Inspection on 08/04/08 for St Georges Care Home

This inspection was carried out on 8th April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Georges Care Home 10/08/10

St Georges Care Home 07/04/10

St Georges Care Home 14/10/09

St Georges Care Home 14/05/09

St Georges Care Home 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

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE St Georges Care Home Kenn Road St George Bristol BS5 7PD Lead Inspector Jill Cornelius Key Unannounced Inspection 8th April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Georges Care Home DS0000020254.V362490.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.V362490.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 stgeorgecarecentre@tiscali.co.uk St Georges Care Home Ltd Ms Alexandra Crew Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68) of places St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 68 persons aged 50 years and over requiring nursing care. Staffing Notice dated 22/06/2001 applies Manager must be a RN on parts 1 or 12 of the NMC register. Date of last inspection 7th November 2007 Brief Description of the Service: St. George is owned since September 07 by Caring Homes and 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. The aims of the home as written in their brochure: • To be the best providers of care. • To have excellent relationships with our customers and suppliers. • T o welcome people into our home and talk to each other. • To be respectful and professional regarding our customers. Additional information about the home is available in a brochure kept in the entrance of the home and by request. CSCI reports are displayed in the entrance of the home and are available for all to read. The fees range from £650 to £750 per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries and some transport. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 5 St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced, took place over one day and was completed by two inspectors. Evidence to form the report has also been gathered from a number of other sources: • Information provided by the deputy manager during the inspection • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with people living in the home • A tour of the home • Case tracking a number of people living in the home • Talking to a number of people living in the home • Talking to a number of visitors • Looking at some of the homes records • Notified incidences in the home, (Regulation 37’s) • Issues in staffing levels reported to us As a result of this inspection there has been two requirements and three recommendations made. What the service does well: People living at St. Georges Care Home continue to speak of it as a ‘caring place’, ‘relaxed and friendly’. The home’s staff team continue to receive a number of thank you letters from relatives praising the care provided and the dedication of the staff team. One of these highlighted ‘Very helpful and friendly staff’. Our survey responses include comments that ‘ There are high quality people who take their work seriously. They are friendly, respectful and anxious to do their best’. Prospective residents continue to receive clear details of the services the home provides, enabling them to make an informed decision about admission. People living at St. Georges Care Home have the benefit from regular reviews of changing care needs. People’s health living at St. Georges Care Home continues to enhance by the close monitoring of daily nutritional input for those residents at risk. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 7 There continues to be attention to fluid intake and output with close monitoring which is enhancing the health and tissue viability of vulnerable people. The good theoretical understanding that staff have of Adult Protection issues needs is reflected in practice via their delivery of care. It continues to be clear that opportunities exist for people living in the home to participate in a wide range of meaningful activities. People were positive about the recreational activities on offer. Visitors continue to be made very welcome and meals are well managed and provide daily variation, nutrition and social contact for people. There was plenty of ‘thank you cards’ relating to how sensitive and supportive the staff had been in the care of former residents. St. George remains a well equipped home with a safe standard of accommodation provided for people living there. Homeliness in communal areas and personalisation of individual rooms are both well promoted. People living at St. George are supported and protected by the home’s recruitment policy. Staff at the home, are well supported with their training opportunities. Working systems are constantly reviewed. What has improved since the last inspection? What they could do better: The registered provider needs to work on improving the following areas of the service. • Undertaking at least an annual consent with regard to the use of bedrails/lap belt users in the home. • Reviewing with the homes pharmacy, the time taken for the delivery of new prescription. • Increasing levels of safety through provision of notices in all parts of the home where oxygen is in use. • When reviewing peoples care plans show evidence of residents/representatives involvement, or document the reasons why this has not happened. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 8 • Forward all incidents relating to the welfare of people living in the home to the CSCI for monitoring. Requirements and recommendations relating to these areas are made in the table at the end of this report. 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. The summary of this inspection report can be made available in other formats on request. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 9 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.V362490.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and their pre-admission assessment processes ensure that placement is only offered to those whose needs can be met. EVIDENCE: The home’s Statement of Purpose was last reviewed in September 2007 so is therefore up to date. It accurately reflects the current service provision, and contains all the necessary information to enable any prospective resident to make an informed decision about moving to the home. Of the eight residents and four relatives spoken with six stated that they had been given enough information about the home. One resident commented, ‘I visited two homes before St. George Care Home and had no hesitation in choosing to come here’. