CARE HOMES FOR OLDER PEOPLE
St Georges Hall & Lodge Middleton St George Hospital Site Middleton St George Darlington Co. Durham DL2 1TS Lead Inspector
Elsie Allnutt Key Unannounced Inspection 10:00 4 , 5 and 6th March 2008
th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Georges Hall & Lodge DS0000066817.V360566.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.V360566.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 01325 335487 stgeorgeslodge@try-care.co.uk www.orchardcarehomes.com Orchard Care Homes.Com Limited 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) Mrs Alison Clare Pemberton Care Home 83 Category(ies) of Dementia (62), Old age, not falling within any registration, with number other category (21) of places St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following cateory of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, maximum number of places: 62 Old age, not falling within any other category - Code OP, maximum number of places: 21 The maximum number of service users who can be accommodated is: 83 11th October 2006 2. Date of last inspection Brief Description of the Service: St George’s Hall and Lodge is a residential care home with nursing, newly built in 2006. The layout of the building is split into three units that run with distinct staff teams but share some facilities such as the kitchen, laundry and garden areas. There are 83 individual rooms each with en suite bathroom including shower. All rooms are equipped with TV and DVD player. The home also has assisted bathing facilities in communal bathrooms. There are several communal lounges and dining areas. There is a landscaped garden at the rear of the building for people to use and an outside summerhouse 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 not in easy community facilities such as shops, banks, leisure facilities and pubs., however there is a hotel nearby. The home has developed a Service User Guide to inform interested persons about their service and the current weekly fees range from £373.00 to £670.00. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. Although 25 surveys were sent out to service users and 25 surveys to relatives prior to the visits, none have been returned prior to writing this report. The Visit: Unannounced visits were made on 4th, 5th and 6th March 2008. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well:
Good information about the home is available for interested parties and people can visit and look around the home without an appointment. This allows St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 6 visitors to see the home as it is on the day, read information about it and make an informed decision whether it is what they require and prefer. Some of the people who live at this home were originally transferred from two other homes, originally on this site, and some other people stated that they were from the local area. This means that many of the people who live here are used to the area and feel at home here. The home carries out good assessments and receives detailed information about the person before they agree to the person moving in. This ensures that the home is confident that they can meet each person’s needs. An identified, suitably qualified member of staff from the home is responsible for carrying out the pre-admission assessments and for liaising with the referring agencies and families. Each service user has an individual room with en-suite facilities that is individualised with personal effects. This helps service users to feel at home, maintain their identity and retain their privacy. Service users’ care needs are recorded and addressed. A care planning system is in place that is monitored and reviewed regularly. Good recruitment procedures are in place so that only the right sort of person is employed to support service user. So that the home can address a current staffing problem, the home has decided to cease all new admissions. This will give the home the opportunity to recruit a full staff team in such numbers that will address service users’ needs effectively. A relative said, “The home makes you feel involved and the girls are good.” Service users are served food that is of good quality and meets their dietary needs and relative meetings are held so people can have their say in how the home is run. What has improved since the last inspection?
The management team have positive plans in place to improve this service and to address the evident failings. A big recruitment drive is underway and there are plans in place to further develop the service by including service users/their advocates and staff in the process. A new manager has been employed since the last inspection. She is registered with the CSCI and is well qualified to carry out her role. This should bring some stability to the home and allow it to move forward and positively develop.
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 7 All of the areas for improvement identified in the previous report have been addressed. A new fire risk assessment is in place, this means that procedures are in place that, if followed, should protect and keep service users from harm in the event of a fire. Bed rails are only used now with the addition of bumpers to make them safe. Care plans are now monitored and audited to ensure that they cover the main areas where needs had been assessed. This means that service users are supported with the tasks identified in their assessment. The training opportunities now available mean that all staff receive training regarding safe moving and handling techniques. This means that service users are supported in an appropriate and safe way that is comfortable and safeguard them from harm and protect the health of staff. New staff now receive induction training at the beginning of their employment following the Skills for Care standards. This means that staff receive good basic training from the time they are employed and which is completed within a certain timeframe. Therefore staff who have had the appropriate training are supporting service users. Communal toilets, bathrooms and the sluice rooms are now fitted with soap and towel dispensers. This means that service users, staff and visitors have access to facilities that have the necessary resources to maintain good hygienic standards and maintain effective infection control. Service users’ contracts that explain the home’s terms and conditions now include the cost of the fees charged to the individual service user. The service users’ rights to know this information are therefore promoted. What they could do better:
This home has a single registration but is run as three units with separate staff teams. Although clearer management accountability in the home is beginning to emerge, this needs to develop further to enable clarity of responsibility for meeting and maintaining National Minimum Standards. This will mean that service users will receive a service that is in their best interests. The Statement of Purpose and Service User Guide must be adjusted to record the changes made in the home, for example the variation to the registration and any other changes made in the home. This will allow service users and other interested parties to have accurate and up to date information about the service.
