Inspection on 07/04/10 for St Georges Care Home

This inspection was carried out on 7th April 2010.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Georges Care Home 10/08/10

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 11/07/05

St Georges Care Home 23/02/05

St Georges Care Home 20/10/04

St Georges Care Home 08/12/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: St Georges Care Home Kenn Road St George Bristol BS5 7PD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 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): St Georges Care Home Ltd Name of registered manager (if applicable) Mrs Helen Marshall Type of registration: Number of places registered: care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 Care Centre is registered to care for a maximum of 68 people requiring nursing care. The home is situated in a residential area, with easy access to local community facilities. It is less than 3 miles to the city centre. 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, a communal lounge and dining room as well as bathroom facilities. There are pleasant gardens to the rear and side of the property. Passenger lifts provide access to all areas. Care Homes for Older People Page 4 of 31 2 0 1 0 2 0 0 9 0 Over 65 68 Brief description of the care home Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was undertaken in October 2009 and our overall judgement about the quality of the service was poor. St Georges Care Centre became a Zero rated service. We asked Caring Homes to produce an Improvement Plan in order to address those areas of poor practice, and we met them along with adult social care and healthcare colleagues, to review progress. After that inspection we planned to visit again within six months. Prior to this inspection we asked the home manager to complete an annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment had been completed in detail and told us about improvements that have been made. It also gave us their plans for further improvements where they felt they could do better. We sent out care Quality Commission Have your say about St Georges Care Centre survey forms - we received eight completed forms back. This gave us some very useful information about what it Care Homes for Older People Page 6 of 31 was like to live in the home. During the inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to all those staff on duty, the home manager, some of the people who live there, and a number of visitors who were with their relatives. We observed the interactions between the staff and the people they were caring for, and we watched how staff were working. At the time of writing this report, the weekly fees for placement in the home range between 520 and 740 pounds. Additonal charges may be made for other services and these are detailed in the homes brochure. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk /www.oft.gov.uk . Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The following areas of improvement have been made since the last inspection : - The pre-admission process has been strengthened to ensure that placement is only offered after a full assessment has taken place. - Care planning processes have ensured that peoples assessed care needs will be incorporated in to their plan of care and their needs will be met. - People will receive the care and support that they need because the staff team are working better together and will ensure that good quality care is provided. - The management of any concerns of complaints ensures that people will be listened to and any actions necessary, will be taken. - Staffing levels for each shift will take account of the skill mix of the team and the collective dependency levels of all people. - All staff are expected to complete a training programme so will have greater skills in order to meet peoples needs. - The recruitment of new staff is following good practice guidelines however could still Care Homes for Older People Page 8 of 31 be more robust. - We are now notified by the regulation 37 process of all notifyable events. - A full quality assurance survey was completed to help the home identify those areas where improvements were needed. What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is clear information about the home, so people will know what the home has to offer in respect of services and facilities. Admission procedures for new people will ensure that those who come to live in St Georges will have their individual and assessed needs met. Evidence: A copy of the homes Statement of Purpose and Service User Guide is kept in the main reception area - both documents have been updated to reflect any changes that have been made. The home has a colour brochure that is given out to people who enquire about the home. These documents provide details about how nursing and healthcare needs will be met, the private rooms, the social environment, lifestyle and meal time arrangements, and visiting arrangements. People who want to know about what St Georges Care Centre has to offer will be provided with clear and detailed information. All eight people who completed our survey forms said that they had had enough information about the home to make an informed choice about moving there. A Care Homes for Older People Page 11 of 31 Evidence: service user guide is kept in each of the bedrooms. Before any new person is admitted to the home their care needs will have been assessed before they are offered a placement. There have been few admissions since the last inspection but we spoke with one person who had recently moved in to the home. They told us that they had visited with their relative and had spent some time in the home, and been asked alot of questions about their care and support needs. We spoke to one other person who had been visited in the hospital ward. A pre-admission assessment form is completed to record details about a prospective persons care needs. It recorded information about the persons significant medical history, significant social and psychological history and the current medication regime. The information recorded in the two documents we saw was detailed and provided a very clear indication of the persons needs. At this pre-admission stage it is determined whether any specific nursing care equipment is required, so that this can be in place on