CARE HOMES FOR OLDER PEOPLE
St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS Lead Inspector
John Trainor Unannounced Inspection 11th October 2006 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 Hall & Lodge DS0000066817.V315727.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 Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Georges Hall & Lodge Address Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS 0845 6032558 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) www.orchardcarehomes.com Orchard Care Homes.Com Ltd Care Home 83 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (41), Old age, not falling within any other of places category (42), Physical disability (5) St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. May accommodate up to 5 people under 65 years of age in the category of DE. May accommodate up to 5 people aged 50 years and over within the category PD. Date of last inspection Brief Description of the Service: St Georges Hall and Lodge is a residential care home with nursing, newly built in 2006. The layout of the building is split into two units which run with distinct staff teams but share some facilities such as kitchen and laundry. There are 83 individual rooms each with en suite bathroom including shower. All rooms are equipped with T.V and DVD player. The home also has assisted bathing facilities in communal bathrooms. There are several communal lounges and dining areas. There is garden space for people to use and an outside summer house for people who smoke to shelter from the elements. The home itself is no smoking. The home is situated near the Durham Tees Valley airport site and so is far away from any community provision such as shops, pubs or local facilities. Current fees range from £359.00 to £550.00. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit was unannounced and conducted by two inspectors over 6 hours. This included a tour of the home environment, inspection of records including care plans and discussion with people who live in the home and staff to gather their views on the service. Information was provided to the Commission for Social Care Inspection before the site visit to inform the inspection process. What the service does well: What has improved since the last inspection? What they could do better:
This home has a single registration but is run as two units. There was a need for clear management accountability in the home to enable clarity of responsibility for meeting and maintaining National Minimum Standards. It was recognised the current registered manager had been ill and then retired leaving a vacuum in the day to day management presence in the home and a new manager had been recruited and was due to start shortly. Though a fire risk assessment had been completed by the previous manager this could not be located at the time of inspection. Combustible materials were found stored in the electrical cupboard and though these were moved during the inspection it did show poor attention to detail in management of fire safety and highlighted the need for a fire risk assessment management and staff
St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 6 were familiar with and adhered to. Double doors in corridors were fitted with fire closers though these were rendered useless as the small partition door was not kept bolted to allow the door closer to work effectively. These doors were found to be left open throughout the home despite the issue having been previously highlighted and again drew attention to unsafe fire prevention measures and the need for robust fire risk management. Bed rails were found to be in use on the lodge without bumpers to make them safe. Bed rails must not be used without bumpers. Care plans had not been completed for all areas where needs had been assessed and therefore a thorough audit of care plans was needed to bring these up to standard. The current company method for auditing care plans had highlighted deficits in the plans looked at but this inspection suggested these problems may be more widespread and needed addressing. Some poor practice was observed with staff moving and handling people in an unsafe way. People were being transported in wheelchairs without footrests with feet dragging along the floor and staff oblivious to the risks. Staff were also seen to attempt to lift somebody in an unsafe way when a hoist was indicated and detailed in the persons care plan. One member of staff was seen to be delivering nail care in a communal lounge area instead of retiring to a more private area to maintain dignity. Staff training needs were highlighted in the area of moving and handling but other basic induction training was not taking place as should be expected. The absence of a manager may account for some of this and it is hoped the new manager ensures induction is implemented in line with skills for care guidelines and timescales. The company did inform the inspection that moving and handling needs had been identified and training was planned. Cleaning products and air fresheners were found throughout the home. They should be kept locked away to ensure people’s safety. Communal toilets, bathrooms and the sluice rooms were not all supplied with paper towels and liquid soap. These were needed to aid infection control. Where there had been repairs to bathrooms involving the movement of sinks the finish was poor and needed some attention. Contracts needed some revision to detail fees, how they were structured and who was responsible for maintaining which element. 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 Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People were provided with some information in writing to make an informed decision about coming into the home. EVIDENCE: All people in the hall and lodge had been issued with statement of purpose and service user guide. Contracts needed revision to clearly state fees and who was responsible for paying them including the nursing element. Even where there was space to include a fee some contracts did not include this information. People had been transferred in from other homes with existing assessments. There was evidence of review and pre admission assessments were in place for
St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 9 those care files looked at where people had been admitted since the home opened. People could visit the care home prior to making a decision to move in. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People did not have their health and personal care needs met in a planned way in all cases. Care practice was seen to be poor at times and not based on risk management principles. EVIDENCE: The assessment documentation was easy to use and was completed on all files inspected so people had their needs assessed. Unfortunately this had not been carried forward into plans of care for every area where there was an identified need. Two care staff were about to lift a someone from a wheelchair to bed using a dangerous moving and handling technique and the inspector had to intervene. They were also seen to transport the person in a wheelchair with feet dragging along the floor and no use of footrests. Other staff were also seen to
St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 11 transport people without the use of footrests where people were not able to raise their feet and when confronted one member of staff said, “I know she won’t lift her feet.” Inspectors had to intervene and show staff how to use footrests safely. There were gaps left in day to day recording and NMC recording guidance was not being followed. There were some gaps in recording on Medication administration sheets and improvements to the recording of hand written changes were needed. The PCT pharmacist was due to come out to advise on medication. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People had some activity to occupy their time and were encouraged to make choices. EVIDENCE: Menus were good offered choice and a balanced diet and people said the food was good. The activities coordinator was shared between the hall and lodge. Group activities were provided as well as one to one sessions with people. The activities co-ordinator assisted with feeding people who required help at breakfast time on the lodge whilst other staff were occupied in personal care tasks. These hours would be better deployed for activities provision. The home is geographically isolated and access to community facilities is poor this increases the need for the home to provide meaningful activity. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 13 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People were protected by the home’s procedure and policy on complaints and abuse. EVIDENCE: The home had policies and procedures to protect people from abuse and respond to concerns and complaints. There had been no complaints since the home opened. People spoken to said they would go to the manager if they had any concerns. Every person had a copy of the complaints procedure in their statement of purpose which was also on display on the notice board of both hall and lodge so people were clear about how to complain. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 14 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People had a comfortable and clean environment to live, though more attention to health, safety and infection control measures were needed. EVIDENCE: The environment was clean and tidy every room had an assisted en suite shower. Dissolvable laundry bags were being used for soiled linen to aid infection control. There were two assisted bathrooms and assisted shower on each floor of the hall and lodge.