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 8 Risk assessments should relate to each service user as an individual and should be used to develop a risk strategy plan to identify how the risk is to be minimised. Such plans should be an important part of the care plan that guides staff to support the service user in a safe way. Service users must be supported to dress appropriately and in their own clothing so that their dignity is promoted and protected. More effective systems in the laundry need to be developed so that clothing is not lost or mixed up and that service users’ individual clothing is treat with respect and returned to the appropriate person. Furthermore so that good hygienic practice is promoted and service users are kept safe from the possible spread of infection, dirty, disguarded clothing must not be left on bathroom floors. So that service users have the opportunity to develop interesting lifestyles the home should employ an activities organiser with the sole responsibility to organise and develop activities throughout the home, bearing in mind the diverse needs of the people living here. The valuable information regarding the individual service users life histories that staff have recorded, could be used to develop and stimulate activity that is meaningful and interesting to the individual service user. This is particularly important for those service users with dementia. At the same time the information can be used to assist staff when supporting service users to make decisions and choices. More effective use could be made of the space that the design of the building offers. The home is very large with plenty of space for service users to wander and sit in different areas, including areas of the passageways and smaller rooms that are nicely furnished with easy chairs. This would mean that service users would have more choice to sit alone or with smaller groups and would not be sat altogether in one lounge. The dementia care unit could be more engaging by providing interesting activity so that service users are motivated to be happily employed in activity they enjoy. Specific use of colour and design within the unit could make it easier for the service users to orientate themselves and as a result have more independence and privacy. The outcome of the complaints made could be more effectively used to improve the standard of care and the service people living at this home receive. The poor standard of cleanliness throughout the home reflects the ineffective number of domestic staff on duty and the many maintenance issues evident reflect the absence of a general maintenance person. The size of the home St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 9 and the needs of the service users dictates the demand for improved domestic and maintenance support to be addressed as a priority. So that the home is confident that they continue to meet the necessary fire regulations, the advice of the local fire service must be sought. This will mean that the safety of the service users is promoted. Service users must always have access to calling members of the staff team for support or attention. An emergency call cord must therefore always be available, whether this is in the service user’s room, en-suite facility or the communal bathroom. Such facilities should also be available for staff to use in an emergency situation when they may need assistance. Emergency call cords must be at the reach of service users, not tied up out of reach unless a risk assessment has identified different. 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.V360566.R01.S.doc Version 5.2 Page 10 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.V360566.R01.S.doc Version 5.2 Page 11 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): 1,2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with good information about the service including a contract. This helps people to make an informed decision about where to live, while at the same time they are informed of the home’s terms and conditions. Pre-admission assessments demonstrate residents’ needs and assists the home to make informed judgements as to whether they can meet these needs. This ensures that the resident receives the appropriate sort of care and support from the home. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home has developed a Statement of Purpose and a Service User Guide. Both documents are currently being reviewed and updated to reflect recent changes in the home and to supply current service users and other interested parties with accurate and up to date information about the home. Service users are issued with contracts that describe the home’s terms and conditions and include the cost of the fees to be paid. Several people seeking a care home environment for a relative or friend visited the home. All were given a warm welcome and shown around the home during which time the manager clearly explained the pre-admission procedure. Service users’ files include comprehensive pre-admission assessments received from the referring agencies and an assessment carried out by the home. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans inform staff of the service users’ needs, however service users could be further empowered to lead their plan of care if they were more service user focussed and friendly. Satisfactory procedures are in place for the safe administration of medicines, however service users have at times been put at risk as a result of staff omitting to fully complete the medication record sheet. EVIDENCE: Service users are assisted to access healthcare appointments. The home has its own general practitioner who visits regularly and other healthcare professionals, such as the community nurse and chiropodist visit service users at the home when needed. Records are kept of such visits. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 14 Every service user has a care plan that informs the staff team of the person’s needs and how these should be addressed. However, although some good information is included, the care plans are task orientated and do not include the service users’ specific preferences, likes or dislikes. There is no evidence therefore that service users have been involved in the development of the care plan, neither does the style they are written in allow the service user to understand them. The care plan is used with risk assessment documents to ensure that any identified risks are addressed. Risks however are identified in tick boxes and lack in detail. They are not specific or related to the individual. For example the recording of the risks related to the use of bedrails are the same for everyone who uses them and the individual’s specific need is not identified. The care plan document covers all aspects of service users’ healthcare needs and these are monitored monthly and reviewed annually. The monitoring process records any changes evident during that month. Staff receive training regarding different medical conditions experienced by the service users. This includes training related to Parkinson’s disease, the effect of strokes and challenging behaviours. In addition to this specialist healthcare professionals give advice regarding individual conditions, for example pressure relief care and special dietary needs. This information is recorded in the care plans. Although service users were generally dressed appropriately, looked smart and well cared for, there were occasions when the dignity of service users was compromised. One service user exhibited an agitated state due to not being able to find their socks or footwear and the same person had not been assisted to groom themselves. At the same time another service user walked around the unit inappropriately dressed. During this time staff were more focussed on other tasks and failed to see the need to assist, therefore both service users were left in an undignified and agitated state. Relatives made comments that there are problems with the laundry system and it is not unusual to find their relative dressed in someone else’s clothes. They also added how upsetting this is when knowing that enough clothing had been supplied for the individual. Recent complaints from relatives and issues taken to safeguarding strategy meetings over the last two months have related to issues regarding the lack of care and failure to promote service users dignity. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 15 Adequate medication procedures are in place. The storage and administration of medication are satisfactory, however it was noted that the medication records were not always fully completed. Signatures were missed in some of the boxes on the Marrs’ sheets, making it unclear as to whether the medication had been given or not. This was brought to the attention of the manager who confirmed that this would have been picked up and addressed in the weekly audit. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals are healthy, nutritious and attractive and are prepared to meet residents’ individual dietary needs. Relatives and friends are encouraged to play an active part in the home resulting in service users not feeling isolated. However the current absence of an activities organiser means that the opportunity for service users to develop and maintain interesting lifestyles is compromised. EVIDENCE: The person who was employed to arrange and coordinate activities throughout the home has recently left her post, however this post is currently advertised. There was no structured activity plan for the home available, neither was there plans in place for future trips out, or entertainers to visit the home. The only organised activity going on was with one member of staff who actively encouraged three service users to take part in a quiz and on another day assisted a service user to walk around the newly landscaped garden.
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 17 Although one service user who is able to go out independently went to the local airport for the day, service users and relatives confirmed that is it is very rare that service users participate in community activity. The majority of care staff were involved in supporting service users with physical tasks rather than affording time to interact or organise group or one to one activities with service users. Service users were generally found sitting in their rooms or in the main two lounges. A member of staff stated: “It is easier to see where everyone is when they are together.” The dementia care units, one on the ground and the larger of the two on the first floor, offer little stimulation for people with dementia type illnesses and who may wander and on occasions become disoriented and agitated. The managers are aware of current good practices regarding dementia care. They were interested to discuss the different activities that could be introduced to stimulate and employ service users’ time and interests, while at the same time offering choice and an opportunity to be independent. Relatives meetings are organised and it is the aim of the home to involve relatives in the life there. Although care staff had little time to plan activities, a relative was actively involved with a group of service users, stimulating conversation and listening to music. Later they assisted service users to go into the dining room for lunch. Other relatives sat with service users in their rooms interacting in conversation. A midday meal was taken with a small group of service users on the ground floor. The tables were attractively set and the dining area extended into the conservatory, in preparation for when more service users move into this unit. The food served is nutritious and varied to suit individual dietary needs. Residents said: “The food is always good and we get a choice.” “I like the food.” “We have a good cook.” St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 18 The cook is experienced, enthusiastic and trained in relation to different dietary needs. Although different menus are offered each day and service users are given a choice of foods, there is a flexible approach when service users have forgotten or changed their minds to what they have ordered. Consideration is given to service users who may not eat well and who may be at risk of eating a diet that is poor in nutrition, therefore foods they prefer to eat are enriched, for example full cream is added to puddings and meals with higher calories are provided. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to help protect service users from abuse and to address complaints and concerns about the service. However the outcome of some complaints made has not always effectively improved the service provided. Service users are therefore at risk of receiving a service that is not delivered in their best interests. EVIDENCE: The home has a comprehensive complaints procedure in place that service users and their representatives are aware of. Although the home is proactive in recording and addressing complaints, relatives feel that their complaints have not always made a difference to the service delivered. The main complaints relatives discussed and felt were ongoing include, lack of and consistent staffing resources; a poor laundry service; poor cleaning practices and lack of organised activities. The area manager and the managers of the home are confident that plans are now in place to effectively address all of the concerns raised.