admission. The admission process has been improved and this means that only people whose needs can be met will be accommodated in St Georges. Two of the beds in this home were previously contracted to be Safe Haven beds and people would be admitted in to these rooms, from the community, by the Intermediate Care Team in order to prevent hospital admissions. The contract for these beds will need to be renewed before this service can be used again. Currently the two rooms are on the first floor and at the end of the corridor. The home manager plans to swap rooms around so that the two safe haven rooms are nearer the front entrance and the visiting healthcare workers do not have to walk through the home. This will be a much better arrangement. Once this service is up and running again, the home manager or registered nurses employed by the home will continue to have a say about who is admitted into these beds. This is so that inappropriate admissions will be avoided. The home provides placement for those people with general nursing care needs or end of life care needs. They are able to provide short term respite stays for people when they have vacant beds. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning processes will ensure that care needs are identified. People receive the individual care and support that they need, but some risk assessment processes need further work to ensure that risks are managed appropriately. People have access to the healthcare services that they need. Medication procedures are in line with good practice and are safe. Evidence: We looked at four peoples care planning documentation to determine how the care arrangements for each person are planned. Following the full assessment of care needs, care plans are prepared for each person. The information in the plans is well set out and is easy to read. Identified needs will each have a desired outcome and a plan of care. Any identified strengths are recorded so as to ensure that the person is encouraged to continue doing what they can for themselves. Personal preferences are included in the plans and evidence a person centred approach to the persons care needs. We saw plans had been prepared for each person about decision making these include decisions that care staff may need to make in respect of the persons well being. Some specific examples were included in the plans, that were relevant to Care Homes for Older People Page 13 of 31 Evidence: the person involved. Risk assessments are completed in respect of the likelihood of developing pressure sores, nutrition, the probability of falls, and to identify any risks involved in manual handling tasks. From the manual handling assessment a moving and handling care plan is written - in general these contained clear instructions for staff on what they needed to do and what equipment is needed. Some of these plans needed more information recorded and this was discussed with the manager during the inspection. We had expected to see a risk assessment completed for a person who had a recent hospital visit after a fall from their chair but this had not been undertaken - a shortfall like this could potentially have placed that person at risk from further injury. Specific risk assessments had been undertaken for some people where other risks had been identified. A staff member undertaking any risk assessment must ensure that there is a correct identification of what the risk is. This is so that an appropriate risk management plan can be devised. One particular risk assessment needs to be revisited so that staff are fully aware of what is expected of them. There are procedures in place to monitor peoples healthcare status. We saw that food and fluid intake charts were being filled in where required. We saw that people with diabetes were having their blood sugar levels monitored. Peoples body weight will be monitored on a monthly basis, or weekly if necessary. Guidelines have been prepared for the care staff and nurses to follow if people are losing weight. On a weekly basis the GP is given a list of those people whose weight has reduced. Fortified foods or supplementary drinks are provided as necessary. Care plans and risk assessments are reviewed on a monthly basis. Where a review identifies a change in need the plan of care will be amended. A daily record is completed and the quality of those recordings seen was generally good and informative. Care staff and nurses must ensure they make accurate recordings to explain and justify any best interests decisions the make on behalf of the person they are looking after. A Collaborative Care document records GP and other healthcare professional contact. Most people are registered with one doctor who works from the next door health centre - ward rounds are completed every Monday, Wednesday and Friday morning and most people will be seen at least once a week. People are able to retain the sevices of their family GP, if the GP is agreeable to visiting them in the home when necessary. Other healthcare professionals will visit as and when necessary. Medication systems were discussed with one of the registered nurses. There are safe Care Homes for Older People Page 14 of 31 Evidence: procedures in place for the ordering, receipt, storage, administration and disposal of all medications. Regular meetings have been held with the pharmacist who supplies all medications. Regular medication audits are undertaken and controlled drugs are checked on a monthly basis. There is a homely medication policy and this has been agreed by the homes GP. We saw that hazard warning signage was displayed where oxygen therapy was being used. We spoke with a number of people who live in the home and they were all very positive about the approach of staff - all very good and there when you need them. One person told us that they felt they were always treated with respect by the staff, but another said that the staff were always very busy and didnt have time just to sit and chat. This was also mentioned to us by staff members when we asked what they thought could be better - more time to sit and chat with residents. We received eight of our survey forms back from people who live in the home positive responses were received to the question do you receive the care and support you need. One of the areas identified in our last inspection report was in respect of