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 11 A copy of the document is kept in the main reception area along with copies of the service users guide and previous CSCI inspection reports. A service users guide is provided for all new residents, along with a residency agreement and a letter of welcome to the home. Each resident is provided with a statement of terms and conditions regarding their stay – these will be different for privately funded residents and for those funded by the local authority. A pre-admission assessment is always undertaken. Either the manager or the deputy manager completes this, before any placement is arranged. This ensures that the home will be able to meet that persons needs and that they have the necessary equipment in place. Where appropriate, assessments and care plans from the local authority and/or primary care trust are obtained, as part of the information gathering process. The documentation completed for two recently admitted residents was examined. The information obtained is used to form the basis of the resident’s plan of care. Once the resident is admitted the care plan is expanded upon with any additional information that is gained. The home offers placement to older people aged 65 years and over who have general nursing care needs. The home is not registered to look after residents whose primary care need is Dementia, however the home does look after many people who have memory problems and degrees of confusion. The majority of residents are admitted from local hospitals, and family members will have previously visited the home, had a look around, found out what the home has to offer and will have had a conversation with the manager. One relative commented, ‘ I came along to look at St. George and I liked the atmosphere. I knew my relative would be happy here’, whilst a resident said ‘ my son chose the home for me’. All new admissions are reviewed after a ‘trial period’ of about four weeks, but this may be extended if the resident’s have not settled and needs longer to make the decision that the home is the right place for them. One relative spoken to confirmed that a review meeting had been held along with the social worker. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive care and support to meet individual needs. Relationships between staff and people living at the home are respectful. Medication procedures are in line with good practice. Peoples choice of how/where they end their life when given are recorded in their care file so they can be assured at their time of death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: Since the last inspection of November 07, St. George has introduced new care planning documentation. Following a comprehensive assessment, care plans are prepared for each person. Six care plans were reviewed and they all reflected current needs of people living in the home, evidencing that care plans are in place for all people who live at St. George. The care plans contained St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 13 sufficient information, and provided instructions for staff on how to met care needs. One relative told us, ‘new information we pass to the staff about our relative’s specific communication needs was incorporated into his care plan’. When looking at the social care needs two persons care plans did not provided instructions for staff on how they could meet the persons social care needs, but only detailed what the person had done during their life. Along side the care planning documentation, risk assessments are completed in respect of the likelihood of developing pressure sores, nutritional needs, the possibility of falls, and to identify the risks involved in any manual handling procedures. From the manual handling assessments a safe system of working is devised – these were detailed and gave clear instructions to staff on what they needed to do. Where bed rails or lap belts are used to maintain a residents safety, the appropriateness of this course of action is determined following a risk assessment, and consent for their use is obtained from either the resident or their representative. Evidence of this is kept with their care plan. Good practice would suggest that consent be sought at least annually. Care plans had been reviewed on a regular basis. Where a review identifies a change of needs these should be clearly reflected in the care plan, as an additional or amended need. Only four of the care plans reviewed evidenced consultation with the resident or their representative where appropriate. When reviewing peoples care plans evidence of residents/representatives involvement need to be documented or the reasons why this has not happened need to be documented. A daily record is completed for each resident – the quality of what was written was generally good and informative. Records reviewed showed that people were enabled to access all health care services available. A record is kept for each person, of GP and other healthcare professional contact, the reason for referral, and of any outcomes from this, such as what treatment may be required. Examples include chiropody, dentists, opticians, continence advisor; diabetes nurse advisor, dieticians and palliative care support. Access to the physiotherapy services is available when needed and Homeward support people requiring tube feeding. The home has adequate supplies of nursing equipment. On reviewing the accident log it was noted that a number of incidents relating to people living at the home had not been forward to the CSCI on a notification form. These were events such as skin tears; bruising; found on the floor. Senior nursing staff had followed these up with actions taken and outcomes such as risk assessments documented correctly. Senior staff, were, reminded to forward notified incidences in the home, (Regulation 37’s) to the CSCI. People spoken to say they received the care that they required. One person said, ‘The staff are always caring and respectful and are helped to be as independent as possible’. A relative spoke of how their relative is ‘assisted St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 14 daily in their choice of meals, clothing and activities in a discreet respectful manner’. The medication systems were looked at to determine the procedures in place for ordering, receipt, storage, administration and disposal of medications. Accurate records were viewed for the receipt, storage, and administration of medications. Staff told of the problems that using a new pharmacist has caused. Such as, chasing up new prescriptions, which we were told was very time consuming. This takes staff away from the floor in providing care for people at St. George. Temperature recordings for the fridge on the ground floor were within safe limits. It was noted that one person in their room had oxygen being used. This had appropriate stabilising security in use but there was no signage on the door to highlight it being used, as required by the safe handling of medications. This was raised and a notice was immediately put up. Residents preferred form of address is established prior to admission and noted in the documents. Choice as to whether or not to have the bedroom door open is given to the people living at the home. Staff were observed to be knocking and waiting for a response before entering the rooms. Privacy and dignity issues are discussed during induction. Staff interactions were seen to