St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 15 Rooms all had t.v., dvd and fridges though the fridges could not be used in the cupboards where they were meant to be placed. Six months after opening this issue had not been resolved Some areas in the communal bathrooms had poor finish where sinks had to be moved to allow people to get into and out of the bath. COSHH products were found in communal areas and steradent and razors had been left in communal bathrooms even in the dementia unit. Toiletries were found in communal bathrooms which were not labelled suggesting communal use. Bars of soap were also found in communal bathrooms which is bad practice for infection control. Several communal bathrooms and toilets did not have paper towel dispensers and the sluice had neither soap dispenser nor paper towel dispenser. Paper goods and flammables were being stored in the electrical cupboard but were moved during the inspection. This hazard should have been identified during a fire risk assessment. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 16 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staff were deployed in sufficient number to meet people’s needs based on current occupancy levels though more attention to induction and health and safety training was needed when staff started work. EVIDENCE: Staff were recruited safely and deployed in sufficient number to meet the needs of the people resident. 63 of care staff were trained to NVQ level 2 or above. Some poor areas of practice were observed highlighting the need for staff training in moving and handling, induction and more robust supervision to improve the service for people and keep them safe. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 17 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, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Management of the home showed little strategic overview of the service on a daily basis and needed more attention to staff supervision and health and safety risk management. EVIDENCE: There was no registered manager at the time of inspection due to the retirement of post holder. A new manager was due to start shortly. Electrical and gas installations were being maintained safely. Service user monies were kept and recorded well and were auditable.
St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 18 Regulation 26 visits by the provider were taking place and seemed to be effectively identifying some deficits in the home, which action was being taken to address. Care plans were being audited and moving and handling needs had been identified with training planned for a future date. The environment was not being maintained safely with due attention to fire safety management and other health and safety issues. Supervision was not taking place and induction of staff was not taking place. Clear lines of accountability within the home were not evident. The management structure needed rationalisation with decisions about the future management made and implemented. St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 1 X 1 St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation 5 (bb), 5A Requirement Contracts/Terms and conditions should be revised to include fees including a breakdown of wall elements and who is responsible for paying them. Where care needs are identified from assessment these must be developed into a plan of care to instruct staff how they are to be met. The home must produce a fire risk assessment and manage the risks identified from this process. In particular double doors in corridors must have the smaller side locked after use to ensure the effectiveness of door closing mechanisms in the event of a fire. The environment must be maintained free from hazards to service users from COSHH products, denture cleaners and razors. These should be stored in a locked place. Sluice areas, communal toilets and bathrooms must be supplied with liquid soap and paper towels to aid infection control in
DS0000066817.V315727.R01.S.doc Timescale for action 31/12/06 2 OP7 15 31/12/06 3 OP19 23 (4) 11/10/06 4 OP19 13 (4) 11/10/06 5 OP26 13(3, 4) 31/12/06 St Georges Hall & Lodge Version 5.2 Page 21 6 OP30 18 (1(c)) 7 8 OP36 OP38 18(2(a)) 13 (4) the home. All staff must receive structured induction and foundation training in line with skills for care guidelines. Moving and handling training must be provided. All care staff must be supervised 6 times per year. People must not be transported in wheelchairs without footrests unless a specialist risk assessment identifies a need to do so. People must be moved and handled within recognised good practice and risk assessed principles. 31/03/07 31/10/07 11/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended where hand written instructions or changes are made to Medication Administration Record Sheets these are initialled and counter initialled by staff to ensure and accurate reflection of the prescribing instruction. Administration of medication should be robustly recorded with no gaps on administration sheets. It is recommended all health and personal tasks are delivered in private to promote dignity. It is recommended activities are tailored to individual need and preference and the activity co-ordinators hours are focussed on this area rather than the delivery of personal care. Where changes have been made to bathrooms the finish is sometimes poor and requires attention to improve. 2 3 OP10 OP12 4 OP19 St Georges Hall & Lodge DS0000066817.V315727.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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