the response by staff to call bells. There was also an issue about some people not always having access to their call bells. We asked people what the situation was like now and the following was stated - very good sometimes not so quick if they are busy and always come quickly. We noted during our inspection that call bells were attended to promptly by the staff team. A new procedure has been put in place whereby senior staff check access to call bells to ensure they are within reach and usable. This is followed three times a day. We looked at the records for these checks and they confirmed people had access to their call bells. Where this was not the case for behavioural reasons, a risk assessment is completed and staff will check on the person every hour - in the case of one person they were still able to draw the attention of staff. The staff at St Georges Care Centre have the necessary skills and experience to look after people who are at the end of their life and who are dying. Some of the care staff and registered nurses have been involved in the St Peters Hospice End of Life project. Nurses are competent in setting up and administering pain management medications. We saw letters of compliment that had been sent to the home, praising the staff about how they looked after their loved ones. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can participate in a range of different activities if they choose to and can spend their time as they want to. The menus and meal time arrangements have been changed in order to meet peoples individual needs and provide a nicer dining experience. Evidence: We looked at activities arranged in the home and spoke with the activities organiser who is employed for 40 hours a week (Monday to Friday). Care staff are encouraged to be involved in any activities that are arranged. There are plans to involve families and volunteers, to expand the number of outside home visits that can be made. There is a range of activities organised throughout the week including arts and crafts, quizzes, skittles, hair dressing and pamper sessions. A copy of the weekly activities plan is displayed in the main foyer. Since the beginning of the year a monthly newsletter is produced - we saw one that told readers about changes planned in the reception area, use of the main dining room and the new hairdressing salon. Because of the frailty of the majority of people who now live in St Georges, some of the group activities are not attended by many. For this reason an increasing amount of time is spent one to one with an individual or in small groups. The organiser is in the process of completing a life plan for each person that will give information about the Care Homes for Older People Page 16 of 31 Evidence: individuals past life, occupation, relationships, interests and hobbies. This information will be used to enable person centred activities to be arranged. In the AQAA, the home manager told us that all birthdays and anniversaries are celebrated and families can hold parties in the home if wanted. One person whose birthday had been the day before said the staff sung happy birthday and she had a cake made. One relative who had completed our survey on behalf of their relative said good activities and entertainment. We saw evidence that people are able to encouraged to make decisions for themselves and are offered choices. This may be in respect of the time they have help in the morning to get up, what they have to eat and where they take their meals, and when to retire to bed at night. We observed care staff asking the person they were helping about what they wanted to do/where they wanted to sit for example. The home has an open visiting policy and friends and relatives can visit at any reasonable time. Visitors can join their relative for lunch upon arrangement. Health and social care professionals are however requested to avoid meal times, when they book appointments. This is so that people can have protected meal times and enjoy their food. We looked at the meal arrangements in the home and found there is a good variety of meals provided and the menu confirmed this with choices available. People we spoke with told us the meals were very good, I enjoy the food here, and there is a good choice. Records of meals provided showed choice being given and those instances where people had chosen a different meal. Each person will be encouraged to use the dining room for their main meal of the day though staff were very clear that it is the persons individual choice. The cook told us that she felt this meant the meal was better presented and everyone got their meals quicker then previously. There are a number of people living in the home who require pureed meals and we noted that these meals were well presented with each part of the meal served separately. One person we spoke with told us they always have their meal in their room and its not a problem they know its my choice. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of any concerns or complaints will ensure that people are listened to and any actions taken. People will be safeguarded from harm. Evidence: The homes complaints procedure is displayed in the reception area and is included in the service user guide which is supplied for each bedroom. All eight people who returned our survey forms told us that they were aware of who to talk to if they had any concerns or complaints. We spoke to people during our visit and they made the following comments - the nurses are very helpful and listen to me, things are so much better here and your only have to mention something and it gets sorted. There has been a vast improvement in the management of complaints and we have greater assurance that any complaints made are taken seriously. We looked at the homes complaints folder and found there had been nine complaints made since October 2009. The complaints related to a number of areas: the no smoking policy of the home, meals, staffing and loss of personal items. We looked at the responses to these complaints and are satisfied they had been addressed and responded to in a professional manner and where practice needed to change this was undertaken. All of the complaints had been investigated within the homes complaints procedure timescales. The home has an adult protection policy and staff whistleblowing policy. Both policies