because no supply had been received. Three examples were seen where medicines had not been administered for several days because they were out of stock. To protect residents’ health action must be taken to address this. A policy for the use of homely remedies within the home was available although no homely remedies were seen. Secure storage is available for medicines on each floor of the home. At the time of inspection a door had been propped open leaving some medicines insecure. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 13 Weekly Nomad boxes are received several days in advance of their use and need to be stored in a locked cupboard. All medicines must be stored securely at all times. Several oxygen cylinders were kept in the downstairs medicine storage area, these need to be secured so that they cannot fall and cause injury. A medicine fridge is available on both floors. Records showed that one fridge often had temperatures of below 0 degree C. For safe storage of medicines temperatures should be in the range of 2 to 8 degrees C, if temperatures are outside of this range action must be taken to adjust the fridge. Suitable storage for Controlled Drugs and Controlled Drugs registers are available on both floors. One register showed that on three occasions medicine had to be borrowed from one service user to administer to another whose supply had run out. Medication must only be administered to the person for whom it is prescribed and whose name is on the label. Two prescribed medicines were seen without a pharmacy label, this means that staff cannot check the correct dosage instructions and increases the risk of medication errors being made. All prescribed medicines must be kept in the labelled container. Nomad boxes indicated that medicines had been administered as recorded on the medicines administration record sheet, however it was often not possible to audit medication supplied in standard packs because no record had been made of when the pack had been started. It is recommended that action be taken to address this to allow staff to check that medicines have been administered as recorded on the medicines administration record sheet. Staff have already arranged to start monthly audits of medication to improve quality in this area. The pharmacy print new medicines administration record sheets every month. Previous reports have highlighted that many of the prescribed medicines are not printed on the medicines administration record sheet and have to be handwritten by the nurses when the medicines are received. As noted in previous reports many of these handwritten additions are of a poor standard and are not signed and dated by the person making the addition, this could increase the risk of mistakes in the medicines administered. Confirmation of current medication was seen for two admissions by the rapid response team. Staff keep records of the receipt of medicines on the medicines administration record sheets. In some cases medicines received outside of the normal weekly supply had not been recorded. Records must be kept of all medicines received into the home. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 14 Arrangements have been made for the disposal of unwanted medication and records are kept of this. A record must be kept of when the registered disposal company removes medication from the home. Residents spoken with confirmed that their preferred form of address is established prior to admission. This was observed in most of the care documents viewed. During the inspection staff were observed to be knocking and waiting before entering residents’ rooms and bathroom and toilet doors. Staff and residents’ interaction were seen to be friendly and supportive. There are 3-shared rooms with ceiling track curtaining providing privacy for these residents. St Georges Care Home DS0000020254.V311990.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 The overall quality in this outcome area is good. St. George continues to provide residents with opportunity to experience a stimulating and varied life where various informal activities are regularly made available. Visitors are made very welcome and meals are well managed and provide daily variation, nutrition and social contact for people. EVIDENCE: St. George has a full time co-ordinator who organises the varied activity schedule. Time is spent with the residents gathering information on their likes / dislikes, feedback and suggestions for activities / events. There is a planned event most days which includes visitors / entertainers to the home as well as organised trips from the home. Residents spoken with were very complimentary of the activities and said they participated in and enjoyed most events. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 16 A request from the activities co-ordinator for families and friends to complete a pen profile was observed in all residents’ rooms. Two of these were observed for case tracking. These were then used in formulating person centred care for meaningful activities. A programme of in-house activities is maintained. Posters are displayed advertising four monthly programmes, supported by monthly activities. Awareness of what is available is also promoted by verbally by staff daily. It was noted from 2 out of 25 feed back forms, ‘have your say’. Highlighted that they ‘were unaware of family inclusions of planned events’. Discussion took place with the activities co-ordinator relating to this and her thoughts were to introduce a news letter and a schedule of activities to be sent to families and a copy placed in each resident’s room. It was noted by the inspector that a large number of residents were keen to make sure they were in place for the start of the afternoon’s activity on one of the days of inspection, ‘going to the pictures’. This was greatly enjoyed and many residents joined in singing with the musical. A movement session was also enjoyed in another part of the home. Those unable to participate were observed having one to one involvement with carers at different times in the day. Also there is two volunteers ‘listening team’ whom come in once a week providing one to one to a number of residents who do not actively participate planned activities. One resident who has a listener attend said, “I do enjoy our time as I do not like to join in with other activities”. Forthcoming events include Bristol Zoo visiting St. George; Halloween Party; Bonfire Night and Hot Dogs. A schedule of events for Christmas Celebrations including Christmas Table Top Sale; Church Service; Trip to Garden Centre to see the Christmas displays and shopping; Christmas Meal; Residents’ Christmas Party with children singing from a local primary school; Salvation Army Carol Night; Staff Carol Night; Relative Support meeting. St. Georges’ have a library of videos that are appropriate for residents accommodated in the home. The home holds a number of annual fetes; coffee mornings; and members of the local community are invited. This was confirmed in the relatives meeting minutes. It was noted that all relatives are invited to the organised functions where food, drink and entertainment are provided. There is a church service that takes place on a monthly basis. Reflexology and aromatherapy sessions are held once a week in addition to visits from the hairdresser. The staff and management team also confirmed this information. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 17 Rising and retiring choices are indicated by the residents’ daily and accommodated in balance with assessed needs. During the inspection, there were a large number of visitors on both floors of the home. Residents spoken with said that they felt visitors were welcomed. Local clergy of different denominations visit the home. Meal times are appropriately spaced throughout the day. There is also opportunity to use the refreshment service areas on each floor. A four-week menu plan is provided and this is on display in the home. There is also a menu board with the menu of the day displayed in the dining room. During the inspection the inspector requested a number of residents in the dining room of their opinion of the meals, everyone commented on the food said how “good it was”, “there is always seconds on offer”. 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. Comments received in relation to meals from the “have your say” forms completed by residents and visitors were mixed. One said; “ I would like to have mashed Swede and parsnip instead of cubed”. The chef was asked about the monitoring of the returned plates following meals from around the home, in particular residents with a poor appetite. This is undertaken but there is no immediate feedback to the nursing staff. Discussion around this took place and the chef had a number of ideas to explore. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 18 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, 18 The overall quality in this outcome area is adequate. Arrangements remain in place for responding to concerns. These are satisfactory so that residents and their relatives and friends can feel that any complaints will be taken seriously. Staff continue to have a good theoretical understanding of Adult Protection issues but this needs to be better applied in practice. EVIDENCE: There is a complaints procedure with a formatted document for recording complaints available. This was viewed and found to be correct with outcomes of complaints completed. Residents’, visitors and staff comments showed that people feel comfortable discussing any concerns with senior staff or management. The home has an Adult Protection policy and procedure and staff have received training making sure as far as possible that residents live in a safe environment. However there are important gaps in care delivery as detailed earlier in this report. St Georges Care Home DS0000020254.V311990.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 23, 24, 26 The overall quality in this outcome area is good. St. George remains a well equipped home with a safe standard of accommodation provided for the residents. Homeliness in communal areas and personalisation of individual rooms are both well promoted. All areas of the home smelled pleasant and were generally cleaned to a good standard. EVIDENCE: The environment continues to be well maintained and suited to the current residents’ needs. Access is on the level promoting independence for all who St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 20 visit St. George. The home was purpose built ten years ago to care for elderly people. There is an ongoing programme of decorating and refurbishment. There are appropriate arrangements in place for the service and maintenance of plant and equipment. Two maintenance men work full time at the home. At the time of inspection the home was nicely presented and well maintained. The grounds look tidy and are well maintained. At the time of inspection the hanging baskets and borders were being planting out with Autumn/Spring flowers. Four residents shared their “delight that these give them”. Residents’ bedrooms continue to look homely and were personalised with residents’ personal possessions and furniture. The bathroom and toilet facilities are sufficient to meet the needs of the residents. However, due to the lack of space for storage of essential equipment there is discussion between the manager and Commission for Social Care Inspection regarding relaxing the number of these facilities within the home. All areas of the home smelled pleasant and were cleaned to a good standard. There is a day to day/weekly cleaning schedule in each residents’ room. Those viewed were signed and dated. Sluice areas demonstrated control of infection procedures and included a sluicing disinfector on each floor. Good maintenance records with all servicing and certificates being up to date were noted. St Georges Care Home DS0000020254.V311990.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 The overall quality in this outcome area is adequate. In general the number of staff employed match the residents’ needs, however, when the care needs heighten for very frail residents this has the potential to lead to a shortfall of support and therefore the actual number of staff deployed should be kept under careful review. Residents are supported and protected by the home’s recruitment policy. Staff at the home continue to be well supported with their training. EVIDENCE: The hours needed for personal and nursing care needs are kept under review and altered according to need. It is noted that the rotas viewed for the month of August are set at the staffing notice. During the inspection it was noted how busy care staff were in attending to their duties. Eight residents felt that the response time for answering bells were at times lengthy. Comments included: “bells should be answered more promptly, especially for toilet needs”; “ it is not uncommon for me to wait for 20-30 St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 22 minutes for someone to come and assist during the early evening”; “I have waited for over 30 minutes for someone to come and answer”. Another 7 residents’ feedback confirmed that they were mainly happy with the response time from using their call bells but said at busy times (mornings and at week ends) they have a lengthy wait. This could be detrimental to the welfare of residents. The files of 6 employees examined randomly demonstrated good employment practice being followed. The details of staff and two volunteers ‘listening team’, was viewed. Police checks through the Pova First/ Criminal Records Bureau were observed. A record is kept of the outcome; this record is kept separately to other staffing records and available for inspection in accordance with Criminal Records Bureau Code of Practice. A random sample of the training records for a range of staff was observed. These evidenced a broad range of skills available amongst the staff team and an on-going commitment to staff training and development. All staff individual training records evidenced signatures of attendance and certificates in the training file. Members of staff confirmed they have opportunity to attend training and confirmed they do attend. St Georges Care Home DS0000020254.V311990.