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 20 The home follows the local authority’s safeguarding adults procedures and staff receive training regarding these. Staff are aware of the action they would take if an abusive incident was observed by or reported to them. The home has used these procedures appropriately and competently in response to allegations of abuse on several occasions over the past 12 months. Those allegations were found to be up held and involved staff employed by the home. They were appropriately addressed. This included the home following their disciplinary procedures, putting risk assessments in place and improving care practices. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Due to the lack of an ongoing maintenance programme, effective cleaning routines and good hygienic practices, the environment does not always promote a positive image of the people who live here. EVIDENCE: The design of the building offers service users an environment that is spacious and accessible, however the area where it is located, although quiet and rural, does not offer easy access to community based facilities. Access into and within the home is good and meets the needs of those service users who have mobility difficulties and who use walking aids, such as zimmer frames or wheelchairs.
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 22 The bedrooms are large and spacious and allow service users to have their personal belongings without the rooms looking cluttered. Service users are encouraged to furnish their rooms with personal items, resulting in this area being familiar to them, as well as having the opportunity to express their individual personalities. However it was disappointing to note that although the home has been opened for less than two years, there are several areas that are showing wear and tear and a lack of effective maintenance and cleaning routines. For example, several bedrooms have deep scratches taken out of the walls, made when moving the beds, torn wallpaper surrounds these areas and ensuite facilities are used as storage for wheelchairs. There is a broken panel in one of the en-suite doors and there are several beds that are not functioning properly and need to be repaired. On different occasions dirty clothing was found lying on bathroom floors. This is poor practice and can spread infection. The inadequate number of domestic staff reflects the poor standard of cleanliness throughout the home. Carpets are dirty, individual bedrooms are dusty and several areas of the home have unpleasant odours. There are several bedrooms and bathrooms where the emergency call cords are tied up out of the reach of service users with no risk assessments in place to support this action. This is dangerous and unacceptable practice. An emergency exit door on the first floor was jammed and would not open. Although this was repaired within two hours of it being reported, it was not clear how long it had been in that state. There were no records to show how often it is checked. In addition to this, the emergency box that is used to open the door is hidden behind a curtain, making it difficult to find and activate in the case of an emergency. This must be addressed. Some fire doors throughout the building are not held fully back by the magnetic mechanism to allow service users to freely and safely walk through. It is almost two years since the local fire service last inspected the building. The environment is not specifically designed to meet the needs of people with dementia, for example, the signs on toilet and bathroom doors could be more prominent, with the use of signs/pictures that the service users can identify with and in the same way service users’ individual bedrooms could be made easier to identify. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 23 Consideration should also be given to the use of colour and design used in decoration within the unit, so that this reflects current research and enhances the lives of the service users. Discussions took place with the home’s managers regarding how to access current research and up to date good practice. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. The home employs a qualified staff team following robust recruitment procedures to ensure only suitable carers are used. However due to recent staffing problems, including low staff morale and the need to use agency staff, the staff team is currently failing to work effectively and consistently. Service users’ care and support therefore is at times jeopardised. EVIDENCE: Staff are recruited following good recruitment procedures. Staff files include clear and detailed application forms and two appropriate references that clearly show the individual’s past and current work history, as well as their suitability for the job. Criminal Record Bureau clearance and Protection of Vulnerable Adults (POVA) First Checks are obtained for all staff. The home offers good training opportunities to ensure that staff are competent to carry out their roles. This includes an induction programme that follows the Skills for Care standards, as well as an in house induction programme that over three days, covers the service procedures.