Care Homes for Older People Page 18 of 31 Evidence: are displayed in the home and the staff room. We were told that no staff member has raised any concerns through the whistleblowing process. We spoke with staff about their understanding of Safeguarding Adult issues - they were able to give us good examples of what could be considered as abuse in a care home setting. These included not taking people to toilet when they needed to, not treating people with respect and giving choice, ignoring people when they asked for assistance. All of the staff were very clear that if they had any concerns they would report it to the manager. We asked what they would do and who they would report to if they felt their concerns had not been addressed or were unhappy about the managers response. Staff were not all aware that they could report safeguarding concerns themselves to the local authority for investigation. There have been two safeguarding events investigated by the local authority since the last inspection and in both cases the allegations had not been substantiated. The issues raised however had been discussed with staff. There is an ongoing programme of staff training in safeguarding adults (SOVA). Training records evidenced that some staff have completed the e-learning training package (generally the registered nurses), whilst others had not received training for some time. In the staff room there was displayed a reminder note to those staff who have yet to complete SOVA training. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Georges Care Centre is a well equipped and comfortable nursing home where people will be looked after in a clean tidy and fresh smelling environment. Evidence: St Georges Care Centre is a purpose-built two storey home designed specifically around the needs of elderly people and those whose mobility is reduced or severely impaired. The home is surrounded by attractive gardens with well established shrubbery. Plenty of car parking is available to the front of the property and there is level access to the front door. The main entrance is locked and during office hours callers will be welcomed by the receptionist. The reception area is currently in the process of being moved out by the main entrance. Out of office hours, visitors can gain access by ringing the door bell, which then displays on the call bell system. The home manager has relocated her office in order to be more visible. There are two passenger lifts up to the first floor as well as a central staircase. Various information boards are displayed in the foyer and main reception area. There are several communal areas located throughout the home. The main lounge on the ground floor is currently being renovated. Part of the room is being divided off and a new hairdressing salon and waiting room is being built. This will provide a more pleasant area for people to rest in whilst waiting for the hairdresser. The lounge is a pleasant room, comfortable furnished and decorated and consists of a sun room. The Care Homes for Older People Page 20 of 31 Evidence: main dining room is on the ground floor. This is set out hotel style and has access out into the rear gardens. The dining room is increasingly being used although people still have the option to take their meals in their own rooms if they so wish. In addition there is a small dining room and a small lounge on the first floor. On each floor there is a kitchenette where visitors are able to make refreshements. Toilets and assisted bathrooms are located throughout the home. One of the bathrooms on the ground floor is to be upgraded in the near future, to a wet room, taking into account the changing needs of people who are now living in St Georges. Each floor has sluice room facilities, separate from the bathing facilities. The home has a sufficient range of mobility equipment to enable staff to undertake their duties and to move people safely - this includes hoists, stand aids and slide sheets. All but a couple of beds are electric profiling beds or hospital type beds. The two divan beds are at present suitable for the people using them but will be replaced as and when necessary. There is a plentiful supply of pressure relieving mattresses and pressure cushions. A nurse call bell system is installed in each bedroom and the communal areas. The corridors throughout the home are wide, able to accommodate wheelchairs and are fitted with grab rails. There are three shared bedrooms and 62 rooms for single occupancy. All bedrooms have ensuite faciltities of a toilet and wash handbasin. Each of the bedrooms are well furnished, spacious and able to accommmodate moving and handling equipment, have a wardrobe, chest of drawers and a bedside cabinet with lockable drawer. People are encouraged to bring in any items of furniture they want and to make their private bedroom their own. Some bedrooms have patio doors leading out on to the rear garden. We saw all parts of the home during this inspection. All areas were well decorated, clean tidy and smelt fresh. There is an ongoing programme of refurbishment. The front hall is to be redecorated and new laminate flooring laid. Bedrooms will be redecorated when they become vacant. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of those staff on duty each shift will be appropriate to meet the collective care needs of the people living in the home so people can be assured that their care and support needs will be met. Staff have access to a set training programme but would benefit from more specific training sessions. There is greater confidence and morale amongst the staff team which means they will fulfill their role. Evidence: We were assured during this inspection that staffing levels are arranged based upon the collective dependency levels and care needs of the people who live in the home. At the current time there is a significant number of vacant rooms and concerns were expressed by some staff spoken with during the inspection, that staffing numbers may not be readjusted as new people are admitted. To care for the 50 people at present residing in the home, there are three registered nurses each morning, two in the evening and two for the night time period. On the day of the inspection there were also eight care staff in the morning and eight in the evening. The staffing rotas for several weeks showed that on some day