be friendly and supportive. People living at the home can meet visitors in their own rooms, lounges or in a quite room. Call bells were answered quickly. People living at St. George tell us they are treated with respect. Comments from people spoken with during the course of inspection – ‘mother looks well cared for, clothes are clean and she looks comfortable’, ‘when I visit the home it seems a happy one. Except at the weekend, this can change as there is no Manager or admin support to speak to’. The home has policies on managing the terminal stages of care, expected and unexpected deaths, which were viewed by us and were comprehensive documents. Peoples choice of how/where they end their life when given are recorded in their care file; we visually evidenced this in two documents during the inspection. There is access to the local ministers who will attend the home at any time. Hospitality would be offered to relatives if need be where service users are being nursed in the terminal stages of illness. There were plenty of ‘thank you cards’ relating to how sensitive and supportive the staff had been in the care of former residents. St Georges Care Home DS0000020254.V362490.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in a wide variety of social activities that are suitable for their needs, and are very well fed. They have full control over their lives and good relationships are established with families and visitors. EVIDENCE: The home employs specific activity co-ordinator staff, which arranges group and individual activities. The organiser listens to the requests from people living at the home for activities and takes key information from their social assessments. There is an overall annual plan and the weekly activity plan is displayed on the notice boards and also a copy is given to all the residents. This means that each resident will be aware of what is going on. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 16 An outside entertainer visited the home on the day of the inspection and one resident said, “it was lovely, I really enjoyed it”. Another resident said that the “staff had helped them go to a concert during the winter”. One relative wrote in a CSCI survey form “I have been allowed to bring in my relatives dog that I am now looking after, and this meant so much. It is a home not an institution”. People living at St. George also have an opportunity to take part in film clubs, karaoke, arts and craft sessions, and quizzes and have regular trips out into the local community. A number of people wanted to be involved with a charity run for ‘sports aid’. The activity organiser and manager put together links from the local police for escort and children from local schools supported the event. Some comments from persons who had undertaken this: • • • “Absolutely wonderful everything went to plan except the weather” “I really enjoyed the whole day we went to the pub as well” “The staff helped us by pushing our wheelchairs and getting us around the course” A hairdressing service is also provided during the week, and a number of residents have their hair attended to on a regular basis. One resident said, “I like to have my hair done regularly, it is so important to me. The lady is very good”. Monthly resident meetings are held, the home is thinking of the idea of having two resident representatives who will play an active part in raising issues on behalf of the others. One resident who was spoken with during the inspection said, “If I have any thing that I want discussed I would be able to tell the manager”. The minutes of the last meetings were examined and evidenced that the residents are greatly encouraged in having a say about how the home is run, what meals are served and what activities get arranged. It was noted that the home does not at present have a ‘resident representative’ who will speak up on behalf of the others. If this were to be implemented, people living at St. George would have ‘another voice’ for their views. The Home has a seasonal 6-8 week set menu that rotates on a weekly basis. The home displays a copy of the week’s menu choices on the notice boards. Breakfast is served in individual rooms. This was undertaken in a relaxed manner and as each person wished to have their breakfast ranging from 8am to 10am. Each day there is a choice of two meals at lunchtime however the kitchen will prepare alternatives if neither is acceptable. On the day of inspection there was a choice of a fish pie or a vegetable crumble served with fresh vegetables, but some residents had omelettes. One resident confirmed that they often have a meal that is different from the advertised meals. The home offers a well-balanced and varied menu. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 17 All of the residents who were spoken with during the course of the inspection made positive comments about the quality of meals. When residents have a birthday, a ‘Birthday Treats Menu’ is offered – they get a choice of what they want to eat for the whole day and a cake is made for them and any visitors. Meals are either served in the dining rooms, but residents can have their meals in their rooms if this is preferred. The dining tables are set out ‘hotel-style’, are covered with linen tablecloths, with place settings and condiments at each table. One resident said “I like to go to the dining room normally but if I am not feeling too good, they bring my meal along to me. Another resident said” I can have a cooked breakfast every day if I want”. St Georges Care Home DS0000020254.V362490.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 and investigated thoroughly. Staff continues to have a good theoretical understanding of Adult Protection issues. 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 including any actions taken in response to any such discussions. 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 has received training making sure as far as possible that residents live in a safe environment. Four members of staff were asked to answer, “What do you understand of the Protection Of Vulnerable Adults”. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 19 Those staff answered in a knowledgeable way. These staff was also able to give me examples and how they would react to the situation. This was also true when questioning about St. Georges “Whistle Blowing Policy”. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well-equipped and safe environment that is pleasant smelling and cleaned to a good standard. Homeliness in communal areas and personalisation of individual rooms are both well promoted. EVIDENCE: The home was purpose built to care for elderly people. It is an impressive large building offering care over two floors, situated in St George adjacent to The Air Balloon GP Surgery. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 21 It has been designed to create a feeling of homeliness by the provision of several separate communal areas. Service users can choose to socialise in one of the more populated areas or have quiet time in their own room or one of the less used smaller communal facilities. There are appropriate arrangements in place for the service and maintenance of plant and equipment. Maintenance staff is employed providing full time cover for the home and gardens. At the time of the unannounced inspection the home was well decorated, pleasantly furnished and nicely presented. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared for by staff that has access to a range of relevant training opportunities. Staff will always be recruited properly following robust procedures. This will ensure unsuitable workers are not employed. EVIDENCE: The hours needed for personal and nursing care needs are kept under review and altered according to need. The rotas for the end of March and first two weeks in April where observed. Five 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 10 minutes” Another seven residents’ comments include: “I am happy with the response time from using my call bell”; “I have no problems”; “ It’s not a problem you expect to wait a little”. Those staff spoken with during the course of the inspection did agree that at certain times of the day and night, it could be extremely busy. Discussion with the deputy manager evidenced that nursing care needs are kept under review and staffing levels altered according to need. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 23 In order to determine that the home follows safe recruitment procedures, the files of all staff, which have started working in the home since the last inspection November 07, were examined. For each person there was a written application, two written professional references with the least one from a previous employer, a declaration of medical fitness and CRB (Criminal Records Bureau) checks. There are procedures to monitor that the qualified nurses have maintained their NMC (Nursing Midwifery Council) registration and that work permits remain up-to date. All files were in order evidencing that the homes follows safe procedures and ensures that only suitable staff are employed. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well managed and is run in their best interests. Risk assessment process’ takes place ensuring that people living at the home are safeguarded from falls and accidents, as much as is possible. EVIDENCE: The home manager Mrs Alex Crew and has been the registered manager for St. George since it opened in May 1997. She is responsible for the running of the home, is a registered nurse and has already achieved the NVQ Level 4 in Management. She works all her hours during the week and is supported in the St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 25 running of the home. There is also deputy manager who has also achieved a Level 4 NVQ, who works shifts and covers alternate weekends. Regular resident and relative meetings are held and their views and opinions are welcomed about any matters concerning the running of the home. The most recent minutes of these meetings were examined. It was noted that the home does not at present have a ‘resident representative’ who will speak up on behalf of the others. See previous entry in standard 12. Staff meetings are held on a regular basis with all staff expected to attend. Residents and staff confirmed during the inspection that their views are sought, listened to and acted upon. This evidences that the home has an open style of management. This benefits all who live and work there. The home has several different methods of monitoring its own performance. The Homes Manager writes a regular regulation 26 report after consulting with residents and staff about home life. Copies of this report are available for review by the CSCI when requested. Health & Safety audits are completed in sections throughout a three-month period and a full report written at the end of this period. Staff and residents surveys are carried out on an annual basis, the last one having been completed October 2007. A business and development plan is formulated in respect of the results of these surveys. The home has retained the ‘Investors in People’ award in recognition of the training opportunities available for staff. Residents or their families are encouraged wherever possible to manage their own finances. For some residents a local authority finance officer is appointed to manage a resident’s money. Where amounts of money are kept for safe keeping by the home, good administrative systems are in place to show all transactions to and from the accounts. There is a cascade arrangement for staff supervision in place with senior staff supervising a group of junior staff. The training co-ordinators have attended supervision training to enable them to carry out staff supervision. Any issues that arise during a staff supervision session are fed back to the home manager. The home manager sees all notes kept of meetings and signs them off. Records were seen to conform these arrangements and staff confirmed they have regular supervision. The home has good record keeping systems in place and all the records that were required for the inspection were readily produced. The home is well maintained and in good decorative order. All maintenance records and utility servicing is up to date. The home manager “walks the floor” on a daily basis and regular checks on the environment are made. Any defects that need attention are referred via a “defect sheet” to the maintenance team. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 26 The maintenance manager completes regular health and safety audits. All the necessary fire checks were up to date as was staff training and fire drills. The environmental health officer last visited the home in April 2007. Information provided stated that all catering staff had completed basic food hygiene training. The home has arrangements in place to dispose of clinical and domestic waste. St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 27 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 HOICE 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? None 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 OP9 Regulation Reg 13 (2) Reg 37 Timescale for action The registered person shall make 18/07/08 arrangements for the notification of using oxygen in all areas of the home.1 The registered person must 18/07/08 forward all relevant incidents relating to the welfare of people living in the home to the CSCI for monitoring. Requirement 2. OP8 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 Good Practice Recommendations When reviewing peoples care plans show evidence of residents/representatives involvement, or document the reasons why this has not happened. Review with the homes pharmacy, the time taken for the delivery of new prescriptions. Undertake at least an annual consent with regard to the use of bedrails/lap belt users in the home. OP8 OP9 St Georges Care Home DS0000020254.V362490.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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