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 25 Over 60 of care staff are qualified in NVQ and two qualified nurses are employed to lead each shift. One RMN (Registered Mental Health Nurse) is employed as supernumerary to carry out assessments and to give support and advice when needed. Many of the staff that are employed by the home originally transferred from a hospital establishment that was on the same site. A change in their terms and conditions of service has caused a lot of unrest that has resulted in some staff leaving the home and this in turn has caused staff shortages. Staff attitude about the home varied. Staff comments include: “People are unhappy at the moment and there are lots leaving.” “I don’t like the long shifts.” “We all receive training and it is good.” “I like the long shifts, it fits in with me fine.” Relatives and visitors voiced concerns regarding the poor numbers of staff available to support the service users effectively. Comments include: “We sometimes have to wait a long time after pulling the call cord for assistance.” “I come as often as I can to assist with X, because I know that there is not always enough staff on duty.” However all relatives said that the staff available work hard and are good. Such issues have also been discussed in safeguarding adult strategy meetings and some have concluded that poor care practices have been carried out partly due to the large use of agency staff, who might not be fully aware of home’s procedures and individual care plans. Inadequate systems and staffing resources in the laundry have resulted in service users clothing being lost or mixed up and dirty clothing left on the floors in the bathrooms, putting service users at risk of cross infection. Furthermore poor numbers of domestic and maintenance staff have resulted in the standards in the environment falling. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. A well-qualified management team is supported by a qualified senior care team to run the home, however there are some management systems in place that are not effective, therefore service users do not always receive the standard of service that is planned. EVIDENCE: The registered manager has been in post since September 2007. She is a Registered General Nurse with 10 years experience as a registered manager in previous homes and 20 years experience in the care sector. She has also
St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 27 successfully completed the Registered Managers Award (RMA) and is a qualified NVQ assessor. She is up to date with mandatory training and is currently attending training regarding dementia care. A second manager is employed by the home to run the dementia care unit on the first floor where 42 service users are accommodated. She too is an experienced, qualified person with a certificate in professional studies, Caring for People with Dementia and who has worked for the home since it opened in 2006. Until recently the two managers have managed the service from separate offices but are currently in the process of moving into the one office on the ground floor, where there will be more opportunity to share ideas, support one another and share the responsibilities of running the home as a whole. A good quality assurance system is in place and the home has been awarded the Investors in People Award, however the quality review systems in place have at times proved to be ineffective. Although both managers are supernumerary, the demands of addressing the administration, maintenance and health and safety issues, in addition to carrying out the general management role, has proved to be challenging. There is evidence that some elements of the management systems have failed at times, for example: when the lack of staffing resources have resulted in poor care practice and poor standards in the cleanliness and maintenance of the building and although complaints have been made, no improvement has been made. All have resulted in the dignity and comfort of service users being compromised. There are now signs of the service moving forward, both managers and the area manager have weekly meetings to discuss this and to put plans into action. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 28 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4(1)(a-c) Requirement Timescale for action 30/04/08 2. OP7 15(1) 12(2) 3. OP9 17(1)(a) 4. OP10 12(4)(a) The registered manager must ensure that Statement of Purpose is reviewed and adjusted to reflect the recent changes in the home for example those changes made as a result of the variation made to the registration. The registered manager must 30/04/08 ensure that the service user/representative is involved in the development of the care plan, and that they record the care plan in a style that is accessible to the service user/representative, and that it is signed by them. The registered manager must 30/04/08 ensure that a signature or code is recorded on the Marr’s sheet for all medicines given, refused or otherwise. The registered manager must 30/04/08 ensure that service users are supported to dress themselves: in a way that promotes and safeguards their dignity, and in using their own personal clothing.
DS0000066817.V360566.R01.S.doc Version 5.2 St Georges Hall & Lodge Page 30 5. OP12 16(2)(n) 6 OP16 12(1) 7 OP19 23(2)(b) 13(3) 8 OP19 23(4) The registered manager must ensure that all service users are given the opportunity and support to participate in social and community activities of their choice, whilst at the same time taking into consideration the needs of the service user. There should be systems in place to ensure that complaints are used to review and improve, if necessary, the quality of the service delivered to service users. The registered manager must ensure that the repairs needed throughout the building are addressed and the standard of cleanliness is improved throughout and ensuring the home is free of unpleasant smells. The registered manager must ensure that home continues to meet the necessary fire regulations; the advice of the local fire service must be sought. This will mean that the safety of service users is promoted. 30/05/08 30/04/08 30/04/08 30/04/08 7 OP19 12(1) 8 OP27 18(1) The registered manager must 30/04/08 ensure that service users have access to emergency call cords and that these are not tied up out of reach. The registered manager must 30/04/08 ensure that a full complement of staff are employed in effective number that meet the needs of the service users and this number is kept under review regarding: the changing needs of the service users; and the increased numbers moving into the home. An effective number of domestic staff must be employed so that the home is kept clean with good
DS0000066817.V360566.R01.S.doc Version 5.2 Page 31 St Georges Hall & Lodge 9 OP33 24(1) 10 OP38 12(1) hygiene standards, free from dirt and unpleasant odour. The registered manager must ensure that the management systems in the home are effective and that when they are proved to be ineffective they are reviewed and addressed to improve the service delivered. The registered manager must ensure that all of the health and safety issues brought to her attention are addressed. 30/04/08 30/04/08 13(4)(c) 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. Refer to Standard OP7 OP19 Good Practice Recommendations It is strongly recommended that risk assessments/strategy plans are developed to reflect the individual need of the service user. It is strongly recommended that a maintenance person is employed to keep the home in a well maintained state that is safe and pleasant to live in. St Georges Hall & Lodge DS0000066817.V360566.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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