there are more care staff on duty. We have been notified on just one occasion since the last inspection that a shift was worked short staffed - this had been because of last minute sickness where agency cover could not be arranged. The overall opinion from the staff team was that staffing arrangements were much improved, that any new staff could be supported properly in their new role and that the skill mix of experienced carers and less experienced staff Care Homes for Older People Page 22 of 31 Evidence: was better managed. There has been a significant reduction in the use of agency staff since the last inspection - this is because vacant posts have been filled, and staff sickness levels are reduced. Most recently there has been no agency use at all. The nurses and care staff are supported in meeting peoples daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. Hostesss are employed to serve out meals and hot drinks and this means that carer time is freed up to provide care and support for the people they are looking after. We were told by the home manager in the AQAA form that of their 35 care staff, nine have already achieved a National Vocational Qualification (NVQ) in health and social care, Level 2 or above. This is a slight reduction in the numbers of trained members of care staff, however prior to the October 2009 inspection, there had been a large number of staff who left the home. Six staff have recently just commenced their NVQ training. As part of the development plan for the home, they aim to improve the numbers of staff who have achieved an NVQ. We looked at the recruitment and selection records for four members of staff who had started working at the home since the last inspection. We found that detailed application forms had been completed with a full history of previous employments. CRB checks had been undertaken as well as POVA1st checks (now called ISA1st checks). Two written references are obtained for each applicant but we noted that in one instance a second reference had been obtained from a friend of the individual. We noted that records kept as a result of an interview were very limited in the level of detail and therefore we could not evidence how the interviewer had gained assurance that the applicant was suitable to be employed. There needs to be a more robust approach to staff recruitment to ensure that people are safeguarded from the potential of being looked after by unsuitable workers. The following improvements need to be made - wherever possible obtain references from previous employers that are subsequently validated, and records of interviews be kept which evidence the interviewees response to questions, and their knowledge and understanding of the role for which they are applying. All new staff will complete an induction programme of training at the start of their employment - the programme meets Skills for Care guidelines. During the induction period the member of staff will be supernumerary to the staffing numbers, and will be allocated to work alongside a senior carer or registered nurse. They will have received basic training before working with people. This includes moving and handling training and fire awareness. The training they complete via an E-Learning programme is submitted to the Caring Homes training department, assessed and marked. We saw Care Homes for Older People Page 23 of 31 Evidence: certificates that had been provided when induction training had been finalised. We asked staff about training they had received and they told us that currently all staff are undertaking an E-Learning training programme in health and safety, infection control, first aid, food hygiene, fire awareness and moving and handling. We looked at a sample of staff files - they showed that some staff have not had training in a particular subject since 2006 or 2008. We were told that not all the records are being kept up to date. Some staff have made better progress in the completion of the ELearning programme than others. Registered nurses have completed mental capacity act (MCA) and deprivation of liberty safeguards (DOLS) training - we could not evidence that any of the care staff have completed this training. One staff member commented that they found it better and learnt more when training is undertaken by a trainer visiting the home or they attend external training sessions. The activities organiser told us they had not undertaken any training around the providing of activities in a care home setting. In addition to the E-Learning programme examples of other courses attended by staff include peg feeding, pressure area and skin care. There has been no training around areas of care associated with old age such as stroke care, parkinsons, diabetes management and mental health awareness. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant improvements in the management of the home and the staff team ensures that the people who are living in St Georges Care Centre will receive the service that meets their needs. The home is safe and the staff are working in the best interests of the people who live there. Evidence: The home manager Helen Marshall has been in post since March 2009, having previously been a registered manager at other nursing homes in the South West region. She is a Registered Nurse, has completed the Registered Managers Award and has just completed the registration process with the Care Quality Commission to be the registered manager for this service. We asked about the approach of the manager and senior staff. Staff told us that the manager was starting to listen and they found her more approachable. The manager has started consultation meetings - these are chaired by an outside manager and are an opportunity for staff representatives to raise issues of concern. Care Homes for Older People Page 25 of 31 Evidence: Minutes we looked at showed that the following areas had been discussed - moving and handling practice and equipment, appointment of a moving and handling lead advisor, meal time arrangements, and daily routines. Staff meetings are held on a monthly basis, and minutes are kept of these meetings. Resident and relative meetings are held on a three monthly basis. There is a greater feeling of openness, with the staff team working together with the manager, to provide a care service that meets peoples needs. It is up to us