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 36, 37, 38 The overall quality in this outcome area is poor. The residents and staff team benefit from an experienced manager who continues to encourage an open style management approach. The views of family and friends are sought on how the home is run. Staff are regularly supervised. Residents’ best interests are not consistently safeguarded by the home’s record-keeping practices. The safety of the building for service users and staff is well promoted but the health and welfare of residents is not consistently promoted and protected. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 24 EVIDENCE: 31 The manager Mrs. Crew has been in post since the opening of St. George and has had previous management experience. Mrs. Crew is accountable to the Board of Directors who provides management supervision. 32 The residents and staff spoken with felt that they were supported and that Mrs Crew was accessible. Mrs Crew stated that she tries to speak to most of the residents and staff each day. Mrs Crew likes to have an open door policy for staff and residents to speak with her at any convenient time. Minutes were observed for residents meeting held in July 06. There are staff meetings, the minutes of which were not available for inspection. A copy of these is to be forwarded to the Commission for Social Care Inspection for observation. 34 The Board of Directors manages the business and development plan. A current Insurance certificate was on display. 36 There is an annual appraisal process, which ties in with supervision frequencies of 6 times a year for care staff. Overview sheets and individual training records both made reference to clinical supervision for Registered Nurses. Evidence of the level of staff supervision was observed. Evidence was obtained by viewing four staff records. This was verbally confirmed as being undertaken by two staff members when asked. 37 The residents’ register was in order. The employment records viewed were satisfactory. Monthly reports related to unannounced visits by a representative of the registered provider were discussed. Copies are available at St. George for the Commission for Social Care Inspection to view. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 25 It was noted that one resident had attended the Bristol Royal Infirmary following a fall and this event had not been forwarded to the Commission for Social Care Inspection for observation. Notification of illness or other events in the home concerning residents was discussed and the manager agreed for any future events to be forwarded to the Commission for Social Care Inspection. This can then be used as a monitoring tool. Accident reports were properly completed and reviewed. Care plan documentation is kept in the offices behind the nursing stations on each floor. Detailed comments about the quality of this documentation are to be found earlier in this report. 38 Good maintenance records with all servicing and certificates being up to date were noted. Documentation showed that relevant checks were maintained correctly and at required intervals including all fire alarms and equipment, emergency lighting. Evidence about the assessment, management and recording of issues relating to risk and restraint for residents are detailed earlier in this report. St Georges Care Home DS0000020254.V311990.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 3 x 3 x 3 n/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x 3 3 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X 3 1 2 St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1), 15(2)(b) Requirement Ensure all care plans reflect the residents changing or current needs and fully demonstrate how all their assessed needs are being met. Review care plans in a manner that demonstrates the involvement of residents in this process. Ensure information about specialist equipment being used for individual residents is recorded in the care plan, is updated as equipment needs change in relation to assessed need, and is evidenced in the risk assessments. Improve the monitoring of nutritional and fluid intake for frail residents to ensure they receive sufficient fluids and an adequate diet. Ensure that prescribed medication is available for administration and that all prescribed medication is kept in the labelled container. DS0000020254.V311990.R01.S.doc Timescale for action 31/01/07 2. OP7 15(2)(c), 15(2)(d) 30/09/06 3. OP7 14(2), 15(1) 30/11/06 4. OP8 12(1)(a) 30/09/06 5. OP9 13(2) 30/09/06 St Georges Care Home Version 5.2 Page 28 6. OP9 13(2) Improve the quality of the medicines administration record sheets to reduce the risk of medication errors. Store medication securely at all times. Maintain medicine fridges at safe temperatures. Keep records of all medicines received into the home. Ensure wound care documentation evidences the assessment of wound type and gives specific dimensions so that the improvement, deterioration or time scale of any of the wounds can be tracked. Ensure risks identified are formulated into an action plan to identify the care / management required to reduce, minimise or remove these risks. 30/09/06 7. 8. 9. 10. OP9 OP9 OP9 OP37 13(2) 13(2) 17(1)(a) Schedule 3.3 (i) 17(1)(a) Schedule 3.3 (k) 30/09/06 30/09/06 30/09/06 30/09/06 11. OP38 13(4)(c) 30/11/06 12. OP38 13(8) If any form of restraint is used to 30/09/06 minimise risks (for example, a lap belt or bedrails used for personal safety) a signed consent form must then support this. 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 OP8 Good Practice Recommendations Consider nutritional risk assessment for at risk residents, together with weight monitoring to act as a nutritional guide. DS0000020254.V311990.R01.S.doc Version 5.2 Page 29 St Georges Care Home 2. OP27 Keep the actual number of staff deployed under careful review. St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 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. Extracts may not be used or reproduced without the express permission of CSCI St Georges Care Home DS0000020254.V311990.R01.S.doc Version 5.2 Page 31 - 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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