all to work together well and to regain the good reputation of the home was one comment made during the inspection. We found that the home manager was much more approachable and co-operative during this inspection. Following the last inspection a full quality assurance survey has been completed by Caring Homes in order to assess the satisfaction rate of relatives/friends/advocates, and the staff team. Questions were asked about the care environment, the cleanliness of the home, friendliness of the staff, laundry service, communication methods and the general atmosphere in the home. Staff were asked about communication, team working, training opportunities and morale within the home. An action plan was devised and the home was given six weeks to complete the necessary actions. In December/January 2010, staff morale was rated as only 53 good, however this had increased significantly by the end of March 2010. Following the last inspection visit the home manager devised an improvement plan for the home in order to raise standards. The plan told us about the measures they would put in place to raise standards and ensure ongoing compliance with the national minimum standards and regulations of the Care Standards Act. Since the last inspection there has been a real committment by the staff who work in the home and Caring Homes to raise standards and there have been regular visits by regional, area and peripatetic managers. Monthly Regulation 26 reports are completed and a list of action points made. It would be a good idea if these were signed off by the person who completes the task, as a good evidence trail. Subsequent visits will however check out that the action points have been addressed. In addition the home manager has to complete monthly management and risk reports and submit these to Caring Homes. These measures will ensure that the quality of the service is measured. The home looks after personal monies for some people and there are satisfactory accounting and auditing arrangements in place to ensure that peoples financial interests are safeguarded. Staff supervision is shared between the home manager and registered nurses, each Care Homes for Older People Page 26 of 31 Evidence: with a group of staff for whom they are responsible. There is an expectation that all staff will receive a formal face to face supervision session on a two monthly basis. Most staff spoken with during the inspection confirmed that they have regular supervision although some said that its hit and miss. Records evidenced that there is a programme of regular staff supervision. All records that we requested to see during the inspection were made available. We did discuss with the manager the need for staff to make accurate recordings when they have made a best interest decision for a person who lacks capacity, on either a long term or temporary basis. In general we saw staff following safe moving and handling procedures, however one member of staff was questioned about how they helped a person to stand up from a chair. The home manager acted accordingly and a training session was arranged for the following day. We looked at this persons training file and saw that they had not had recorded manual handling training for over three years. All staff must receive manual handling training on an annual basis. Since the last inspection a manual handling lead has been appointed for the home - they will be undertaking further training for trainers training in the near future. Manual handling plans for each person are devised following a moving and handling risk assessment and a copy of the plan is kept in each persons room. This is good practice. We looked at the records that have been kept in respect of any accidents or incidents that have occurred. We found that not all records are signed of by the home manager and there was no recordings made on the same form of any follow up actions or observations made. This would be good practice. Regulation 37 notification forms are completed and sent to the Care Quality Commission as per our guidance. Since the beginning of the year we have received 19 notifications - this is not a significantly large number bearing in mind the size of the home. We have been notified about expected deaths, falls where an injury was sustained, hospital admissions and medication issues. Information included in the AQAA, submitted by the home manager indicated that the maintenance of all equipment in the home is up to date and that environmental audits of the home are completed on a regular basis. This includes regular fire safety checks and drills. There were no health and safety concerns raised during this inspection. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 20/11/2009 ensure that full recruitment checks are always completed before new staff are taken on. This is so that people will not be cared for by unsuitable workers. Care Homes for Older People Page 28 of 31 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, Care Homes 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 8 13 The registered person must ensure that any risk assessment processes correctly identify what the risk is. This is so that an appropriate risk management strategy can be devised. 07/05/2010 2 29 19 The registered person must ensure that full recruitment checks of new staff are completed. This must include a proper interview assessment and references from appropriate sources. This is so that all measures are taken to prevent the employment of unsuitable workers. This requirement is being repaeted. 07/05/2010 Care Homes for Older People Page 29 of 31 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 1 7 Daily recordings in peoples care notes should include accurate recordings where best interest decisions have been made on behalf of the person. Staff should be reminded of the local authority safeguarding reporting protocols. This is so that they can report any concerns directly to the appropriate authority. Continue working towards achieving a 50 ratio of care staff with at least a Level 2 national Vocational Qualification in Care. Staff training records to be kept up to date. All accident/incident records should contain a record of any follow up observations or actions taken. 2 18 3 28 4 5 30 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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